August 06, 2008

Breast Self-Exam Slackers: Good news?

[By Crabby]

(Photo credit: emilygoodstein)

There may be some of you out there who've managed to actively embrace the whole monthly breast-self exam process.

Do you dim the lights, turn on soft music, and perhaps chant some uplifting affirmations as you create your own empowering, nurturing self-care ritual?

Oh Goody, It's That Time Again!

Oh wait, sorry, this is Cranky Fitness. If you are that sort of person, there's a good chance you're here by mistake. Darn that Google, huh? You perhaps meant to be here instead. Buh bye!

It's more likely that you do breast self-exams dutifully but grudgingly. It's a chore, right? And a slightly creepy, anxiety-provoking one at that. But the gynecologist told you to and it's dumb to disobey your gynecologist so you sigh and get it over with.

Breast cancer is not something to mess around with and you don't want to take your chances.

Of course there is yet another subgroup of women. These women nod obediently when their gynecologists tell them to do self-exams. But then they go home and they never, ever do them. Bad, bad breast-exam slackers!

[Photo: His Noodly Appendage. Seriously.]

I have to confess I'm one of these terrible slackers.

It's just that I find self-exams awkward and stressful. I never really got the hang of the whole thing. Plus (warning: TMI alert) I have the lumpy fibrocystic kind of tissue that always feels suspect. My gynecologist can do the exam without freaking out, but I can't. So when she asks if I've been doing them every month I usually just stammer some excuse and promise to be better about it in the future.

But I'm lying! I will never be better about doing them in the future. Ain't gonna happen.

(I am, however, incredibly conscientious about getting my annual office exams and mammograms).

So a few years ago I read a surprising study that seemed to suggest that doing regular breast self-exams didn't even help women survive breast cancer. That's right--women who didn't do self-exams still had the same breast cancer survival rates as those who did.


While this information helped justify my self-exam avoidance, I didn't really believe it. I figured another study would come a long any minute and contradict it, because the result didn't seem to make any sense.

Now there's been a follow up breast self-exam study: and yet again, they found that women who did self exams had virtually no increase in cancer survival rates!

It still confounds me, because it really seems like catching cancer early is better. Certainly that should boost survival rates? But the study involved almost 400,000 women and followed them over 10 years. There were 292 breast cancer deaths in the self-exam group as opposed to 295 in the control group--the difference wasn't statistically significant. Plus, the regular breast self-exams doubled the risk of undergoing a biopsy.

So does this mean I can finally stop feeling guilty for not doing the damn things?

What do you folks think? Do you do them? Will you keep doing them?


  1. Something that I've found is that many women end up very stressed and panicked when they find something that they think is a serious lump. Very often, it is a cyst or something benign, but the stress that they live with while they decide to get it checked, wait for the appointment, wait for the mammogram, wait for the results, often wait for an ultrasound... it's very, very hard on them.

    I didn't think much about it until I, too, went through it. Just this week, I had two women come in to my office (I'm working an on-site real-nurse gig!) with lumps that were very, very likely cysts, but they were both very freaked out, and with one, her partner was even more freaked.

    So, I'm wondering, is the self exam really worth it?

  2. I remember my first visit to the US on 2000. Somehow the whole "breast cancer" buzz had not made its way to France, or maybe I wasn't paying attention. In any case, I am visiting a girlfriend in Tucson, I go to take my shower and... what... what is this "fondle yourself" how to manual hanging on her shower head??????? Just could not believe my eyes.
    I have never been a self checker... I know, bad.... but not as bad as I first was led to believe...

  3. I don't do them either since my breasts are always lumpy too. Fun isn't it? It just causes me unnecessary angst. I go to the doctor if I have a cyst that isn't going away but otherwise, I try to not stress over it.

