A study published in the Canadian Medical Association Journal and released yesterday has raised a storm of controversy. The report, conducted under the auspices of the Canadian Task Force on Preventive Health Care (funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada), acknowledges that breast cancer is a significant health concern for women, affecting some 20,000 Canadian women each year, 5,500 of whom will die. It is the most frequently diagnosed cancer among Canadian women.
However, the study found that several large trials did not show a benefit in performing routine breast self-examination (BSE), while "there is good evidence of harm from BSE instruction". Yesterday's newspapers featured this story prominently: "Breast self-examination of no use, doctors declare", blared the front page of the Globe and Mail; "Breast exams cause 'harm': study", trumpeted the National Post; and the Toronto Star chimed in with "Stop 'useless' self-exams on breasts, women urged".
Naturally, women in Canada were shocked and dismayed. Many had religiously performed BSE every month, and now they were being told it was useless. Worse than useless: harmful. But how could it be harmful?
I, being a confirmed skeptic, particularly where the news media is concerned, looked up the original article that fomented this frenzy. It turns out that the study's primary definition of "harm" was: "significant increases in the number of physician visits for the evaluation of benign breast lesions and significantly higher rates of benign biopsy results." The study also mentions that biopsies cause "permanent scarring and may cause significant breast deformity and emotional distress".
This definition of harm struck me as very odd indeed. First off, it's based on economics. The harm is that our health system has to respond to people's - especially women's - health concerns. The message is clear: don't "waste" the doctor's time with your worries about this major killer of women. It's a sad day for Canada when dollars are more important than health.
And another thing: isn't a benign biopsy far preferable to breast cancer and potential death? What's so harmful about a benign biopsy? I'd rather have a scarred breast than no breast at all. I'd choose deformity over death any day.
Finally, and most tellingly, the study is silent on the fact that biopsies require a doctor's intervention: it's not like women do BSE, discover a lump, and head off to the nearest hospital. Oh no! They go to their doctors, who examine the lesion and decide what to do. Seems to me it's the doctors who should be better trained to interpret the natural lumps that occur in women's breasts. Surely it's the doctors, not the women themselves, who are responsible for all the "unnecessary" biopsies. But the study doesn't mention this. I was flabbergasted at this obfuscatory logic that lay behind the report's recommendations. It's blaming - I want to say terrorizing - the victims, while leaving their accomplices unscathed.
Many women came forward to say that they believed that they were alive today because of their own early detection of cancerous tissue. My own mother's breast cancer was too far advanced, when diagnosed, for adequate treatment; she lost her breast, and then her life, to this disease, with several years of pain and anguish in between.
So what, then, should be the message here? Ignore your body, women? Trust your doctor? I think not. Be aware of your body (many lumps are found during clothing, bathing or sexual relations). If you choose to do BSE, be sure you're doing it correctly; if not, do what I do (for it's too stressful for me to manage) and go see your doctor every 6 months for a clinical exam. And, as much as you can, be sure your doctor knows what they're doing. It's your life, not theirs.
Read the CMAJ article I refer to at