In October of my freshman year of college, a women’s group on campus made pink shirts that had two painted handprints on the chest, along with the slogan, “Feel Your Breasts.” They were cute. They were cheeky. They were provocative, in a body-positive way. They were also, sadly, unnecessary.
Regular breast self-exams feel, for many women, like one of those things we should be doing but always seem to forget, like signing up for Mint or finally sending those thank-you notes. Since the 1970s, the message from the medical establishment had been clear: Every month, women should thoroughly palpate their breasts to check for tumors. There was a part of the exam you were supposed to do in the shower, and another that you had to do lying down. You were not supposed to giggle; it was for your health.
But actually, everyone from cancer specialists to gynecologists to the advocacy group Susan G. Komen no longer recommends breast self-exams. They haven’t since the early 2000s.
Breast cancer is the most common cause of cancer among American women, and early detection is still a key way to reduce the risk of death. But in 1997, a big, randomized trial of Chinese women found that those who performed regular breast self-exams had the same chance of getting and dying from breast cancer as those who didn’t. Instead, the self-examining women found more benign growths, the removal of which carries its own risks. A Russian study from the late 1980s had yielded similar mortality results.
Breast cancer turned out to be more complex than researchers originally thought.
“We used to think that all cancers were the same—that they all grew at a certain rate,” said Susan Love, a Los Angeles breast surgeon.
“But what kills people isn’t what’s in the breast—it’s breast cancer cells in other, more important organs, like the lung, brain, blood stream, and lymphatic system.”
Some cancers are so fast-growing that by the time you find them, they’ve already spread. Others grow so slowly that they barely pose any danger at all.
Practitioners in the real world also realized the “self-exam” message wasn’t working, from a practical perspective. “Women felt guilty because they thought they should do it, but they hadn't,” said Susan Brown, a nurse and managing director of health education with Komen. They would forget, or feel embarrassed, or they “were so focused on how to hold their hands, they didn't focus on what was really important—the warning signs.”
Most women who found their own breast tumors, she said, found them in the course of everyday life—while they were dressing or sleeping or during sex. They weren’t setting aside special breast-squeeze shower time.
“Finding cancers through religious self-exam is not any better than noticing or rolling over in bed or having your lover find the lump,” Love said.
These days, breast-cancer advocates and doctors simply push “breast-cancer awareness,” a purposefully vague term that mostly entails being aware of the general look and feel of one’s own breasts.
“One of the messages is ‘know what is normal for you,'” Brown said. Komen also recommends prevention through healthy lifestyle choices and regular screenings. Mammogram screenings were found in one study to reduce breast cancer mortality by 15 percent for women between 39 and 49, and Komen recommends women get one every year once they turn 40. (However, a big study from earlier this year contradicted earlier findings and found that not even mammography reduces breast-cancer mortality.)
Komen and other breast-cancer groups recommend that all women be on the lookout for seven breast-cancer “warning signs” and report them to your doctor:
- A lump, hard knot or thickening inside the breast or underarm area
- Swelling, warmth, redness or darkening of the breast
- Change in the size or shape of the breast
- Dimpling or puckering of the skin
- Itchy, scaly sore or rash on the nipple
- Pulling in of your nipple or other parts of the breast
- Nipple discharge that starts suddenly
- New pain in one spot that does not go away
It's a good idea to head to the doctor if any of those things are going on just a few inches south of your face. But you don't have to feel guilty if you didn't catch it by following an instruction card in the shower.