    My mother had breast cancer so I should probably be more vigilant but I don't see it happening, especially now that Cranky Fitness has relieved me of my guilt. :-)

  4. I was way better about it when I was younger. Now, I'm very neglectful about self-exams. It was always suggested that the exam take place about 5 days after the start of your menstrual cycle. Well, with that being erratic to non-existent, it's much harder to remember when to do the self-check. Interesting study outcome. Now I don't have to feel bad about not checking. Thanks for keeping us ummm abreast of such things. ;)

  5. I don't bother. I have from time to time, but then I forget.

  6. you know, I've read so many studies all saying different things - when I was in grad school for public health, they had a field day with BSEs in Epidemiology and Biostats class because just how DOES the average woman figure out what's what with all the conflicting evidence. I admit, I don't do them, and I'm a health writer who worked at Planned parenthood. I have an aunt who had breast cancer but no other family history. I do, however, have a strong fam history of...oh...EVERY other disease, from MS to diabetes to depression. So instead of doing self checks, I am BFF with my insurance company and get screened regularly for lots of stuff from skin cancer to paps to mental health. I', very dutiful about it. And I'm sure, once I hit 40, I'll start doing BSEs more. But for now, I just know I'll feel a rib or something, freak out like the hypochondriac I am, and end up at the doctor...where I likely already have an appointment!

  7. While I do not get stressed about the breast exam, I simply don't do them.

    I am a surivor of ovarian cancer and even though some whacked as doctors had found the tumor early on, they said it was "possibly" a cyst and let me go on for another year until a real doctor told me the truth.

    In the end, I don't think we know what to really feel for in our boobs (I too have those lumpy things in my tetas) so really, any lump can make a woman go mad.

  8. I do them when I think about it---I think I rest too much on the fact that mine as small so I feel em up daily when I cram into my sportsbra and think Id notice.

    probably a bad call...

  9. I do that when I remember to. I'm sure it isn't once a month and definitely isn't on some sort of schedule, but it is better than nothing. I did have a minor freak out recently because I had a spider bite that I thought could be a Lump and I completely overreacted and had trouble falling asleep, and then the next morning it itched and I remembered what it felt like when I was younger and would get spider bites traipsing in the woods.

    I saw that article somewhere, but I figure, it can't hurt. The problem is I'm not sure what capital L Lumps are supposed to feel like. I've felt the models before, but I'm not so good at remembering how stuff feels like.

  10. I couldn't even find the lump in the model at the Dr.'s office. The nurse was very stern as she declared, "Can't you feel that! Let me take your hand and HELP!"

    I never had lots of confidence that I could ever find anything in my lumpy-bumpys, so I gave up years ago.

  11. I'm another member of the lumpy boob club. I had one lump scare which ended up being nothing, but it freaked me the hell out. I don't do self exams. I know I should but I can never tell what is a bad lump and what's a normal lump. I know, I would probably know if I felt myself up every month, but I'm using the excuse that my long term memory is crap and I wouldn't remember what was where anyway.

    Excuses, I has them.

  12. Ooh! The "feel yourself up in the shower" instructions! We had those on our shower heads in college. The other side has "grope your own balls in the shower" instructions for guys. ;)

  13. I had the good fortune to be a "lay teacher" for breast exam to medical students. You leave that experience being quite sure you know what you're doing! As one of the fibrous-breast brigade, I was never sure before what I was feeling, or whether I was really doing it right. Even so, I was pretty irregular about it, and now that menopause has removed my monthly cue I've gotten much slacker.
    My former boss found a lump that her mammogram had missed the month before, and had a lumpectomy two years ago.

    Mary Anne in Kentucky

  14. Nope, never do it, and have no intention of starting.

    I have a friend who does it religiously. Found a lump, which turned into an inconclusive biopsy, which turned into an operation to remove a big chunk, which upon examination turned out to be totally benign.

    Months of psychological hell, many thousands of dollars in medical bills, and a lasting scar, all for nothing. The stress of it is probably enough to CAUSE cancer.

  15. I won't say too much since I've had 5 women on one side that have had cancer (4 breast and 1 ovarian), with 3 survivors. They figure my 29 year old cousin survived because of them. Maybe she was just one of the 3 that made the difference, but I figure if I have even a slim shot I'll do them. I've seen almost first hand what dying of cancer is like and I don't want any part of it! Oh, the joy of being traumatized!

