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Commentary

Is it time to stop teaching breast self-examination?

Larissa Nekhlyudov and Suzanne W. Fletcher
CMAJ June 26, 2001 164 (13) 1851-1852;
Larissa Nekhlyudov
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Suzanne W. Fletcher
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  • Value of Clinical Breast Exam and Breast Self-Exam
    Jeff Garwin
    Posted on: 14 August 2001
  • Fatal Errors
    Irwin D. Bross
    Posted on: 05 July 2001
  • Posted on: (14 August 2001)
    Value of Clinical Breast Exam and Breast Self-Exam
    • Jeff Garwin, President
    Dr. Bross’s main point is well taken, on the value of the physical breast exam. However, he has misrepresented the study by Miller et al (JNCI 2000; 92:1490-99) in one particular. All the women received instruction in breast self examination, and all the women received an exceptionally thorough (10-15 minute) clinical exam by a nurse practitioner. Half the women received, in addition, annual screening mammograms. From the s...
    Show More
    Dr. Bross’s main point is well taken, on the value of the physical breast exam. However, he has misrepresented the study by Miller et al (JNCI 2000; 92:1490-99) in one particular. All the women received instruction in breast self examination, and all the women received an exceptionally thorough (10-15 minute) clinical exam by a nurse practitioner. Half the women received, in addition, annual screening mammograms. From the study design, it is not possible to determine how much the self-exam contributed to the efficacy of the palpation-only arm. However the results presented by Miller et al. do highlight an important issue for further study: the thoroughness and precision of the physical breast exam.
    Show Less
    Competing Interests: None declared.
  • Posted on: (5 July 2001)
    Fatal Errors
    • Irwin D. Bross
    The recommendation in CMAJ (1) “Is it time to stop teaching breast self-examination?”, has created consternation, confusion, and sometimes anger in Canadian women (2). This commentary involves two fatal errors, omission of the best available data from the review and making an assumption which leads to an absurd conclusion.

    The latest data (2000) from the Canadian National Breast Screening Study...
    Show More
    The recommendation in CMAJ (1) “Is it time to stop teaching breast self-examination?”, has created consternation, confusion, and sometimes anger in Canadian women (2). This commentary involves two fatal errors, omission of the best available data from the review and making an assumption which leads to an absurd conclusion.

    The latest data (2000) from the Canadian National Breast Screening Study reports on a genuinely scientific Canadian study. This is the only clinical trial with adequate follow up that is directly relevant to a recommendation for Canadian women (3). The failure to include this study in the review was a fatal error of omission.

    The data for the 13th-year of a randomized trial involving almost 40,000 Canadian women, half of them screened by a combination of mammography and self examinations (“MA SE”) and the other half by self-examinations alone “SE”, showed that there were about the same number of deaths from breast cancer in both arms of the trial. Hence the results of the study can be succinctly expressed by the logical equation: “SE” = “MA SE”.

    The unequivocal conclusion from this equation is this: Addition of mammography to self-examination did not result in any additional reduction in deaths from breast cancer,. Hence, the only logical recommendation that can be made from this result is that mammography should be dropped -- not that self-examination should be dropped. The best and most pertinent data on the topic gives no support for a recommendation to drop self-examination (a tacit assumption that “SE” = 0). Indeed, adding this assumption to the logical equation gives this nihilistic null conclusion (0 = 0): Earlier detection of breast cancer does not improve survivorship. If this conclusion seems silly, then it follows logically that the recommendation to drop self-examination in breast cancer is equally silly.

    Irwin D. Bross, President
    Biomedical Metatechnology Inc.
    109 Maynard Drive
    Amherst NY 14226
    (716) 832-4200

    REFERENCES

    1. Nekhlyudov, L. and Fletcher, S. Is it time to stop teaching breast self-examination, CMAJ 2001; 164 (13): 1851-2.
    2. Toronto Sun Letter to the Editor 2001 Saturday June 30.
    3. Miller AB, To T, Barnes CJ, Wall C, Canadian National Breast Cancer Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years. Journal of the National Cancer Institute 2000; 92 (18): 1490-99.
    Show Less
    Competing Interests: None declared.
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Vol. 164, Issue 13
26 Jun 2001
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Is it time to stop teaching breast self-examination?
Larissa Nekhlyudov, Suzanne W. Fletcher
CMAJ Jun 2001, 164 (13) 1851-1852;

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Is it time to stop teaching breast self-examination?
Larissa Nekhlyudov, Suzanne W. Fletcher
CMAJ Jun 2001, 164 (13) 1851-1852;
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