New NIH Director

In a previously reported investigation of 616 women with breast cancer included in a case-control study, we found an association between tumour stage at presentation and breast self examination (BSE) (Mant et al., 1987). Women who had both practised and been taught BSE had more favourably staged tumours than other women. A number of other studies, summarised in the meta-analysis by Hill et al. (1988) support this observation and it now seems reasonable to conclude that, after adequate teaching and if carried out at reasonably frequent intervals, BSE does lead to earlier diagnosis. It is still unclear, however, whether this earlier diagnosis leads to a clinically important benefit in terms of reduced breast cancer mortality. Overall breast cancer mortality in the UK Trial of the Early detection of Breast Cancer (UKTEDBC, 1988) was not reduced by mass education in BSE. However attendance at the BSE education session was limited and Locker et al. (1989) reported a marked difference in survival between attenders and non-attenders. This difference could be due to selection bias but Foster and Costanza (1984) have also reported from Vermont, USA that 5 year survival in women who perform BSE is 75% compared with 57% in nonperformers, and that this difference could not be accounted for by the recorded characteristics of the women (other than