    Now, since it doesn't increase your chances forgoing will probably not be terrible. Did they ever say if you increase your life expectancy? I'll have to look it up.

    My cousin said it felt hard like a mike and ike under your skin and larger than the usual lumps (I have lumpy tissue too). Maybe that helps? Probably not if you have the model to feel up :) Don't they make the tissue smooth except the lump though?

  16. I never do them - the only time I feel myself up is when I'm trying to figure out if I"m preggers or not (my breasts get really tender when I'm first pregnant). But since the hubs took that little trip to the weinie doctor a couple of years ago, I don't feel them up anymore.

    I thought about buying that little kit that Olivia Newton-John was peddling a few years ago, but I never did. It's just one of those things I don't ever think about doing until I'm like, in the middle of a restaurant or a department store, and ya know, that kind of thing is frowned upon in modern society.

    So to make a long story short (too late) - NO. I don't do them.

  17. I do one each quarter. I didn't like doing them every month, but I knew I should, so I made that bargain with myself. I think it's far.

    But yes, it always make me anxious because the whole point is finding soemthing. I don't want to find anything!

  18. I've never been a self-checker, but I don't see a problem with knowing what's what so you can tell if something's not right. I always forget that there is the best time to do it to -- before? after? during? Your period? Lunch? Nordstrom's Half-Yearly Sale?

    It's so confusing!

  19. Hi Crabby,

    I rely on my mammography, but Mary Anne's comment got me a bit nervous.

    I know how you like free stuff, so be sure to pop over to Women of Mystery today. We have links to contests for free books.


  20. I don't do them. My grandmother did, and when she got a mammogram, the doctors told her that the suspicious lump was nothing, except she noticed it getting bigger. By the time the doctors did anything, it had already spread to her bones. She didn't survive.

    So doing them for me brings back bad memories and makes me angry.

  21. I've read several times where lumps were detected by husbands. I figure mine checks me out way more often than once a month, so I'm not going to waste any effort on it. (Mine are also smallish and not lumpy, so I feel pretty safe not doing them.)

    I AM, however, really awful about getting my mammograms in a timely fashion. But wasn't there something in the news a while back that said post-menopausal women don't need to do them every year? Or was I dreaming? (I went through menopause at age 40!)

  22. Interesting topic. I was going to say 'it couldn't hurt' but after reading these comments I'm not so sure.

    Yeah, checking in the shower helped my brother with his cancer, but do I do anything? Nah.

  23. I'd say I do a BSE in the same proportion as I floss my teeth - meaning that I should floss every day but I end up flossing a couple times a month, and I should do a BSE every month but I only remember a couple times a year. And in both cases, when I go see the dentist/doctor, I feel the same amount of (shame's not the right word, more like oops I'll try to do better), except that the BSE always seemed like it could have a bigger impact.

    But maybe not. Maybe I shouldn't feel so bad about forgetting. I'm another one in the camp of the lumpy breast, so I never really know what's normal and what's not.

  24. I NEVER do them. I don't even think about it.

    But OMG, I LOVED the shame picture. LOVED. I could use that picture for so, so many things.

  25. The Bag Lady is such a slacker in so many things, and this is one of them. But she does manage to go to the doctor on a reasonably regular basis.....

  26. I am a self checker slacker...I am the same way, I stress over something that isn't there.

  27. I don't do them. I also have the fibrocytic breast (had an adenofibroma taken out at age 35, after a suspect baseline mammogram, even). It's so lumpy in there, that all I do is upset myself. So, after a few months of attempting it back in my younger years, I gave up.

    I'll hope for better and better breast imaging....

    The P

  28. Crabby,
    I do the breast exam when I accidentally remember I have breasts, and mine aren't all that tiny. I get my mammograms though.

    Too bad there's no real *feelie* test for uterine cancer!

  29. I'm a slacker for sure, I'm glad the annual squish-o-gram seems to be the way to go now.

  30. Have to admit I don't do them - I have to many fibroid thingys (that's the correct technical term, right?) and would be in a constant panic. I do get my yearly mammograms though!

