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.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.