Aug 11, 2015


Dr. Miller: Should we still be performing breast examinations to discover cancer? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi I'm here with Dr. Hanadi Farrukh because she's an internist in the department of medicine and an associate professor at the University of Utah. Hanadi welcome to the program.

Dr. Farrukh: Thank you Tom, pleasure to be here.

Dr. Miller: So should women still be seeking or performing breast examinations as a manner of screening for cancer? I've heard some controversy about that. I heard ten years ago that we were advising women to perform self breast examinations, but since to date has been a little conflicted about that, I've even heard that we've told women maybe to stop doing self examinations.

Dr. Farrukh: That's true Tom, the topic is quite controversial and at this point the evidence is difficult to interpret. We do not have enough evidence to recommend for or against breast self exam at this point. The initial studies done in the 1990s also showed conflicting data. There was a large Chinese study that did not show any benefit, but there was a Swedish trial that showed women who do more breast self exam discovered their tumors earlier and reduced risk of death. But those studies did not take into account the benefit of chemotherapy. So at this point if a woman does breast self exam there's more likelihood of finding benign tumors and there's always a risk of more procedures, more imaging, and more discomfort and anxiety.

Dr. Miller: And that's maybe the thing that they don't understand automatically. It just would seem that the self exams are a simple and easy thing to do when you're in the shower and if you tell a woman, "Well don't bother with that," I think their initial reaction might be well, "Why? If I find something, if I have a problem shouldn't I find it myself?"

Dr. Farrukh: True, every woman has to decide what she's comfortable with. Certainly we know there is a percentage of women who benefit from breast self exam. Those are the women who are high risk such as those who have a family history or women who carry the BRCA1 or BRCA2 gene, we do recommend that they have breast self exam.

Dr. Miller: So high risk women should do self exams?

Dr. Farrukh: Most probably they would benefit from that.

Dr. Miller: And how often do you recommend that women in the high risk category do those examinations?

Dr. Farrukh: Once a month usually, if the breast is not swollen or tender, we usually recommend that a week after the period is done. A clinical exam by a physician is recommended a minimum of every three years right now.

Dr. Miller: And what do you tell your patients, the new patients that come in to see you regarding breast cancer screening, are you telling your average risk patients that it's up to them to do a self examination on a regular basis or do you just not mention it? How do you approach that?

Dr. Farrukh: Well I assess the risk, the overall risk. If they are lower risk then it's up to them. But the technique of breast self exam is also important to detect early tumors. So there was a new update for the recommendation of how to do a breast self examination that came out last year and that includes doing the exam in a vertical way rather than around the nipple and going in circles around the breast.

Dr. Miller: That's really interesting. So with all of the multimedia sources out there, are there videos or Google applications that you could point your patients to where they could learn this new examination?

Dr. Farrukh: Yes, the American Cancer Society on their website have instructions on how to do adequate breast exams and we recommend two positions. First laying down and going in a vertical motion starting from the collarbone going parallel to the breastbone in a vertical position. Starting with a very light touch initially to detect the tumors close to the skin and then going in a deeper pressure to detect the deeper tumors.

Also the second position is standing up and putting hands on the hips, and this way you can see any skin dimpling, the woman also has to inspect their nipples, make sure there's no cresting or any discharge that is abnormal, especially bloody discharge.

Dr. Miller: And how often do you recommend that they perform a self examination if they're high risk?

Dr. Farrukh: Once a month.

Dr. Miller: So if a woman does find by checking every once in a while that she has an abnormality, she shouldn't ignore that just because we might say that there's not value to doing as self examination if you're in a low risk category for breast cancer.

Dr. Farrukh: True. So most tumors turn out to be benign but that has to be determined by the physician, so it's best for the woman to go seek care and get a good exam by her physician and then the physician will determine if she needs imaging, that includes a diagnostic mammogram and an ultrasound.

Dr. Miller: And the breast examination is not in lieu of a regular mammogram for screening, is that correct?

Dr. Farrukh: Correct, in the United States and in advanced countries where mammography is available and advanced treatment with chemotherapy is available, mammograms and adequate treatment saves lives. But in third world countries where medical imaging is not available and advanced treatment is not available, breast self exam saves lives.

Dr. Miller: So in summary it sounds like a woman should have a breast examination once every three years at least if they're at an average risk, and that self examination if you're at average risk isn't necessary. But if you find something that's concerning, bring that to the attention of your physician. And if you're in a high risk group, the monthly self examination according to the new guidelines on the American Cancer Society website would be the thing to do.

Dr. Farrukh: Correct, high risk women should seek care and do their own exam as well.

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