Rethinking Breast Self-Examinations: Are We Asking the Right Questions?
نویسندگان
چکیده
The debate over the effi cacy of breast self-exams (BSE) tends to be couched in economic terms based on data aggregation. There are confl icting reports of its effectiveness as well as its overall costs to the health care system. Researchers and most funding agencies suggest it is not a useful tool in cancer prevention and often drives up health care costs because of the number of false positives. On the other hand, many physicians still recommend it because their patients have detected lumps through selfexams. A case–control study within the Canadian National Breast Screening suggested that the use of certain BSE techniques may lead to fewer breast cancer deaths (Harvey, Miller, Baines, and Corey, 1997). A later meta-analysis by Canadian researchers found no benefi t for BSEs in any age group and resulted in the Canadian Task Force on Preventive Health Care recommending against teaching BSE. (Baxter et al). The authors did recommend further research be conducted on BSEs and, in an interview in the Lancet, the lead author expressed concern that “we don’t seem to be able to teach them [women] to do breast self examination better. We’re concerned that women will stop being aware of their breasts, and that’s not the message we want to come out of this.” (Larkin, 2001, p. 2109). Thus she suggests that perhaps technique—not procedure—is partly at fault. However, the “gold standard” study of over 260,000 women by Thomas et al. (2002) reported that the effi cacy of conducting BSE for decreasing breast cancer mortality was unproven. One important caveat, as noted by the authors, was that this study was a trial of the teaching of BSE, not of the practice of BSE:
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