Benefits of breast self-examinations for medically underserved populations: A systematic review

Abstract

Background: Breast self-examination (BSE) was previously recommended to help early-stage breast cancer detection to improve prognosis. However, BSE is not recommended in the United States anymore due to the findings that it fails to significantly decrease mortality while increasing biopsy cases, causing unnecessary harm. Nonetheless, international researchers have continued to investigate the benefits of BSE in medically underserved regions. These studies raise the possibility that BSE could be beneficial in rural America, where people face higher mortality from chronic diseases compared to the general population.

Objectives: Determine if BSE has benefits for medically underserved populations to inform a potential reevaluation of breast cancer screening recommendations.

Design: Systematic review.

Data sources and methods: A systematic review was conducted using a set of terms to identify articles on breast cancer survival and BSE in rural and/or underserved populations within the past 10 years. The search yielded over 200 articles across 3 databases (PubMed, CINAHL, and SCOPUS), and they were further screened to include studies that show rural populations performing BSE, effects of BSE in breast cancer diagnosis and/or mortality of breast cancer patients, factors contributing to the efficacy of BSE, factors that affect women's willingness to perform BSE, and effects of BSE on breast cancer awareness/behaviors to seek further screening.

Results: The final synthesis from 12 articles suggests that BSE is associated with early breast cancer detection (4/12), increased accessibility to breast cancer screening (2/12), and positively influence women to seek further breast cancer screening in rural populations (3/12). It also identifies a potential need for improved education on breast cancer and screening, including BSE practices, to promote early breast cancer detection (3/12).

Conclusion: The reevaluation of the current recommendations to determine if exceptions should be made to specific populations would be helpful in addressing late detection and poor prognosis in medically underserved populations.

Keywords: breast cancer; breast cancer screening; breast self-examination; rural health; women’s health.

Figure 1.

PRISMA flow diagram of the systematic review workflow and the number of articles at each stage of the review process (n).

Figure 2.

Summary diagram of the systematic review. 230 articles from PubMed, SCOPUS, and CINAHL were screened as described above. Twelve of the 230 articles were included in the review whose results suggest that breast self-examination (BSE) practice may provide benefits in rural and underserved communities as outlined in the figure.