  31. By the time you can feel breast cancer the term early has gone out the window, that is why there is not increased survival. Most people who feel a mass, the mass is greater than 3cm (over an inch)which in the real would is not large but in the world of tumors is big. So if self exams make you want to have a nervous breakdown, then don't. However, if something changes or you happen to feel something new, get thee to a doctor quick. Denial can kill faster than anything else.

  32. I think Crystal may have hit the "survival" thing on the head. Survival usually means very small lump that hasn't spread. I'm sure by the time I could a lump, it would not affect survival.

    I rarely if ever do a self-exam. I have my mammo annually and have a yearly exam. Like many others, my breasts feel lumpy to me, so who knows if I'd feel something and know that it's something new/different.

  33. TMI ALERT! I like doing my BSE's. I like feeling in touch with all parts of my body and like to know what's going on with the girls on occassion. So I don't mind the monthly exam. And my boobs are teeny tiny so it's not like it takes a lot of time. I'm also an avid mole checker in case anyone wanted more info on my personal habits;)

  34. My mother had breast important subject. Thank you.

  35. I always forget and I'm not in the least ashamed. I did have a lump once and I easily found it without having to do a formal exam on a certain day of the month.

    Funny thing is that I wasn't very worried, and after I did a little research, I became even less so. It was the effin' DOCTORS who tried to get me to freak out!

    For example, I was naked from the waist up, waiting for the ultrasound guy, and damn if he didn't troop in with half a dozen students and only THEN ask if I minded. (I didn't because I used to be a pre-med, but that's not the point.) Then he did the ultrasound, with me watching the screen while he pointed out to the students all the things one should look for. He said, "These are the signs of a classic fibroadenoma." But would you believe it, after the exam, he tried to tell me...*cue the scary music* might be CANCER!

    Fucking bullshit.

    Finally the surgeon checked me, shrugged and said it was almost certainly benign and I could have it out or not, my choice. But he warned me that adenomas tend to keep growing, so I decided to have the lump taken out. I couldn't afford custom bras.

    Anyway, probably TMI, but cancer is unheard of on either side of my family, I have no risk factors, and in my own experience I find my lumps without even trying. Probably because I'm pretty small.

    Regular self-exams are the right call for some women, but the scare-mongering the medical profession indulges in pisses me off to no end. Can ya tell?

  36. i don't do them.... my tissue is lumpy too, and i have a mild anxiety disorder, so why cause myself more panic than is completely necessary? besides, i'm 22, and none of the women in my family (that i know of) have had cancer.

  37. I figured that the breast exam didn't have anything to do with survival rates- I thought it was just so that you could find out if you had cancer or not and catch it early on and hope for the best. (yep, you can tell I sure do my research:P).

    My doctor is male and awkward in a funny/cute way. One time he asked me haltingly if I do breast exams. I said I hadn't (but I have breast cancer in my family). So then he pauses awkwardly and he says, "okay, well, I suggest you do a self exam. Theres no need for me to do it. I'm sure that you can do it yourself just fine." Lol.

  38. Crabby, I'm so there with you! At 33, I found a little lump and after an ultrasound, mammogram and needle biopsy it was determined to be just a cyst. But it scared the you-know-what out of me. I never know if what I'm feeling is supposed to be there or not.

    So I generally don't do them. I'm 40 now, though, so I have a yearly mammogram. And I do have an exam done by the doctor each year.

    But for me to do my own exam freaks me I don't.

  39. I don't do the self-exams either. My first lump made itself known by hurting. The resulting mammogram and biopsy were very stressful. That one was benign. A year later it hurt much more and had grown, so I had it taken out. It was while I was checking the incision for that one that I found the other lump.

    It wasn't until a year later that it was diagnosed as cancerous. I have so much scar tissue in (what's left of) that breast now, that I just let the Dr. do the exam and with annual mammograms I don't worry. I get exams every 6 months on the other side now though, because they found calcium crystals that they want to keep a close eye on.

