Some Doctors Stop Urging Monthly Breast Self-Exams
Prudish older women might avoid self-exam because it requires touching one’s own body in what might be considered a sinful manner.
It is not just prudishness that is fueling aversion. Monthly breast self-examinations (BSE) are on the decline. Some ladies leave it to their gynecologists. Others may poke around a bit during October in response to all the pink ribbons. Many may just be interested in the annual pink fashions. It has been said among the medical community that women who are taught to examine their breasts tend to do it badly or not at all.
There is daily contact with breasts while showering and getting dressed. But pressing deeper into the tissue requires traversing a psychological taboo. F.D. Moore alludes to fear, dislike or dread of breast self-examination that arouses apprehension of cancer, pain, and death. Theoretically, people don’t like considering the possibility of serious disease so they focus attention elsewhere. A clinical study even questions BSE efficacy. There is no single reason for non-compliance. What are your feelings toward it?
A New Awareness
Medical professionals have tried to motivate with statistics. Forty percent of women with breast cancer find their own lump or breast change. Doctors highlight advantages of a woman becoming intimately familiar with her own benign bumps and bulges—and to focus on any new ones as a form of breast self-awareness (BSA).
The dichotomy of assuming, ‘They may be trying to kill me’ prevents some women from performing anything more than a cursory inspection of breasts that are generally esteemed for their form and function than health indicators.
Up to 94 percent of American women are aware of the breast self-examination procedure and its stated benefits. Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai School of Medicine in New York City, says that one of the problems with the monthly BSE is that “many women say they don’t feel like they know what they’re doing.” Dr. Deborah Axelrod recommends “feeling your breasts every 2 or 3 months, mainly to get to know what’s ‘normal’ for you.”
How Do You Feel?
Here is a difference. While performing a BSE, perhaps while lying in bed or in the shower, the focus is on discovering a lump. There may be one or more that represent a woman’s normal anatomy. Lump discovery leads to much anxiety. There is time and expense for fruitless doctor visits and radiology. Finally, she is reassured everything is alright. To prevent this cycle of anxiety, expense and reassurance, she gives up on checking herself, feeling she does not know what she is doing.
Heidi Trott, a nurse practitioner uses “the term awareness rather than examination.” She says, “It’s important to inspect the breast, to look at it in the mirror, to get a sense of what your breast tissue feels like.”
Breast self-awareness is not necessarily performed monthly. The point is to be familiar with personal characteristics. There may be an overall lumpy texture. Multiple large soft masses could be common. In either case, breast self-awareness takes this into account and searches for atypical texture or appearance.
The poster entitled Anomalous Areolae depicts 13 different areolae ranging from typical to atypical. Along with 6 other illustrations, it discusses many of the questions women have about this important aspect of their anatomy.
You Are Not Just Feeling For Lumps
A mirror helps women pay attention to more than a new lump or mass. Invasive lobular carcinoma (10 to 15 percent of breast cancers) show up as a thickening, puckering, or retraction. Inflammatory breast cancer (5 percent of breast malignancies) manifests breast swelling, redness, and palpable warmth. Breasts appear infected or pitted, like an orange peel.
Because of breast density and limitations of technology, women cannot simply rely on mammograms. Discovering new masses early, whether benign or requiring life-saving treatment, can be more reassuring than uncertainty. So if you are hesitant to palpate yourself monthly, at least be aware of personal anatomical characteristics and periodically check for anomalies.
- To BSE or not to BSE? Diane Mapes, 2014, fredhutch.org
- Why Monthly Breast Self Exams Are a Thing of the Past (and What’s Replacing Them). Alice G. Walton, 2011, forbes.com
- Some thoughts on why women don't do breast self-examination. C. J. Baines, 1983, ncbi.nlm.nih.gov