Breast self-examination: be alert but not alarmed?

To the Editor: I read with interest the position paper on breast self-examination by Crossing and Manaszewicz.1

I would like to point out an error of fact. The New South Wales Breast Cancer Institute (NSW BCI) has been promoting breast self-examination for many years.

As a practising clinician, every month I see several women who have found small breast cancers using instructions from an old New Idea shower card or similar information.

The position of the NSW BCI, which is stated clearly on our website, is as follows:

• Women should consider an annual breast examination by their general practitioner, particularly when they attend for a Pap test or a blood pressure check.

• Mammography should be performed at least every 2 years, particularly for women over 50 years, and earlier for women with a family history of breast cancer.

• Women should practise regular breast self-examination (BSE). Information about BSE can be obtained from GPs and the BCI has produced a fact sheet (www.bci.org.au/public/guides/g8bse.htm).

• BSE costs nothing and, in our opinion, does more good than harm. However, BSE should be combined with regular mammography and an examination by a GP.

• For a woman with a family history of breast cancer, or who has been diagnosed with breast cancer, BSE can be helpful in finding disease.

• Mammography is only about 95% reliable. BSE complements mammography.

Certain types of breast cancer are often difficult to diagnose with mammography, for example “lobular” cancer, and BSE may help in finding such cancers.

No evidence has been published that would justify a change in this position.