The Evidence Behind Clinical and Self-Breast Exams

January 30th, 2024

For many women monthly self-breast exams have long been considered an essential part of their health routine, alongside maintaining a balanced diet and regular exercise. However, conflicting advice from healthcare professionals over the years has left women of all ages feeling uncertain about whether they should continue this practice.

In 2009, the U.S. Preventive Services Task Force recommended that women at average risk for breast cancer should not feel obligated to learn how to perform self-breast exams. This recommendation echoed the guidance provided by the American Cancer Society in 2003. The task force, an independent panel of national experts in disease prevention, reaffirmed this recommendation in their updated 2016 review of breast cancer screening.

These recommendations were based on extensive studies conducted in 2003, which revealed no significant benefits to self-exams. In fact, the studies highlighted potential harm caused by unnecessary biopsies and a false sense of security when small lumps go undetected, leading women to forgo mammograms. This comes from two population-based studies conducted in Russia and China, involving nearly 400,000 women found no evidence that self-exams reduce breast cancer deaths. In fact, the findings, suggested that self-examinations had no significant impact on survival rates and may even lead to unnecessary biopsies. The group that performed self-exams underwent 3,406 biopsies, compared to 1,856 in the group that did not perform exams. And, there was no significant differences in breast cancer deaths were observed between the two groups.

Breast self-exams have more benefits for women at higher risk for breast cancer, such as those with a strong family history of the disease, previous benign biopsy results, or genetic mutations such as BRCA 1 and BRCA 2.  Those women are encouraged to visually examine their breasts monthly and undergo annual breast imaging studies starting at age 30 or even earlier. Additionally, women at higher risk may choose to have clinical breast exams between their yearly mammograms, ultrasounds, or MRI screenings, depending on their individual cancer risk. Factors that put women at higher risk include hormone replacement therapy, being overweight or obese, leading a sedentary lifestyle, and consuming more than the recommended amount of alcohol.

Still it is important to note that even having a clinical breast exam should be part of a shared, informed decision with your doctor. While the American College of Obstetricians and National Comprehensive Cancer Care Network recommend that women at high risk for breast cancer receive a clinical breast exam yearly and women who are low risk receive a clinical breast exam every three years the American Cancer Society does not recommend patients receive clinical breast exams as they may lead to false reassurance or unnecessary testing.

For women who still prefer to conduct self-exams, it is recommended to learn the proper technique from a healthcare professional. Most physicians, keep synthetic breast models on hand to provide hands-on lessons to patients who request assistance. Regardless of your decision regarding self-exams, it is crucial to regularly visit your healthcare provider to discuss all cancer and health screenings.

Breast cancer prevention, screening, and management are becoming more individualized and it is important that informed decisions are being made through a shared decision model with your doctor. Thus, it is crucial to be aware how these lifestyle choices affect your risk of breast cancer and to talk to your doctor about the need and frequency of breast cancer screening. Physicians also recommend seeking guidance from a nutritionist, participating in exercise classes, and in some cases, consulting with a genetic counselor to determine breast cancer risk.