Education for breast self-examination: why, who, what, and how?

Analysis of the continuing controversy about the value and effectiveness of breast self-examination is provided and suggestions are made about the kinds of data needed to establish it's effectiveness. Research data about characteristics of women who perform breast self-examination regularly and those who do not and about the usefulness of mass communication, group efforts, and individual approaches to obtain regular and correct self-examination are assessed. Research and educational efforts focusing on six activities are needed: (a) obtaining regular and correct breast self-examination practice by women, (b) reducing delay by women after suspicious findings, (c) teaching physicians to do correct breast examinations, (d) reducing delay by physicians in referring suspicious cases to surgeons, (e) reducing women's delay after referral, and (f) teaching surgeons to do breast examinations correctly and reducing their delay in beginning treatment. Most of the research reported deals with regularity of breast self-exam, while some deals with correctness. The only intraindividual variables that have differentiated consistently among regular and less-regular BSE practitioners have been knowledge and confidence of ability. Very little research has been carried out on the other five activities and is therefore sorely needed. Suggestions for desirable educational efforts in each of these six areas are made.