Medical questions & health advice by board certified doctors
"How does one perform a self breast exam?"
I'm trying to stay good on my breast self-exams, but I find that there's actually a significant variation in how organizations say you should do them, and how often. Is there one authority I should trust above all others where this is concerned? What is the right way to do it?
This is a question that is somewhat debated. On topics of preventive medicine, I refer patients to the United States Preventive Services Task force guidelines, available at www.usprentiveservicestaskforce.org. These guidelines are prepared by multidisciplinary groups, and are not skewed by the experience of specialists. This is important, since seeing breast cancer patients all day has a tendency to make physicians recommend screening practices that may harm women who do not have breast cancer. This task force actually recommends against teaching breast self exam. It reached this conclusion based on multiple studies where teaching self exam resulted in many additional biopsies (each biopsy each carrying risks of pain, bleeding, infection, etc.) without reducing the number of deaths due to breast cancer. These data are in stark contrast to mammography, which has been proven to reap huge benefits when used as a screening method in the right population group. The task force has also observed the evidence to be inconclusive about whether clinical breast exams performed by health care professionals provides any benefit. All of that being said, I will tell you the technique I have been taught by several breast oncologists at a major cancer hospital. When examining breast cancer patients, they cite several papers showing that a grid pattern, moving linearly from top to bottom, then inching over and palpating from bottom to top, until the entire breast has been examined, helps ensure more complete coverage by the examiner. This technique results in better detection rates. Additionally, no exam is complete without viewing the breasts for asymmetry, dimpling, or change, with arms at sides, hands on hips, and hands behind the head.
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