Breast self-exams were once touted as an essential screening tool for early detection of breast cancer. However, over the past couple of decades, major health organizations have moved away from recommending regular self-exams. This shift in guidelines has left many women wondering why self-exams are no longer encouraged as a screening practice.
What are breast self-exams?
A breast self-exam involves a woman looking at and feeling her breasts for any changes or abnormalities. It can be done while standing in front of a mirror, lying down, or during a shower. The main things to look for are:
- Lumps, hard knots, or thickening in the breast or underarm area
- Changes in breast size or shape
- Nipple discharge, tenderness, scaling, or retraction
- Redness, scaliness, swelling, or skin changes
Typically, it was recommended that women start performing monthly self-exams in their early 20s. The rationale was that women who thoroughly and regularly examined their breasts would be more likely to detect cancers at earlier stages when they are most treatable.
When did breast self-exams stop being recommended?
In the 1970s through the late 1990s, breast self-exams were heavily promoted by cancer organizations as an essential part of preventive healthcare for women. However, in the early 2000s, several major health groups began backing away from routine self-exams:
- In 2003, the U.S. Preventive Services Task Force (USPSTF) concluded there was insufficient evidence to recommend for or against breast self-exams for women 40 and older. They found the harms outweighed the benefits.
- The Canadian Task Force on Preventive Health Care reached a similar conclusion in 2004, recommending against teaching or promoting monthly self-exams.
- The American Cancer Society moved away from recommending monthly self-exams in 2015. Now they simply recommend women be familiar with how their breasts normally look and feel and report any changes to a doctor right away.
Other major medical associations followed suit by either not endorsing self-exams or stating that the current evidence does not support their routine practice.
Why did recommendations change?
There were two primary reasons these groups started advising against regular self-exams for breast cancer screening:
1. Lack of evidence for mortality benefit
Research increasingly showed that teaching women to perform structured, technique-oriented self-exams monthly did not actually lower breast cancer deaths compared to women who did not do exams:
- A large clinical trial in Russia found no significant difference in breast cancer mortality between a group of women who were rigorously taught self-exam techniques and a group who received only standard care.
- A systematic review of 8 studies found no evidence that adding breast self-exams to routine care reduced breast cancer mortality rates.
Without clear evidence that structured monthly self-exams led to saved lives, it was hard to justify recommending them as a screening tool.
2. Potential harms
In addition to a lack of proven benefits, some potential downsides of self-exams emerged in studies:
- False positives: Self-exams can lead to unnecessary testing, biopsies, and treatment for benign lumps or other non-cancer abnormalities.
- False reassurance: Negative self-exam findings may create a false sense of security in some women.
- Over-diagnosis: Increased early breast cancer detection may lead to overdiagnosis and overtreatment of slow-growing tumors that would not have caused harm.
- Increased anxiety: Doing frequent self-exams may make some women more anxious about developing breast cancer.
In light of the lack of mortality benefit and these potential harms, major health groups determined that a blanket recommendation for monthly self-exams could not be justified.
What do experts recommend now?
The move away from routine self-exams does not mean experts want women to ignore their breasts altogether. Instead, they recommend:
- Know your breasts: Women should make an effort to be familiar with the look and feel of their breasts normally so they are more likely to notice any changes.
- See your doctor with any concerns: If women notice any breast changes or abnormalities, they should bring them to their doctor’s attention promptly.
- Get routine mammograms: Women ages 40-44 should have the option to start annual mammograms. Routine mammography is recommended for women ages 45-54 every year and for women 55+ every other year.
The hope is that de-emphasizing the need for scheduled self-exams will reduce some of the previously mentioned harms, while still encouraging women to be breast aware.
What are the benefits of mammograms over self-exams?
There are several reasons mammography is now preferred over self-exams for breast cancer screening among average-risk women:
- Earlier detection: On average, mammograms detect breast cancers 1-3 years before a woman can feel a mass. Finding cancers when they are small and localized improves treatment outcomes.
- Specialized skill: Radiologists receive extensive training to analyze mammograms. Studies show that interpretation by multiple experts increases cancer detection.
- Conclusive testing: Suspicious findings on a mammogram lead to targeted diagnostic imaging and biopsy to confirm or rule out cancer.
- Improved mortality: Multiple large trials and population studies show routine screening mammography reduces breast cancer mortality in women 40 and over.
In other words, mammograms outperform self-exams in finding early-stage cancers and lowering death rates.
Does this apply to women at high risk?
The advice against routine self-exams generally applies to women at average risk of breast cancer. Recommendations may differ for the small percentage of women at very high risk due to inherited genetic mutations or strong family history:
- Women with BRCA1/2 mutations may be advised to start monthly self-exams at an earlier age along with other screening.
- Some doctors may teach self-exam techniques to women with extremely high risk to aid early detection.
However, there are varied opinions on whether intensive self-exams should be performed even in these highest-risk groups. The latest guidelines emphasize that high-risk women should have access to regular MRI scans, mammograms, and clinical exams—not just self-exams.
Does this advice apply to all age groups?
Here are the current recommendations on self-exams for different age brackets:
Ages 20-39
Major health organizations do not recommend monthly self-exams for women in their 20s and 30s. Instead, women in this group should make an effort to be aware of how their breasts normally look and feel and report any changes promptly. Clinical exams should be done every 1-3 years.
Ages 40-54
Most experts advise against routine structured self-exams for women once they reach their 40s. Rather than self-exams, annual screening mammograms become the recommended mainstay of early detection starting at age 40 or 45. Women should continue seeing their doctor for clinical breast exams every 1-3 years.
Age 55+
There is universal agreement that women 55 and over should stop routine self-exams. Regular mammograms every 1-2 years along with clinical breast exams every 1-3 years are recommended for breast cancer screening in this age group.
Across all age groups, women should make prompt medical appointments to investigate any new or unusual breast changes instead of waiting for their next screening test.
Are self-exams still worthwhile for some women?
While not recommended on a population level, some healthcare providers still believe self-exams can offer benefits for certain individuals. Potential advantages for some women include:
- Finding interval cancers not picked up on mammograms.
- Detecting changes sooner for women unable to get mammograms regularly.
- Increased body awareness and peace of mind for anxious women.
- Opportunity to discuss breast health with daughters.
Ultimately, decisions about self-exams should be made on an individual basis after weighing the pros and cons with a medical provider. Some doctors and organizations take the approach that they will teach self-exam techniques to women who request the information.
Are breast self-exams being discouraged entirely?
It’s important to note that health professionals are not discouraging women from looking at or being familiar with their breasts altogether—they are moving away from formally recommending thorough deliberate self-exams on a defined schedule for the general population.
Many in the medical community emphasize there is value in women being aware of how their breasts look and feel normally, with the goal of noticing any changes or irregularities. They simply no longer endorse rigorous routine self-exams as a helpful screening practice.
Conclusion
In summary, breast self-exams were once widely touted for early cancer detection but are no longer routinely recommended due to lack of evidence that they substantially lower mortality. Mammography and clinical breast exams are now the preferred methods for breast cancer screening in average-risk women. However, women should remain breast aware and discuss the potential benefits and limitations of self-exams with their healthcare providers to determine what is right for them as individuals.