Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2003;2003(2):CD003373.
doi: 10.1002/14651858.CD003373.

Regular self-examination or clinical examination for early detection of breast cancer

J P Kösters  1 , P C Gøtzsche
Affiliations

Regular self-examination or clinical examination for early detection of breast cancer

J P Kösters et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: Breast self-examination and clinical breast examination have been promoted for many years as general screening methods to diagnose breast cancer at an earlier stage in order to decrease morbidity and or mortality. The possible benefits and harms remain unclear.

Objectives: To determine whether screening for breast cancer by regular self-examination or clinical breast examination reduces breast cancer mortality and morbidity.

Search strategy: The Cochrane Library and Medline were searched for randomised trials; date of last search October 2002. The specialised register maintained by the Cochrane Breast Cancer Group was searched.

Selection criteria: Randomised clinical trials, including cluster randomised trials.

Data collection and analysis: Decisions on which trials to include were taken independently by the reviewers based on the methods of trial. Disagreements were resolved by discussion. Intention to treat analyses were conducted using a fixed effect model with 95% confidence intervals.

Main results: Two large population-based studies (388,535 women) from Russia and Shanghai that compared breast self-examination with no intervention were included. There was no statistically significant difference in breast cancer mortality, relative risk 1.05 (95% confidence interval (CI) 0.90 to 1.24) (587 deaths in total). In Russia, more cancers were found in the breast self-examination group than in the control group (relative risk 1.24, 95% CI 1.09 to 1.41), while this was not the case in Shanghai (relative risk 0.97, 95% CI 0.88 to 1.06). Almost twice as many biopsies (3406) with benign results were performed in the screening group compared to the control group (1856), relative risk 1.89, 95% CI 1.79 to 2.00.

Reviewer's conclusions: Data from two large trials do not suggest a beneficial effect of screening by breast self-examination whereas there is evidence for harms. There were no randomised trials of clinical breast examination. At present, breast self-examination cannot be recommended.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 1 Mortality from breast cancer.
1.2
1.2. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 2 Cancers identified.
1.3
1.3. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 3 Carcinoma in situ (Tis).
1.4
1.4. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 4 T1‐tumors (2 cm or less).
1.5
1.5. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 5 Total number of biopsy examinations (both benign and cancer).
1.6
1.6. Analysis
Comparison 1 Breast self‐examination versus no breast self‐examination, Outcome 6 Total number of breast biopsies with benign histology.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Philippines 2006 {published and unpublished data}
    1. Pisani P, Parkin DM, Ngelangel C, Esteban D, Gibson L, Munson M, Reyes MG, Laudico A. Outcome of screening by clinical examination of the breast in a trial in the Philippines [Outcome of screening by clinical examination of the breast in a trial in the Philippines]. International Journal of Cancer 2006;118(1):149‐54. [PMID: 16049976 [PubMed ‐ indexed for MEDLINE]] - PubMed
Russia 1999 {published data only}
    1. Semiglazov VF, Manikhas AG, Moiseenko VM, Protsenko SA, Kharikova RS, Seleznev IK, et al. Results of a prospective randomized investigation [Russia (St.Petersburg)/WHO] to evaluate the significance of self‐examination for the early detection of breast cancer [Article in Russian]. Voprosy Onkologii 2003;49(4):434‐41. [PMID: 14569932 [PubMed ‐ indexed for MEDLINE]] - PubMed
    1. Semiglazov VF, Moiseenko VM. Breast self‐examination for the early detection of breast cancer: a USSR/WHO controlled trial in Leningrad. Bulletin of the World Health Organization 1987;65(3):391‐6. - PMC - PubMed
    1. Semiglazov VF, Moiseenko VM, Bavli IaL, Migmanova NSh, Seleznev IK. Work experience of the WHO International Reference Center in assessing the effectiveness of self‐examination for the early diagnosis of breast cancer (results of 2 years' research) [Article in Russian]. Voprosy Onkologii 1988;34(8):969‐74. - PubMed
    1. Semiglazov VF, Moiseenko VM, Manikhas AG, Protsenko SA, Kharikova RS, Popova RT, et al. Interim results of a prospective randomized study of self‐examination for early detection of breast cancer (Russia/St.Petersburg/WHO) [Article in Russian]. Voprosy Onkologii 1999;45(3):265‐71. - PubMed
    1. Semiglazov VF, Moiseenko VM, Protsenko SA, Bavli IL, Orlov AA, Ivanova OA, et al. Preliminary results of the Russia (St.Petersburg/WHO program) for the evaluation of the effectiveness of breast self‐examination [Article in Russian]. Voprosy Onkologii 1996;42(4):49‐55. - PubMed
Shanghai 2002 {published data only}
    1. Gao DL, Hu YW, Wang WW, Chen FL, Pan LD, Yuan Y, Yu LD, Qian F. Evaluation on the effect of intervention regarding breast self‐examination for decreasing breast cancer mortality [Article in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 2006;27(11):985‐90. [PMID: 17402204 [PubMed ‐ in process]] - PubMed
    1. Gao DL, Thomas DB, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self‐examination in 266,064 women in Shanghai [Article in Chinese]. Zhonghua Zhong Liu Za Zhi 2005;27(6):350‐4. [PMID: 16117898 [PubMed ‐ indexed for MEDLINE]] - PubMed
    1. Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self‐examination: final results. Journal of the National Cancer Institute 2002;94(19):1445‐57. - PubMed
    1. Thomas DB, Gao DL, Self SG, Allison CJ, Tao Y, Mahloch J, et al. Randomized trial of breast self‐examination in Shanghai: methodology and preliminary results. Journal of the National Cancer Institute 1997;89(5):355‐65. - PubMed

