WOMEN HEALTH MANAGEMENT

Women Health Management

Women Health Management

Introduction

Despite improved treatment and dissemination of information on breast cancer screening and early detection, breast cancer remains a leading cause of morbidity and mortality among women in the USA. The American Cancer Society projects that breast cancer will be the most frequently diagnosed cancer, and second-leading cause of cancer-related death in women in the year 2005. In women in the USA, ACS estimates 211,240 new cases of breast cancer will be diagnosed (32 percent of cancers of all sites in women) and 40,410 deaths from breast cancer will occur (15 percent of all site cancer deaths in women) (www.cancer.org/docroot/MED/content/downloads/MED_1_1x_CFF2005_Leading_Sites_New_Cases_Deaths_Estimates.asp). A woman has an estimated one in seven (13.39 percent) lifetime risk of developing breast cancer (www.cancer.org/docroot/MED/content/downloads/MED_1_1x_CFF2005_Probability_of_Developing_Invasive_Cancers_Selected_Age_Intervals_by_Sex_1999-2001.asp), thus many guidelines for breast cancer screening have been developed that focus on secondary prevention measures to reduce morbidity and mortality through early detection (Tabar et al., 1999).

Mammography and Clinical Breast Examination (CBE) remain the standard of care in breast cancer prevention. Professional medical organizations recommend mammography coupled with CBE but vary in frequency and age at initiation of routine screening. While Breast Self Examination (BSE) is another potential method of early breast cancer detection through screening, recommendations for this screening technique are inconsistent and confusing. Our purpose was to review the published studies that have included BSE, to compare recent interpretations of published studies, and to evaluate how this evidence may have affected the development of recommendations issued by various health care organizations.

Summary of current recommendations for BSE

The first step in our review was to compare current BSE recommendations. There is wide variation in the frequency and subgroups of women for whom BSE is recommended. Table I provides a summary of current guidelines on BSE from nine key organizations involved in women's health care. The guidelines range from recommending against BSE by the Canadian Task Force on Preventive Health, to a recommendation for monthly BSE for women of all ages by the American Society of Clinical Oncology.

In issuing clinical guidelines for breast cancer screening in 2002, the US Preventive Services Task Force (USPSTF) continued to label routine BSE a Grade I recommendation, indicating that there is insufficient evidence to recommend for or against routine BSE for general population screening for breast cancer (US Preventive Services Task Force, 2002). In May 2003, the American Cancer Society (ACS) changed its recommendations regarding BSE (Smith et al., 2003). The former guideline, issued in 1997, recommended monthly BSE in women starting at age 20. The newest guideline states, “Beginning in their 20s, women should be told about the benefits and limitations of BSE. It is acceptable for women to choose not to do BSE or to do it occasionally.” The ACS explains the rationale for changing their guidelines as the lack of evidence showing a role for BSE in breast cancer detection.

Other health policy groups, such as the Canadian Task Force on Preventive Health, have recommended against the use of BSE due to potential harmful ...