Intervention can aid in breast self-exams
Intervention can aid in breast self-exams
Is information on breast self-exams (BSEs) included in your care of women? Findings from a 2009 study indicate that a brief intervention program based on a single counseling session and two follow-up phone calls significantly increased the number of women correctly performing such exams.1
For many years, monthly self-exams were promoted as an important prevention tool. However, a 2003 analysis of available scientific data did not find a beneficial effect of screening in terms of improvement in breast cancer mortality.2
The American Cancer Society now says breast self-exams can serve as an option for women starting in their 20s, with providers asked to review the procedure's benefits and limitations with their patients.3 For early detection of breast cancer, women in their 20s and 30s should have a clinical breast exam as part of a regular health exam by a health professional, preferably every three years, the agency advises. After age 40, women should have an annual breast exam, as well as a screening mammogram, according to the society.3
While research has shown that breast self-exams do not reduce the number of deaths from breast cancer,4,5 the procedure can help women become familiar with their normal breast tissue, which aids in identifying new or unusual changes in their breasts. Self-exams are encouraged for women at high risk of breast cancer, which is usually defined by presence of breast cancer 1 and 2 (BRCA 1 and BRCA2) mutations.
The current study, conducted by researchers at the Kaiser Permanente Center for Health Research, involved more than 600 women, ages 40-70, who had a negative mammogram screening within the last two months. Women were randomized to a group that received dietary counseling with no mention of breast self-exam, or the study group, which included a 30- to 45-minute counseling session with an educational BSE video, practice on a silicone model, and discussion of possible barriers to performing self-exams. Women in the study group also received follow-up telephone calls at one and two months after the counseling session.
Prior to the intervention, about 6% of women in both groups were performing adequate self-exams, which were defined as lasting at least five minutes, occurring every month, and meeting specific criteria taught during the counseling sessions. One year after the program, researchers report 59% of women in the intervention group were performing adequate self-exams, compared to 12% of women who received dietary counseling. "At the time we were developing this study, breast self-exam was an acceptable practice for cancer prevention which was recommended by most health organizations," says Nangel Lindberg, PhD, an investigator at the Kaiser Permanente Center for Health Research and lead author of the study. "Because we were conducting two studies dealing with cancer prevention practices, we needed to focus on two cancer-prevention practices that could be taught in similar ways."
Researchers found that teaching BSE involved some of the same features (education, addressing knowledge gaps and personal barriers, and building confidence) that were involved in dietary change, Lindberg observes. Dietary change and BSE fit well with the teaching method tested, she states.
When talking with women about breast self-exams, advise them of the importance of being aware of the normal look and feel of their breasts, and to report any changes. When performing a breast self-exam, women should be taught to look for a hard lump or knot in or near the breast or in the underarm, or a change in the way their breasts look or feel.
References
- Lindberg NM, Stevens VJ, Smith S, et al. A brief intervention designed to increase breast cancer self-screening. Am J Health Promotion 2009; 23:320.
- Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003373. DOI: 10.1002/14651858.CD003373.
- American Cancer Society. Detailed Guide: Breast Cancer. Accessed at www.cancer.org.
- Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst 2002; 94:1,445-1,457.
- Semiglazov VF, Moiseenko VM, Manikhas AG, et al. Interim results of a prospective randomized study of self-examination for early detection of breast cancer (Russia/ St.Petersburg/WHO). Vopr Onkol 1999; 45:265-271.
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