The need and value of breast self-examination

The incidence of breast cancer is higher for black women aged less than 40 years than for white women aged less than 40; however, both black and white women aged less than 35 years have the lowest breast cancer survival rates of all age groups. The issue of breast self-examination (BSE) efficacy has special implications for these women because the BSE and the clinical breast examination (CBE) are the only early detection techniques recommended to them. Breast self-examination is even more important for black women because CBE might not be accessible to them for economic or other reasons.Studies relating BSE practice to tumor stage were reviewed. Most of the evidence was favorable, although it was not obtained with the most scientific methodologic approach. The negative evidence, on the other hand, came from studies with additional methodologic and conceptual problems, and should have little impact when evaluating BSE efficacy.Competence of performance has been shown to affect the efficacy of the self-examination. Most studies on BSE value, however, did not assess the examiner's competence. Because data obtained elsewhere show that most women performing BSE do not perform it competently, the significance of the positive evidence on BSE value is heightened. Most breast tumors are self-discovered, and encouraging competent BSE performance will give more women better means to discover tumors earlier.