Intended for healthcare professionals

Bmj Usa: Education And Debate

Commentary: Breast self examination

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E198
  1. Robert A Smith, director of cancer screening (
  1. American Cancer Society.

    Do we really know what we think we know?

    From BMJ USA 2003;Mar:168

    Austoker salutes the publication of the final results of the Shanghai Trial of Breast Self Examination (BSE),1 and she echoes the conclusion reached by Harris and Kinsinger2 that “routinely teaching and doing breast self examination is dead.” This regrettable choice of words seems to signal a sense of triumph: Now that results from a randomized trial show no benefit from BSE instruction, gold standard science has prevailed over intuition, observational data, and the “breast self examination lobby.”

    However, while celebrating the decisiveness of these findings, Austoker and others overlook the challenge of earlier detection of palpable tumors. The fundamental aim in the control of breast cancer is the application of therapy while tumors are still small.3 4 The distinction between non-palpable and palpable breast cancers is a good measure of this challenge, but it is equally true that it is preferable to treat a smaller rather than a larger palpable tumor. This is important because current imaging technologies lack perfect sensitivity, access to breast imaging is limited among …

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