References to studies excluded from this review

Turner 1984 {published data only}
    1. Turner J, Blaney R, Roy D, Odling‐Smee W, Irwin G, Mackenzie G. Does a booklet on breast self‐examination improve subsequent detection rates?. Lancet 1984;2(8398):337‐9. - PubMed

References to ongoing studies

Boulos 2005 {published data only}
    1. Boulos S, Gadallah M, Neguib S, Essam E, Youssef A, Costa A, Mittra I, Miller AB. Breast screening in the emerging world: high prevalence of breast cancer in Cairo. Breast 2005;14(5):340‐6. [PMID: 16131468 [PubMed ‐ indexed for MEDLINE]] - PubMed
India 1998 {published data only}
    1. Early detection of common cancers in women in India.. Ongoing study Unclear: possibly May 1998..

Additional references

Baines 1986
    1. Baines CJ, Wall C, Risch HA, Kuin JK, Fan IJ. Changes in breast self‐examination behavior in a cohort of 8214 women in the Canadian National Breast Screening Study. Cancer 1986;57(6):1209‐16. - PubMed
Baxter 2001
    1. Nancy Baxter, the Canadian Task Force on Preventive Health care. Preventive health care, 2001 update: Should women be routinely taught breast self‐examination to screen for breast cancer?. CMAJ 2001;164(13):1837‐46. - PMC - PubMed
Brett 1998
    1. Brett J, Austoker J, Ong G. Do women who undergo further investigation for breast screening suffer adverse psychological consequences? A multi‐centre follow‐up study comparing different breast screening result groups five months after their last breast screening appointment. Journal of Public Health Medicine 1998;20(4):396‐403. [MEDLINE: ] - PubMed
Calle 1993
    1. Calle EE, Martin LM, Thun MJ, Miracle HL, Heath CWJ. Family history, age, and risk of fatal breast cancer. American Journal of Epidemiology 1993;138:675‐81. - PubMed
Feig 2000
    1. Feig SA. Ductal carcinoma in situ. Radiologic Clinics of North America 2000;38:653‐68. - PubMed
Gøtzsche 2006
    1. Gøtzsche PC, Nielsen PG. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001877.pub2.] - DOI - PubMed
Hackshaw 2003
    1. Hackshaw AK, Paul EA. Breast self‐examination and death from breast cancer: a meta‐analysis. British Journal of Cancer 2003;88(7):1047‐53. [PMID: 12671703 [PubMed ‐ indexed for MEDLINE]] - PMC - PubMed
Hofmann 2000
    1. Hofmann W, Schlag PM. BRCA1 and BRCA2 ‐ breast cancer susceptibility genes. Journal of Cancer Research and Clinical Oncology 2000;126:487‐96. - PubMed
Janzon 1991
    1. Janzon L, Andersson I. The Malmö mammographic screening trial. Miller AB, Chamberlain J, Day NE et al. Cambridge: Cambridge University Press, 1991:37‐44.
MacFarlane 1992
    1. MacFarlane ME, Sony SD. Women, breast lump discovery, and associated stress. Health Care for Women International 1992;13(1):23‐32. [MEDLINE: ] - PubMed
Magnusson 1998
    1. Magnusson C, Colditz G, Rosner B, Bergstrom R, Persson I. Association of family history and other risk factors with breast cancer risk (Sweden). Cancer Causes Control 1998;9:259‐67. - PubMed
Miller 2000
    1. Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study‐2: 13‐year results of a randomized trial in women aged 50‐59 years. Journal of the National Cancer Institute 2000;92(18):1490‐9. - PubMed
Miller 2002
    1. Miller AB, To T, Baines CJ, Wall C. The Canadian National Breast Screening Study‐1: Breast cancer mortality after 11 to 16 years of follow‐up. A randomized screening trial of mammography in women age 40 to 49 years. Annals of Internal Medicine 2002;137:305‐12. - PubMed
Moody‐Ayers 2000
    1. Moody‐Ayers SY, Wells CK, Feinstein AR. "Benign" tumors and "early detection" in mammography‐screened patients of a natural cohort with breast cancer. Archives of Internal Medicine 2000;160:1109‐15. - PubMed
Semiglazov 1992
    1. Semiglazov VF, Moiseyenko VM, Bavli JL, Migmanova NSh, Seleznyov NK, Popova RT, et al. The role of breast self‐examination in early breast cancer detection (results of the 5‐years USSR/WHO randomized study in Leningrad). European Journal of Epidemiology 1992;8(4):498‐502. - PubMed
Semiglazov 1999
    1. Semiglazov VF, Moiseyenko VM, Manikhas AG, Protsenko SA, Kharikova RS, Ivanov VG, et al. Role of breast self‐examination in early detection of breast cancer: Russia/WHO prospective randomized trial in St. Petersburg. Cancer Strategy 1999;1:145‐51.
UK trial 1999
    1. Early Detection of Breast Cancer Group. 16‐Year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet 1999;353(9168):1909‐14. - PubMed
Welch 2004
    1. Welch H. Should I be tested for cancer? Maybe not and here's why. Should I be tested for cancer? Maybe not and here's why. Berkeley: University of California Press, 2004.
Yang 1999
    1. Yang X, Lippman ME. BRCA1 and BRCA2 in breast cancer. Breast Cancer Research Treaties 1999;54:1‐10. - PubMed

Publication types