Top cancer doctor says self-examination and screening can be bad for your health

Every year, 40,000 women in the UK discover they have breast cancer. And until now, the medical advice has been to self-examine to try to catch the disease early. So why is a top specialist warning women against this simple procedure?
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Women who regularly examine their breasts in a bid to beat cancer risk damaging their health, according to a leading medical expert.

Women who regularly examine their breasts in a bid to beat cancer risk damaging their health, according to a leading medical expert.

Professor Michael Baum, who set up one of the UK's first cancer screening centres, warned yesterday that breast self-examination (BSE) can lead to unnecessary surgery and false diagnoses and does not give women a better chance of surviving the disease.

His views contradict the advice of doctors who have encouraged women to catch cancer early by checking their own breasts for abnormal lumps. Their advice is based on the belief that it is better to remove a tumour early when it is small.

However, Professor Baum, who is emeritus professor of surgery at University College London, argues in a new guide published this month that this approach is too simplistic because not all breast cancers are the same. He believes it can lead to futile biopsies.

Professor Baum is also critical of the amount of money spent on screening women for breast cancer, arguing that overuse of the service can result in unnecessary invasive treatment and over-diagnosis of cancers which are not life-threatening.

He told The Independent on Sunday yesterday: "There is an intuitive belief that regular breast self-examination will prevent women dying of cancer. [But] BSE is bad for you. It is a futile exercise. The answer is to concentrate on more research and better treatment."

Breast cancer is now the most common cancer affecting women from all backgrounds. Doctors diagnose more than 40,000 new cases every year, a figure which has risen partly as a result of changes in lifestyle such as excessive drinking, a rise in obesity and the trend for women to have children later in life.

Last week, it was revealed that Kylie Minogue, the chart-topping singer, has breast cancer and is now receiving treatment at an Australian clinic. The artist Sam Taylor-Wood has also spoken openly about her battle with the disease. The majority of patients are aged 50 and over, although younger women may also be affected.

For many women, it has now become a ritual to check their breasts regularly. This has also been the message from doctors, national awareness campaigns and specific teaching programmes on self-examination techniques.

However, recent clinical trials have suggested that there is no difference in breast cancer mortality rates between women who do and those who do not examine their breasts. Instead, these research studies have shown that women who practise BSE have twice as many false alarms and unnecessary surgery as those who do not self-examine.

In his new guide, which is intended for junior doctors and nursing specialists, Professor Baum says that women should become more "breast aware" instead of obsessively checking for lumps. His advice is that they should learn to distinguish between normal and abnormal changes in their breasts. This includes looking out for any unusual pain, nipple discharge and dimpling of the skin, as well as lumps if they are new and not related to their menstrual cycle.

Breast cancer charities say they have also been trying to get a new message across to women. For example, Breakthrough Breast Cancer will make breast awareness the focus of a new campaign to be launched this October.

The fight against breast cancer has received huge support from celebrities. But Liz Carroll, from Breast Cancer Care, said that sometimes using celebrities instead of trained experts to back campaigns has led to women receiving confused messages.

"Celebrities often give the wrong information to the media," said Ms Carroll, the head of clinical services at the charity. "They are not medical professionals. Women hear one thing and then another. It's not about doing a ritual breast examination once a month but knowing their own breasts when they are showering or putting on cream, getting to know what is normal for them."

However, she said that checking for lumps may reduce the amount of treatment that a woman will need.

"If you find something early it may mean less surgery or no intensive chemotherapy," Ms Carroll added.

"So it does make a difference to quality of life. Every woman would probably have a biopsy if they found something suspicious, or that they thought to be suspicious."

Although increasing numbers of women are getting breast cancer, the death rates have fallen by a fifth in the past 10 years, a drop which has been attributed to improvements in treatment, especially new drugs.

These include tamoxifen, which is taken in pill form by post-menopausal women to help prevent the cancer coming back after initial surgery to remove a tumour. A new generation of drugs, called aromatase inhibitors, are also cutting the death rate even further and are used in cases where the cancer has stopped responding to tamoxifen.

'I was told it was probably benign'

Helen Danzey, 28, from Buckhurst Hill, Essex, has already had two operations to remove tissue from her breast. On both occasions, the lumps proved harmless.

"I definitely don't think self-examination is effective because women lack the education to do it properly. I first noticed I had a lump when I was 24, but because I was so young, I just left it. Your breasts change from month to month, anyway.

"When I went to see the doctor, I was told I was too young for it to be anything serious - they made me feel like an idiot. I had to fight to get seen - they told me they didn't normally examine anyone who was younger than 50.

"When I did finally get an ultrasound scan and the results of a biopsy on the breast tissue, I was told it was probably benign. But I was given the option of having it taken out and I had the operation within a month."

Interview by Karen Hall

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