Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer?
Prepared by N. Baxter, MD, PhD, FRCS (C), with the Canadian Task Force on Preventive Health Care
These recommendations were finalized by the Task Force in October 2000.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Routine teaching of BSE to women aged 40–49 yr |
Evidence of no benefit in terms of survival from breast cancer |
RCTs (I) <27,31,32>, nonrandomized trial (II-1) <34>, cohort study (II-3) <35>, case–control studies (II-3) >36-38> |
Because there is fair evidence of no benefit, and good evidence of harm, there is fair evidence to recommend that routine teaching of BSE be excluded from the periodic health examination of women aged 40–49 (grade D†) |
| Evidence of increased no. of physician visits for breast problems and increased rate of benign biopsy results | RCTs (I) <27,31,32>, nonrandomized trial (II-1) <34> | ||
| Routine teaching of BSE to women aged 50–69 yr | Evidence of no benefit in terms of survival from breast cancer | RCTs (I) <27,31,32> nonrandomized trial (II-1) <34>, cohort study (II-3) <35>, case–control studies (II-3) <36-38> | Because there is fair evidence of no benefit, and good evidence of harm, there is fair evidence to recommend that routine teaching of BSE be excluded from the periodic health examination of women aged 50–69 (grade D†) |
| Evidence of increased no. of physician visits for breast problems and increased rate of benign biopsy results | RCTs (I) <27,31,32>, nonrandomized trial (II-1) <34> |
*See Appendix 1 for definitions of the levels of evidence and grades of recommendations.
†Although
the evidence indicates no benefit from routine instruction, some women will ask
to be taught BSE. The potential benefits and harms should be discussed with the
woman, and if BSE is taught, care must be taken to ensure that she performs BSE
in a proficient manner.
Note: The lack of sufficient evidence to evaluate the effectiveness of the manoeuvre in women younger than 40 years and those 70 years and older precludes making recommendations for teaching BSE to women in these age groups. The following issues may be important to consider: Women younger than 40 years: There is little evidence for effectiveness specific to this group. Because the incidence of breast cancer is low in this age group, the risk of net harm from BSE and BSE instruction is even more likely. Women 70 years and older: Although the incidence of breast cancer is high in this group, there is insufficient evidence to make a recommendation concerning BSE for women 70 years and older.