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Breast Exams Are Just as Effective as Screening Mammography Says Cancer Prevention Coalition Chairman Samuel S. Epstein M.D.

CHICAGO, Oct. 9 /U.S. Newswire/ — Following is a statement by Samuel S. Epstein, M.D., chairman, Cancer Prevention Coalition, professor emeritus, University of Illinois School of Public Health, Chicago:

Contrary to extensive recent media coverage, the Chinese trial on monthly breast self-examination (BSE), published in the October 2 issue of the Journal of the National Cancer Institute, does not disprove its effectiveness in preventing breast cancer deaths. Furthermore, the study is irrelevant to the well-documented effectiveness of BSE, especially when combined with annual clinical breast examination (CBE) by a trained professional.

Contrary to media reports that the Chinese self-exams were done regularly, the researchers admit that BSE was practiced "roughly every 4-5 months" during the first 4-5 years of the 10-year trial, and with unknown frequency subsequently. The researchers also admit evidence, from numerous studies over the last two decades, that: breast cancers detected by BSE "tend to be diagnosed at an earlier stage and to be smaller than cancers diagnosed in the absence of any screening;" that women "practicing BSE tend to have their tumors diagnosed at an earlier stage than women who do not report practicing BSE;" that "women who regularly and competently practice BSE are more likely to find their tumors themselves than women who practice BSE less diligently;" and that tumor size is "inversely associated with the frequency of practicing BSE."

Surprisingly, in their listing of 44 references, the researchers omit reference to the landmark 2000 Canadian National Breast Cancer Screening Study which demonstrates the effectiveness of breast exams in reducing breast cancer mortality. This evidence is confirmed in an editorial commenting on the Chinese study publication: "There is evidence that excellent physical examination practice, whether CBE or BSE, may indeed be effective. Not only is there case-control evidence that excellent BSE may reduce mortality, there is also randomized, controlled trial evidence that excellent CBE done by trained nurse-examiners may be as effective as mammography in reducing breast cancer mortality. The addition of annual mammography screening to physical examination has no impact on breast cancer mortality."

Over the 10-year period of the Chinese trial, the incidence of benign tumors, or false positives, was approximately twice as high in the BSE group as in the controls. This contrasts with a three-fold higher incidence noted in the Canadian mammography group. Such false positives, or overdiagnosis, usually lead to unnecessary biopsies and even surgery.

It should be further stressed that, apart from the importance of self-empowering women, the costs of BSE and CBE are trivial compared to the inflationary impact of film mammography. The estimated annual costs for screening pre- and post-menopausal women is about $10 billion, about 5 percent of the $200 billion Medicare budget or about 14 percent of Medicare spending on prescription drugs. Costs for digital mammography, enthusiastically supported by radiologists in the absence for evidence in improved effectiveness, would be approximately four-fold greater.

Media Contact: Samuel S. Epstein, M.D., chairman, Cancer Prevention Coalition, professor emeritus, University of Illinois School of Public Health, Chicago, 312-996-2297, epstein@uic.edu


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