Breast self examination provides entry strategy

EDITOR—Given what is now known about the long subclinical growth phase of human breast cancers, the finding of a recent study from Shanghai, that teaching breast self examination did not detectably improve survival, is not surprising.1 None the less, Austoker's related editorial, proclaiming the death of breast self examination, should not go unchallenged.2

Many studies have reported a reduction in primary tumour size dependent on breast self examination, which may in turn enable more conservative surgery.3 The editorial's implication that all such end points are rendered illusory by the Shanghai study is overstated; as if to acknowledge this, Austoker concedes that prompt symptomatic presentation (“breast awareness”) remains important. But is the timely presentation of breast symptoms—of which palpation of …