With breast self-exam fallen from favour, how can women reduce their risk of breast cancer?
While self-exams haven’t been shown to reduce death rates, they’re still useful, says Dr. Mojola Omole
For years, physicians recommended women perform monthly self-examinations to check for potentially cancerous breast lumps.
Research, however, suggests breast self-exams don't have a meaningful effect on breast cancer survival rates and groups like the Canadian Task Force on Preventive Health Care actively recommend against telling women to regularly perform breast self-exams because they can lead to unnecessary biopsies.
"We know that there is no data that shows, when it comes to breast cancer, it changes your outcome with that," said Dr. Mojola Omole, president of the Black Physicians Association of Ontario and a surgical oncologist at Scarborough Health Network, speaking with The Dose host Dr. Brian Goldman.
Nonetheless, Omole says that — along with understanding your risk and going for regular mammography as soon as it's available in your area, self-exams are still useful. That's because they provide women with important information about their bodies by making them aware of what feels and looks normal.
"People check to make sure that their blood pressure is normal," she said. "You should also check to see if your breast is normal."
Breast cancer is the second most-common cancer in Canada, and roughly one in eight women are expected to be diagnosed with it in their lifetimes.
What is a breast self-exam?
The shift in thinking around breast self-exams is part of a growing movement in medicine toward the idea of breast self-awareness to watch for changes over time or through the month.
A breast self-exam is a physical process where you touch and feel your breasts to check for things like lumps, skin distortions, discolouration or swelling.
"It is when you check the breast tissue, but also when you check underneath the armpit," said Omole, as breast cancer can also spread under the armpit.
People can perform a breast self-exam by standing in front of a mirror with one hand over their head, with the other hand placed on the breast on the side of the raised arm.
Pretending the breast is a clock, start the exam at 12:00, slowly rotating inward to check for any abnormalities.
"You should also check to see if there's any skin changes," said Omole, including signs of redness, changes in skin tone, as well as unusual dimpling of the skin.
"If you're someone who has larger breasts … that hang a little bit more, make sure to lift underneath to check it there."
If you menstruate, Omole says you should perform a self-exam after you've finished your period. Otherwise, she recommends picking a date and performing a self-exam every month on that same date.
She also cautions that not every lump means cancer.
"Lots of people have cysts and fibroadenomas and just other benign things in their breast," said Omole, referring to noncancerous fluid sacs and lumps that typically don't require medical intervention.
If you do find something, she recommends consulting with a primary care practitioner, or going to a walk-in clinic or emergency department at a hospital with a breast cancer centre.
Mammograms part of early detection
While the breast self-exam hasn't been shown to help reduce breast cancer mortality and the exam's ability to detect cancer early has been challenged by physicians, Omole says the early detection tool can be useful for certain demographics — including younger women around the age of 30 or 40 and racialized women.
"For this population, I actually think it's very important because we know when you present at a younger age with breast cancer, you tend to have more aggressive tumours," she said.
Mammograms, however, offer more accurate detection, according to the Canadian Cancer Society.
Screening mammograms are used to detect breast cancer if there are no other symptoms. Diagnostic mammograms are used after a screening mammogram detects signs of cancer – or if another symptom indicates the presence of breast cancer.
It's worth noting that mammograms can misindentify breast cancer, with one study suggesting that roughly half of all women will experience at least one false positive result over a 10-year period of annual screening.
The age at which women in Canada can be screened for breast cancer through annual mammograms varies from province to province.
Ontario recently changed its guidelines, allowing women 40 and older to self-refer for a screening mammogram, lowering the age from 50.
"Many patients that I see, [and] I deal with a younger population and a racialized population, they found the breast cancer themselves," said Omole.
Data from the U.S. and the U.K. shows that women who are part of the African diaspora, as well as Hispanic, Asian and Indigenous women, tend to present with breast cancer at a younger age than 50.
However, Omole says anyone with breasts — including cisgender men — can perform a self-exam.
"If you have a family history of breast cancer or ovarian cancer and prostate cancer, there could be a gene that increases your risk," she said.
"So all of those people should also do a breast self-exam."
Know the three B's
For his part, Winnipeg Breast Health Centre medical director and surgeon Dr. Duncan Inglis says he doesn't recommend regular breast self-exams, and instead talks to patients about how the "Three B's" can help reduce the risk of breast cancer:
- Be healthy.
- Be aware.
- Be informed.
"We encourage women to maintain a healthy lifestyle and appropriate weight," said Inglis.
That includes following alcohol consumption guidelines, as well as stopping or at least minimizing smoking.
"We tell patients to just be aware of what is normal for them … and then we talk about people being informed of what's involved with specific things like screening programs that are available for their age and their location."
Inglis adds there have been considerable advancements in treating breast cancer, including improved chemotherapy and hormonal therapy.
"Women are doing better with breast cancer," said Inglis.
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