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Epidemiology
The Agency for Healthcare Research and Quality has issued its recommendations for breast cancer screening. In this article, they make a few different recommendations. First, they recommend screening for women 50-74 years. They note that women under 50 should make the choice for themselves as to whether or not they wish to begin screening. They note that there is little evidence to support screening age 75 onward. This body, however, recommends against teaching breast self-examination.
Also noted is that "the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond mammography. They also find that there is insufficient evidence of incremental benefits for the use of digital mammography or MRI. The lack of evidence does not mean that these things are ineffective or do not provide value, just that there is no evidence that they do, which is different.
The most controversial aspect of this recommendation is the recommendation against teaching self-examination. They italicize "teaching" as if to back away from saying that they are arguing against self-examination itself, which is a wishy-washy position. They should either be for or against breast self-examination. This is not a body...
Everybody else is left to wonder what they think of self-examination. This is a very odd way to address this issue.
There are a couple of other interesting elements to this. First, other studies have indicated that breast self-examination confers no benefit (Rosotowich, 2006). It is worth, however, considering the context. The agency does not outline their reasons for their stance on the issue, but another paper outlines one of the arguments against BSE, namely that it increases physician visits for benign lesions and also increases benign biopsy results (Baxter, 2001). The first point is logical fallacy -- physician visits will increase without BSE, because the patients will need to be screened professionally. The second point has no merit either -- a physician has to order the biopsy so clearly physicians are screening the patient subsequent to the BSE. Given how terrifying cancer is for most people, they are going to want to see a physician about anything suspicious, regardless of BSE training or not. Physicians not wanting to see patients is hardly a cause to say that BSE is harmful -- false positives are okay, it is false…
References
Agency for Healthcare Research and Quality. (2009). U.S. Preventive Services Task Force: Screening for breast cancer. Retrieved from http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
Dundar, P., Ozmen, D., Ozturk, B., Haspolat, G., Akydiz, F., Coban, S. & Cakiroglu, G. (2006). The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in Western Turkey. BioMedCentral. Retrieved April 19, 2016 from http://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-6-43
Gwarzo, U., Sabitu, K, & Idris, S. (2009). Knowledge and practice of breast self-examination among female undergraduate students of Ahmadu Bello University, Zaria, Northwestern Nigeia. Annals of African Medicine. Vol. 8 (1) 55-58.
Rosotowich, V. (2006). Breast self-examination. SOGC Committee Opinion. Retrieved April 19, 2016 from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.174.6517&rep=rep1&type=pdf
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