Q. Every time I examine my own breasts I come across some lump or bump that I think is important, but when I see my doctor, he tells me it’s normal. In light of my experience, is breast examination useful?
A. There has been a great deal of emphasis in recent years placed upon the importance of self-examination of the breasts as a means of early detection of breast cancer. Not all breast specialists, however, feel that self-examination is effective, and in fact, many feel its importance has been overemphasized. For example, in her book Dr. Susan Love’s Breast Book, the renowned breast specialist cautioned that urging women to perform self-examination of their breasts may not only promote undue anxiety but may be expecting too much of patients. She added that expecting woman to find their own breast cancer is tantamount to “blaming the victim” and relieving the medical establishment of their responsibility to find better diagnostic techniques. Dr. love has a point. For one thing, a normal breast can feel lumpy, and only a skilled physician can distinguish between normal lumps and bumps and those that are abnormal. For another thing, in some women, self-examination can cause so much stress and unnecessary fear that it is far better for them to visit a doctor at appropriate intervals then to continue to make themselves nervous wrecks.
This is not to say that self-examination is a worthless exercise – not at all. It can be an important tool for the detection of cancer. In fact, 90 percent of all breast lumps are first discovered by the women themselves, and although about 80 percent of these lumps are not malignant, there are cases in which women owe their lives to their own self-examination. Nevertheless, studies have not shown that self-examination improves breast cancer mortality since many cancers that are asymptomatic and easy to feel are simply of the slow-growing and less-lethal type.
In my opinion and in the opinion of most breast specialists, regular mammography combined with a careful examination by an experienced physician remains the most effective and accurate way to detect breast cancer. Together they detect over 95 percent of malignancies.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”