Dr Joe Explains

Why Self-Exams Aren’t Enough

Why Self-Exams Aren’t Enough

A self-examination is when you feel for abnormal tissue in your own breast. This is a simple and easy test that you perform on yourself. While self-exams can be done periodically (every month), they will likely only find a large mass. The smallest mass you can feel is usually about an inch, like the size of a large grape.

As a result, even if an abnormal mass exists, most women who perform self-examinations won’t be able to feel a mass.

Your doctor can also perform an examination (referred to as a clinician examination) of the breast (usually every year), but your doctor will still have the same problem. They also cannot feel a small mass.

Are you surprised by this? If so, you are not alone. 

To help you understand why it’s so hard to find abnormal masses through self or clinician exams, imagine having a bag packed full of packing peanuts. In this bag, there is one large grape, and it is your job to find it by blindly feeling the contents of the bag from the outside.
 
A bag full of packing peanuts is very similar to a woman’s breast. Breast tissue is quite lumpy, and finding the mass, or grape, is very difficult. Sometimes a breast mass can feel a little harder or be painful, but most of the time there is very little difference. Normal breast tissue, benign masses, and breast cancer can all feel the same.
 
For women who have large or dense (firm) breasts, finding masses through self-examinations can be even harder. As the size and the fullness of the breast increases, it becomes more difficult to find a mass. Similarly, the bigger the bag or the more peanuts packed into the bag, the more difficult it is to find the grape.

Many women feel guilty about not being able to find an abnormal mass earlier, but it is not their fault.

Self-examinations and clinical examinations provide only a small benefit for breast cancer patients.1,2 In fact, you may be even more surprised to learn that self-exams and clinical exams are not recommended screening tests on some national guidelines. However, since self-exams are not harmful to do, and they can help some patients, we suggest continuing to do them every month. 

So how can you spot breast cancer early? You need better screening tests.

The most common form of screening for breast cancer is a mammogram (MAM-O-GRAM). Mammograms are well-proven to find breast cancer early and can improve your chances of beating breast cancer if done regularly.
 
A mammogram, in case you haven’t had one, is an x-ray of your breast. Doctors use the x-ray to tell the difference between normal and abnormal breast tissue, allowing them to spot abnormal tissue that is much smaller than a grape.
 
Mammograms are like standing in a lush garden, searching for a single dandelion among many normal flowers. Sometimes you will miss a single dandelion hiding under another flower. Mammograms, unfortunately, are not perfect, missing an average of 16% of cancers.3 These unseen masses are sometimes the ones found through self-examination. 

So, please get your mammograms when they are recommended. And if you do find a hard or growing mass in your breast during a self-examination, see your doctor.

Finally, remember breast cancer just happens and sometimes even in the young and unexpected. Read our book, Dr. Joe Explains… How Breast Cancer Is Like a Dandelion to learn more about breast cancer high-risk factors, prevention options, and screening.

And, if you, unfortunately, know someone who has been diagnosed with breast cancer, be a Girlfriend In Action. Help her through this difficult time by passing this book onto her, giving her a place to start and a guide through her journey.

 

Dr. Joe’s Words of the Day

SELF-EXAMINATION
Using your hands to feel for abnormal tissue in your breast
Dr. Joe says… Feeling for a grape in a bag of packing peanuts
 
CLINICIAN EXAMINATION
Medical professional feeling for abnormal tissue in the breast
Dr. Joe says… Feeling for a grape in a bag of packing peanuts
 
MAMMOGRAM
Screening test that uses x-rays to look for breast cancer
Dr. Joe says… Standing view of the flowerbed

References

  1. Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: Final results. JNCI Journal of the National Cancer Institute. 2002;94(19):1445–1457. doi:10.1093/jnci/94.19.1445.
  2. Semiglazov VF, Mikhailov EA, Manikhas AG, et al. Final results of Russia/WHO prospective randomized trial of breast self-examination (1985–2003). European Journal of Cancer Supplements. 2004;2(3):87. doi:10.1016/s1359-6349(04)90712-4.
  3. Performance Measures for 1,838,372 Screening Mammography Examinations1 from 2004 to 2008 by Age -- based on BCSC data through 2009. Breast Cancer Surveillance Consortium. http://breastscreening.cancer.gov/data/performance/screening/2009/perf_age.html. Accessed February 14, 2017.

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