    Anyone that wants the whole gory story can go to my site, but you have to go back into the archives.

  40. I'm a bit lax on my feminine health at the moment.

    Then again, I'm 22, overworked and underpaid. I'll get to the gyno when I start making some real money and/or I get health insurance.

  41. I forget usually, so it turns into a "whenever I remember self-exam." I suppose though even doing it makes no difference because I can't tell what I am doing. I lack confidence in my ability to notice anything, but I suppose if something was really wrong I would notice. That is probably a terrible way to go about it, but oh well.

  42. A seriously bada** holistic friend told me if you drink enough water (and it's more than you'd think) it reduces the cancer risk down to like, twenty percent of what it would otherwise be given your genes and environment.

    So given the risk of false positives and the stress that would then ensue, and the fact that from everything I've read excess stress is one of the principal causes in any event, and I'm supposed to be doing the water thing anyway, I do it (most of the time) instead.

    Exercise also is supposed to help. I think a big part of it is all about lymph movement.

    Of course, both of my parents are survivors (my dad's was quad tissue, not upper body). So I could be in massive denial.

    Or not - it's easy (and perhaps necessary to defuse sanity-destroying compulsive worrying) to do all the preventative work that you can, but how much control do we really, at the end of the day, have over it, anyway?

  43. Wow, I've never given a thought to breast self exams. Probebly because of my age, but the idea has never occured to me. And I work in a medical field to!

  44. I don't bother. I either tell my gynecologist I've been doing the exams, or I'm honest and tell her I haven't been. My boyfriend, however, is always very concerned that I don't do the exams.
    I probably won't start doing them.

  45. I both a) don't do regular exams and b) lie to my doctor when she asks if I do.
    Meh. It falls so far down on my list of things to feel bad about that I'm pretty sure I'll never get to it.
    On the plus side, I do stay pretty familiar with my breasts (I LIKE them, ok? They FEEL NICE), and even if I didn't, I'm pretty sure my husband would notice something early on(he REALLY likes them).
    For the most part, I just refuse to fear breast cancer. Even if I do get it (very few risk factors), survival rates are so much better than they used to be. I'm much more threatened (statistically) by the drive to the grocery store.

  46. A few years ago I was shopping around for a new gyno, and gave a nurse practitioner a try. She asked the standard, "do you check your own breasts monthly?" and I replied, well, sometimes, when I remember, it's not that often, kind of reply. You'd have thought I'd just admitted to shooting up heroin every evening with dessert. She spent the rest of the exam doing her best to shame me--naughty, negligent girl that I was! I found another health care provider, never did get on the BSE bandwagon, and still have healthy ta-tas, thank you very much.

  47. The paradox you're talking about might have to do with the "grade" of the cancer we're talking about. Those who have more aggressive cancers have a hard time with it even if it's found early. It might make sense for me to do self-exams, though, because the two cancers I've had were graded low to a little above average-- and if we caught yet another one early, I might survive, yet again.

  48. If I remember correctly, what the most recent report said was that most (i.e. non medically trained) women did not have enough experience to recognise lumps in the very early stages when it might help and by the time they could feel them they would have found them anyway. So no benefit. And no - I don't bother either, and I have lumpy breasts.

    Even mammograms are under some doubt - it's not like a smear test for example. The very act of irradiation can cause tumours (maybe) and some health professionals claim that the benefits have been way over-stated and that decreases in morbidity have largely been the result of better treatment rather than early detection. And false positives lead to a lot of unnecessary surgery, which carries its own risk. After reading around a lot (including research papers and medical reports) I decided in the end to *opt in* for those - but then, here in the UK we have them only every 5 years anyway.

    What we need is patient centred medicine i.e. clinical intervention based on your particular risk, not on some 'average' for the population. So if you are healthy, have no family history, are not obese, don't smoke and other indicators, your doctor should recommend a different regime than if you are high risk where regular professional monitoring and even radical surgery may be recommended.

    Just discovered your website by the way - it's brilliant.


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