Why Am. Can. Soc. No Longer Recommends Breast Exams

Hello bOObs Bloggettes:

When I saw that the American Cancer Society (ACS) stopped recommending clinical and self-exams for breast cancer, I was a wee confused. How can something so fundamental to breast health suddenly be dropped?  Let’s investigate…

While I am still researching the above topic for my upcoming book tentatively entitled “bOObs: The Truth Behind Breast Cancer Screening,” what I have uncovered thus far is pretty jaw-dropping.

Here’s what the ACS has to say about breast exams on their website:

“Research has not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves (breast self-exams). There is very little evidence that these tests help find breast cancer early when women also get screening mammograms.”

***Let’s stop right there. I can’t tell you how many women have told me that the mammogram missed their cancer and thank goodness their cancer was picked up digitally during their doctor’s office exam. So what the heck?

ACS continues:

“Most often when breast cancer is detected because of symptoms (such as a lump), a woman discovers the symptom during usual activities such as bathing or dressing…”

***Okay, so the other obvious question is this: Why the heck are women subjected to mammograms and the ensuing radiation every year if she’s picking it up herself? Medicine is arguing itself into a circle.

ACS continues:

“While the American Cancer Society does not recommend regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule, this does not mean that these exams should never be done. In some situations, particularly for women at higher than average risk, for example, health care providers may still offer clinical breast exams, along with providing counseling about risk and early detection. And some women might still be more comfortable doing regular self-exams as a way to keep track of how their breasts look and feel. But it’s important to understand that there is very little evidence that doing these exams routinely is helpful for women at average risk of breast cancer.”

Crazy, isn’t it? Downright confusing! It’s right up there with changing the mammogram screening schedule on us in 2009, telling us to start screening later and not as often for certain age groups (see my blogs on this).

So what’s behind this change in attitude at the ACS on digital breast exams? My guess is that it has less to do with science, and a lot to do with insurance reimbursement for the doctor’s time. I mean, what’s the harm of doing an extra exam as a precaution?

Susan G. Komen’s website brings up over-diagnosis due to false positives as a consideration:

“False positive results occur when a [Clinical Breast Exam (CBE)] finds something that looks or feels like cancer but turns out not to be cancer.

“Getting a false positive result leads to follow-up tests, and can cause fear and worry. However, the goal of CBE is to find as many cancers as possible, not to avoid false positive results.”

Yes, it’s true that medicine is over-diagnosing breast cancer all over the place — but that’s mostly due to the mammogram picking up the micro-calcifications of DCIS (ductal carcinoma in situ), a pre-cancer that generally doesn’t spread and that represents roughly 25% of breast cancers now thanks to mammography (see my blogs on this).

My guess is that insurance doesn’t want to pay doctors to spend their precious time in the office on Clinical Breast Exams. Everything at a doctor’s appointment (as you’ve probably noticed these days) is about getting the patient in and out of the doctor’s office as soon as possible. And most of that time is now spent with this doctor staring at the computer screen and typing.

bOObs Bottom Line: I’m still investigating this and will let you know when I come up with a firm answer to this hypothesis. But if the mammogram was finding our breast cancers before a tumor formed (like thermography is capable of doing), we wouldn’t have to resort to doing other tests such as breast exams, would we?

***NOTE:  Sorry I didn’t blog last week; I help take care of my parents (96 and 97 and still at home!!) and something came up; all is good now:))

Blog at you soon, thanks for reading and helping to spread the word!  (Please see the “share” links below.)  And we’d love to hear comments from you! (see below as well)

Stay healthy,

Megan

Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts

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