Dear Sexpert,

Growing up, I learned that each month I should do a breast self-exam to check for lumps or signs of breast cancer. I wasrecently talking to a friend who said self-exams are controversial, but they didn’t remember why. Can you help me out? If I don’t do self-exams, how else can I protect myself from breast cancer?

— Feelin’ Myself

Dear Feelin’ Myself,

It’s great to hear that you’re proactive and open to talking about your preventative healthcare. Preventative care is important both for reducing risk as well as facilitating early detection. With respect to breast self-examination (BSE), your friend does have a point. BSEs have been the rising subject of debate since the 1990’s when studies began to showing conflicting data.

To start, a BSE is a physical exam, performed on oneself, that looks for changes or abnormalities in the breast tissue. BSEs are favorable because they are simple, noninvasive procedures that can be performed by non-medically trained individuals, and they can help improve sense of control of one’s health and increased comfort with their body. The recommended time to do a BSE is monthly about three to five days after menstruation begins. Also, it is best if done at the same time every month.

While medical training is not required, knowledge about how to accurately and effectively perform a BSE is necessary. Since breast tissue is naturally lumpy and bumpy, and gets less dense with age, and natural hormonal changes or changes related to a menstrual cycle may cause swollen breasts or tenderness, BSEs can incite unnecessary fear and anxiety. In fact, BSEs are known to result in increased number of healthcare visits, unnecessary biopsies, and false-positive test results. BSEs and related false positives often lead to needless and sometimes invasive follow-up testing with potential for increased anxiety and emotional distress. As of 2009, United States Preventative Services Task Force (USPSTF) recommends against teaching breast self-examination as there is moderate to high certainty that they have no net benefit.

Beyond breast self-examination, the USPSTF recommends other preventative behaviors to detect breast abnormalities, including biennial mammography for individuals aged 50 to 74 with the decision to start screening mammography in women prior to age 50 determined based on an individual’s benefits and risk factors. Other screening methods include clinical breast examination (CBE), ultrasonography, and magnetic resonance imaging (MRI). CBE for screening is not recommended by USPSTF. Meanwhile, the American Cancer Society and Susan G. Komen for the Cure Foundation have the most intensive recommendations, encouraging CBE every three years starting between ages 20 and 40, and annually thereafter. Additionally, ultrasonography and MRI are both not first-line screening techniques and are often used in conjunction with others when they can add useful information.

In summary, the medical community is not in agreement about the benefits compared to the costs of breast self-exams, because good clinical decision-making involves consideration of clinical evidence, patients’ medical history and other circumstance-specific conditions. To discuss risks and benefits of BSEs, learn how to perform a BSE accurately, and empower yourself to make educated decisions, talk with your primary healthcare provider or make an appointment with Sexual Health and Wellness (SHAW) at McCosh Health Center.

— The Sexpert