Doctors’ Digital Breast Exams: A thing of the past?

Hello bOObs Bloggettes:

Here’s a surprising turn of events in the world of breasts that caught me (and others) by surprise: The American Cancer Society (ACS) no longer recommends Clinical Breast Exams (CBE), during which physicians examine women’s breasts — but their reasoning may surprise you.

CBE is an examination performed by a doctor, usually during an annual physical, where they visually examine for problems but also palpate for tumors or abnormalities in the breast.

Here is what ACS says about CBEs: “Given the lack of benefit concurrent with the increase in false positive rates, we do not recommend CBE as a method of breast cancer screening among women at any age with an average risk of breast cancer.” So what they’re saying is this:  they’re afraid CBEs are contributing to more false positives of breast cancer (BC) than are already being produced by others things such as mammography screening — which lead to over-diagnosing and treatment of many women (see previous blog).

But the ACS goes on: “Recognizing the time constraints in a typical clinic visit, we encourage clinicians to use this time instead for counseling women regarding the potential benefits, limitations and harms of screening mammography.”

AMEN!

Based on all of the research over the past 3 years I’ve perused, I think ACS hit it right on the nose. Doctors should be talking more to women prior to screening about all the pros and cons of mammograms. But expanding on that, ACS should also recommend to docs to please quit using that stupid Airplane Metaphor when asked about how much radiation we’re getting.  (Patient: “But how much radiation is in a mammogram? I’m getting them every year and am afraid of getting breast cancer from screening.” Doctor: “Oh, don’t worry. Mammograms are low-dose radiation and you only receive the same amount you get as flying over the U.S. in an airplane!” Sound familiar, ladies?)

This is total baloney, as I’ve explained in a previous blog, but most doctors don’t understand this as they aren’t radiation experts. Briefly: The Fly-Over Zee Plane, Zee Plane! metaphor refers to mammography’s scattered radiation across the body and not the absorbed dose going into our breasts — which is a heckuva lot more and can eventually give a woman BC.

But back to CBEs: My personal belief as to why ACS and others are no longer recommending CBEs is that, as ACS mentions, doctors no longer have much time to spend with us during an appointment. Have you noticed this too? The receptionist now dictates how much time you get with your doctor based on how miserable you sound on the phone when calling for an appointment. Let’s see, worthy of 6 min. or 15?  they think to themselves. (If this doesn’t happen to you, consider yourself lucky.) And because of this new hurried schedule, docs don’t have time to check us for BC anymore — but neither do they discuss the pros and cons of mammography, I’ve noticed!  So now we’re getting the worst of both worlds.

I also have a feeling that the insurance companies somehow had a hand (so to speak:)) in this decision because they’re the ones who have to pay for the CBE as an “early detection tool.” I’ve had doctors tell me that insurance companies guidelines, dribbled down from the Government’s Medicare mandates, no longer allow doctors to practice the art of medicine by deciding what’s best for their individual patients. The Standard of Care these days is an average across all patients for a certain disease, and so now we all get handled the same regardless of our circumstances.

Incidentally, the U.S. Preventative Services Task Force (USPSTF) did not recommend that the practice of CBEs be stopped — and the ACS usually follows roughly along the lines of what the USPSTF recommends.  So what’s really behind this?  I’ll keep digging on this and get back to you in another blog if I figure out this riddle.

Now, regarding Breast Self-Examinations (BSE) that patients perform on themselves at home, ACS doesn’t say not to do them, they just point out that the research doesn’t support doing either CBEs or BSEs regularly if you have an average risk of developing BC. An exception, for instance, would be for a woman with an inherited BRCA gene defect making her more susceptible to BC (see previous blog on this).

Here’s a weird personal story: Last time I went to my male doctor, I was going to get into a discussion about mammograms so, as a prelude, I asked him for a mammography prescription (which I was just going to toss out at home). But he refused to give me one unless he or another doctor gave me a CBE first! Now what the heck was that about? I never did understand where he got this Standard of Care from but happily left empty handed.

bOObs Bottom Line:  I say do whatever you’re comfortable with, Ladies. It’s a free-for-all out there!

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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