We can't say checking yourself regularly is a particularly good way of saving lives
Women were first advised to check themselves regularly for breast cancer more than 60 years ago.
Cushman Haagensen, an American breast surgeon, was concerned that women were being diagnosed with large, inoperable tumours and to ensure they got help earlier, he made a short film showing how self-examination was done. It was seen by millions and led to a sea change in what women did.
Recommending self-examination seems a perfectly sensible idea — after all, most breast cancers are detected by women themselves, not doctors or nurses.
And, indeed, for many years the Department of Health and breast cancer charities advised women to check themselves.
But unfortunately, this wasn’t as straightforward as it appeared.
When I was a medical student in the late Eighties, I diligently discussed breast self-examination with patients.
I taught women how to examine their breasts in a spiral, the technique advocated by one doctor, until another said it was best to feel each breast with their hands while lying down, then sitting up, in different sections of the breast (divided into quadrants).
Different doctors made videos showing very different techniques.
There were also differences in the timing of these self-checks.
A leaflet from one charity recommended checking the breast every week while another, from the Department of Health, recommended every month, yet another suggested it should be done before and after each period.
Haagensen suggested checking every two months ‘to prevent the development of an abnormal fear of cancer’.
Eventually, it became clear to me that the reason there were so many opinions was because we didn’t have scientific proof for which kind of breast self-examination was best.
It’s incredibly important in medicine to recognise and acknowledge when we don’t know what is best.
Otherwise we continue doing things that don’t work or do harm.
For example, Dr Benjamin Spock, in his best-selling childcare books, recommended putting babies to sleep on their front because it seemed sensible. He thought babies would be safer from choking.
It wasn’t until many years later — when proper clinical trials were done — that it was discovered that putting babies to sleep on their front increased the risk of cot death.
A major trial was conducted in 2002 to find out whether teaching women to do breast self-examination worked or not.
We haven't fairly tested 'breast awareness', so we don't know that it works or what is best
In the study, published in the Journal of the National Cancer Institute, more than 250,000 women were divided into two groups.
One group was taught how to check themselves and were reminded to do it regularly.
The other group was simply monitored. At the end of the study period, there was no difference in the number of deaths due to breast cancer.
However, there were more biopsies in the self-examination group, which found benign changes, not cancer.
All that recommending, training and encouraging women to examine their breasts regularly did not reduce their risk of dying from breast cancer.
We can’t say checking yourself regularly is a particularly good way of saving lives.
But what is useful? We still don’t have a proper answer.
After the 2002 trial and similar studies, the official advice changed from advising regular self-examinations to encouraging women to be ‘breast aware’.
But what is ‘awareness’? Some charities recommend ‘touch, look and feel’, while others suggest a text reminder every month to prompt a self-examination.
The NHS Choices website lists breast changes to look out for as well as saying that women should check at different times of the month.
And while part of the awareness message is correct — see your doctor if you think there is any change in your breasts or an abnormality — the recommendations for self-examinations, with ‘no right or wrong way’ to do them, remains confusing.
We haven’t fairly tested ‘breast awareness’ in a clinical trial, so we don’t know that it works or what is best.
Last year the Scottish Government ran a TV advert promoting breast awareness. It didn’t recommend regular self-examination, but instead showed pictures of breasts with skin changes, swelling, nipple abnormalities and asymmetry that could indicate cancer. It was straightforward and visually informative.
However, it hasn’t been put to the test in a proper trial so we don’t know whether it had the power to stop deaths from breast cancer.
There’s no doubt that if a woman is concerned about her breast she should get advice — no matter how she noticed the abnormality.
In the meantime, I don’t teach women to do regular breast self-examinations (as I used to in the late Eighties), but instead ask them to see me or another doctor promptly if they notice any changes.
But I would like to be able to do better than this.
It’s high time that we had quality research on the kind of information about breast cancer that best helps women.
The shame is that this could have been done decades ago.
Dr Margaret McCartney is a GP in Glasgow.
Vitamin C may help fight tumours
Women with breast cancer may live longer if they increase their intake of vitamin C, according to new research.
Scientists from the Karolinska Institute in Sweden analysed ten previous studies involving 17,000 women with breast cancer and found this was the case if the women had the vitamin as part of their diet or in the form of a supplement.
Increasing the amount of vitamin C in the daily diet by 100mg — the amount found in a large orange — led to a 22 per cent lower risk of death from their illness.
Women who used supplements after diagnosis had a 15 per cent lower risk of dying prematurely due to the cancer.
Vitamin C works as an antioxidant and may protect against cell damage caused by free radicals, which have been linked with cancer.
Read more: http://www.dailymail.co.uk/health/article-2599153/GP-says-checking-breasts-lumps-harm-good.html#ixzz2yKf1O2Uk
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