TORONTO – Contradicting the advice women have been getting for years, a government-funded medical advisory panel recommended this week that doctors stop routinely advising women 40 to 69 years old to examine themselves for breast cancer.
The recommendations were issued by the Canadian Task Force on Preventive Health Care, which develops guidelines for Canadian doctors on preventive health care. It goes against a longtime practice in Canada and the United States, where women have been told that regular self-examination for unusual growths in their breasts can be crucial to early detection of cancer.
According to the task force, women 40 to 69 years old – the group considered at greatest risk for breast cancer – should stop being routinely taught how to do breast self-examination.
In its report published Tuesday in the Canadian Medical Association Journal, the task force said there was evidence that self-exams do little to save lives and can cause harm by bringing unnecessary stress and medical attention over benign growths.
The task force made no recommendations on self-examination for women younger than 40 or older than 70, saying it lacked sufficient evidence.
In the United States, the U.S. Preventive Services Task Force – similar to the Canadian task force – said in 1996 that insufficient evidence existed to recommend or oppose self-examination for breast cancer.
The director of cancer screening for the American Cancer Society questioned the study’s conclusion. The key to beating cancer is early detection, Dr. Robert Smith said, and self-examination can help.
The Evaluation Committee of the European Society of Mastology concluded in 1993 that routine breast self-exams offered no benefit.
The chairman of the Canadian task force, Dr. John Feightner, said the panel recommends that women 50 to 69 receive regular mammograms and that women from 40 to 69 receive regular clinical examinations for abnormal breast tissue.
“I think that it is quite important for women to realize that there are these other strategies that are important to pursue, even if breast self-exam doesn’t appear to be effective,” Dr. Feightner said.
Some experts said they feared the task force recommendation might deter women from seeking other forms of breast cancer detection, such as mammography and clinical breast examinations.
“How will women react to a sudden reversal in medical advice about” breast self-examination, asked Dr. Larissa Nekhlyudov and Dr. Suzanne W. Fletcher in a commentary published in the journal that argued against the recommendation. The two doctors said assessing the value of self-examination required more study.
Dr. Cornelia Baines, a professor of medicine who supports breast self-examination, criticized the report for focusing on only evidence that supported its position. Dr. Baines was among the experts who conducted a peer review of the report for the magazine.
Dr. Nancy Baxter, who conducted a review of studies on breast self-examination for the task force, however, said no studies to date prove that self-examination saves lives. She also said many women discover harmful growths in their breasts and that will continue regardless if they conduct self-examinations.
