Breast Self Exam

Breast Self Exam (BSE): an inspection of your breasts that you do on your own, typically on the same day every month. Breast Self Awareness (BSA) is a euphemism for BSE, loosely defined as “knowing what is normal for you.” Neither of these practices have been found to detect breast cancer early or reduce breast cancer mortality.

See also: Misinformation

Checking one’s breasts every month in the shower, in front of a mirror, and lying down used to be the cornerstone of education for many breast cancer groups and public health organizations. The standard advice for women over age 20 was to do monthly breast self-exams (BSEs) and get clinical breast exams from trained health practitioners every one to three years. Some groups still recommend BSE even though it has been discredited as a screening tool for many, many years.

breast cancer self-exam regularly

The National Breast Cancer Foundation says: “Adult women of all ages are encouraged to perform breast self-exams at least once a month.”

No Good Evidence That BSE Saves Lives

The World Health Organization defines screening as the systematic application of a screening test in a presumably asymptomatic population. The screening tool aims to identify individuals with an abnormality suggestive of cancer. Evidence of benefit is a significant reduction in mortality as a result of the screen.

Numerous studies have evaluated BSE as a way to screen for breast cancer and reduce mortality. The body of evidence finds no benefit for BSE in terms of early detection or mortality reduction. To the contrary, there is evidence of harm through excessive biopsies.

The National Cancer Institute reported in 2002 that there is no good evidence to conclude that breast self exam reduces one’s chances of developing an invasive breast cancer or reduces breast cancer mortality. A large randomized, controlled study of 266,064 women reported 135 breast cancer deaths in the group of women instructed to do BSE compared to 131 in the control group that was not. After 10 to 11 years of follow-up, the number of invasive breast cancers diagnosed in the two groups was about the same. Yet the women in the instruction group had more breast biopsies and more benign lesions. The researchers concluded that,

“Programs to encourage BSE in the absence of mammography would be unlikely to reduce mortality from breast cancer. Women who choose to practice BSE should be informed that its efficacy is unproven and that it may increase their chances of having a benign breast biopsy.”

The U.S. Preventive Services Task Force found, too, that clinical trials of BSE showed increases in benign biopsies, but no reductions in mortality. In 2009, the group gave BSE a D rating, meaning that it,

“discourages the use of the service because there is moderate or high certainty that it has no net benefit or that the harms outweigh the benefits.”

The World Health Organization finds “no evidence on the effect of screening through breast self-examination” and advises that national cancer control programs should not recommend screening by BSE.

The American Cancer Society changed its recommendations too, making BSE optional as a screening method. In 2003, The Journal for Cancer Clinicians published an update on the ACS Guidelines stating:

“Recent evidence reviews have focused on the absence of direct evidence of benefit…and data indicating that the rate of benign biopsy is higher in women who regularly perform BSE compared with women who do not regularly perform BSE.”

For this reason the American Cancer Society states today that,

“It is acceptable for women to choose not to do BSE or to do BSE occasionally. Women who choose not to do BSE should still know how their breasts normally look and feel and report any changes to their doctor right away.”

BSE is considered to be optional for good reasons. It is useful to have a healthy awareness of one’s body. But awareness is not a sufficient way to find cancers early enough to reduce mortality.

Breast Self Awareness

When the data came in that BSE was not a viable screening modality for breast cancer, some groups repackaged their advice into the euphemistic phrase breast self-awareness (BSA). Loosely defined as “knowing what is normal for you,” BSA is usually bundled with advice about knowing your breast cancer risk, getting screened at a particular age, and making healthy lifestyle choices. Not bad directives in general (though mammography screening is also a controversial population screening tool).

But the message to “do boob checks regularly” because  they “may save your life” is scientifically unsubstantiated. Using the word “may” as a nod to this contrary evidence does not lessen the harmful impact of a campaign aimed at persuading women to “just do it.” BSE/BSA may result in a diagnosis, just as the accidental observation of a lump or new feeling in the breast might. But it does not result in longer survival.


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