[Usefulness of self-examination of the breast and prevalent patterns of surgical approach]

To learn whether breast self-examination (BSE) leads to earlier diagnosis and whether this results in a larger utilization of breast-sparing procedures, we studied the effects of BSE practice and patterns of surgical care in a cohort of 1315 newly diagnosed breast cancer patients. Overall 511 (39%) reported some BSE practice, but only 109 (8%) did it regularly and in a way deemed correct by caring physicians. Patients reporting any practice of the exam had a greater chance (OR = 1.42, 95% Cl = 1.13-1.79) of being diagnosed with a primary tumour smaller than 2 cm. This effect was mostly evident in the subgroup reporting optimal BSE practice. About half the patients with a primary tumour smaller than 2 cm. still had radical surgery. Before advocating massive patient-oriented educational campaigns, priority should be given to physicians education and definition of treatment protocols aimed at assuring that best available care be delivered to most patients.