This otherwise balanced story leads with a frightening anecdote from a woman whose breast cancer was only diagnosed by breast self-exam (BSE). Her statement that she would not have survived if she had not been vigilant about monthly exam may or may not be true. A physician’s quote buried in the piece notes that tumor biology (not size) is the most important predictor of mortality. Introducing the story with such an unfortunate missed diagnosis detracts from the overall message that, in population studies, there is no demonstrated benefit to regular BSEs for low to moderate-risk women.
The story explains how public health and patient advocacy campaigns influenced the widespread promotion of BSE for every woman, and that such recommendations are no longer appropriate based on available evidence. The story references current breast cancer screening guidelines from the American Cancer Society and U.S. Preventive Services Task Force.
In general, the story does a good job explaining that breast self examination is a personal decision, and depending on how someone feels about the increased risk of biopsy can determine whether she wants to do it or not. Two vital pieces of information a woman needs when considering BSE:
It doesn’t cost anything to do a breast self-exam.
The story does mention potential harms of increased doctor visits and unnecessary diagnostic procedures triggered by self-exams, with additional cost implied.
The story discusses two international studies upon which the Cochrane report is based and discusses the findings that there is no demonstrated benefit from regular BSE.
The story lists the downsides of screening via a self-breast exam, namely, over treatment via biopsies for false positives and false reassurance that mammography is not needed. The story appropriately notes a woman’s individual risk is a factor when choosing how and when to be screened. A woman at higher-risk may feel that monitoring tissue changes via self-breast exams is useful.
This otherwise balanced story leads with a frightening anecdote about a woman whose breast cancer was only diagnosed by breast self-exam. We do not know if her doctor also felt this lump. Her statement that she would not have survived if she had not been vigilant about monthly exam may or may not be true. A physician’s quote buried in the piece notes that tumor biology (not size) is the most important predictor of mortality. Introducing this otherwise balanced story with such an unfortunate missed diagnosis detracts from the overall message that, in population studies there is no benefit to regular SBEs for low to moderate-risk women.
The story is based on an update of a report by the Cochrane Collaboration, a credible international group that analyzes bodies of scientific literature to determine overall findings. A range of clinicians put the report and practice of BSE in perspective. Physicians appropriately talk about the revised guidelines for this screening, and note that regular BSE is still an individual woman’s choice. Women should be aware of the harms and lack of sensitivity of the exam. A patient is interviewed for the story, but her story of misdiagnosis seems to undercut the overall message of the piece: women must weigh the pros and potential downsides of regular BSE.
The story mentions mammograms as a better diagnostic option, yet the story also notes that this tool may may miss some cancers in the upper-outer quandrant of the breast. The story notes improved and more specific tactile breast self-exam methods as an option; however, there is little evidence that these techniques improve detection of early breast cancers in a large population. The story references current breast cancer screening guidelines from the American Cancer Society and U.S. Preventive Services Task Force.
The availability of breast self-exams (BSE) is implicit; however, the story appropriately notes that not all physicians or health educators know current BSE technique, and there is a suggestion that inappropriate technique may influence the sensitivity of the self-exam. The story mentions a more sensitive technique–the vertical-strip, three pressure test– used in Canada, which has been validated in a small subset of women.
Breast self-exam is not novel; neither are the recommendations being discussed. The story explains how public health education campaigns influenced the widespread promotion of BSE for every woman, and that such recommendations are no longer appropriate based on available evidence.
The story includes several independent sources and references to published studies. The story does not appear to rely solely or largely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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