Screening for Breast Cancer With Breast Self-examination
A Critical Review
- Michael S. O'Malley, MSPH;
- Suzanne W. Fletcher, MD, MSc
- From the Department of Medicine, the School of Medicine (Mr O'Malley and Dr Fletcher); the Departments of Health Policy and Administration (Mr O'Malley) and Epidemiology (Dr Fletcher), School of Public Health; and the Lineberger Cancer Research Center (Dr Fletcher), University of North Carolina at Chapel Hill.
Abstract
We reviewed evidence regarding breast self-examination (BSE) and screening for breast cancer. To our knowledge, no controlled prospective trial links BSE to lives saved from breast cancer. Compared with clinical breast examination and mammography, the estimated sensitivity of BSE is low (20% to 30%) and is lower among older women. The potential sensitivity of BSE should be higher because women can detect small lumps (0.3 cm) in silicone models. Instruction increases BSE frequency over the short term. Sensitivity also increases, but specificity decreases. The psychological effects of teaching and performing BSE are not yet clear. The cost of screening by BSE is unknown but depends on the accuracy of the test as well as the training method used. Breast self-examination has potential as a screening test for breast cancer, but many questions require scientific examination before this procedure can be advocated as a screening test for breast cancer.
(JAMA 1987;257:2196-2203)
Footnotes
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The opinions expressed in this article are those of the authors and do not represent the opinions of the National Center for Health Services Research and Health Care Technology Assessment or the Robert Wood Johnson Foundation.
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Reprint requests to Department of Medicine, University of North Carolina School of Medicine, Old Clinic Bldg 226H, Box 2 Room 5039, Chapel Hill, NC 27514 (Mr O'Malley).
