Report Says Breast Self-Exam Shows No Benefit.

Doctors should stop advising women between the ages of 40 and 69 to perform breast self-examination, and education about breast self-examination should be limited to women who specifically ask for it, according to a controversial Canadian report.

That recommendation, issued by the Canadian Task Force on Preventive Health Care, contradicts what physicians and women have been taught for 30 years and flies in the face of guidelines from the American College of Obstetricians and Gynecologists, the National Cancer Institute, and the American Cancer Society which either encourage or recommend breast self-examination (BSE) as a means for early detection of breast cancer.

In 1998 the National Comprehensive Cancer Network, a consortium of 16 academic oncology centers, issued preliminary guidelines stating that BSE is an option rather than a standard of care for women who undergo annual mammography and clinical breast exams. The network cited a lack of evidence that self-exams result in better survival.

The U.S. Preventive Services Task Force, which concluded in 1996 that there was insufficient evidence either for or against BSE, is currently reviewing the evidence. The U.S. task force expects to publish an updated recommendation early next year, said Dr. David Atkins, USPSTF coordinator at the Agency for Healthcare Research and Quality.

The U.S. task force agrees that the data reviewed by the Canadian panel fail to show any benefit from BSE in terms of mortality but available studies lack the power to rule out a benefit, Dr. Atkins said.

The Canadian report was based on a review of available data published between 1966 and 2000 and focused on seven studies, including two randomized controlled trials, that evaluated the effectiveness of BSE in preventing death from ...