By Florence Williams
O, The Oprah Magazine | September 20, 2010
Last fall a U.S. task force discouraged women from performing breast self-exams. But Florence Williams asks: Are they really worthless, or do we just need to get better at doing them?
The purple box came wrapped like a gift. Inside was a life-size silicone model of a breast—squishy nipple, smooth skin, and all. I popped the instructional DVD into my laptop and lay down, placing the cool falsie on my chest, just above my own breast. I was ready to enter the newly complicated world of breast self-exams (BSE).
In November 2009, the U.S. Preventive Services Task Force released a recommendation that discouraged manual breast exams, whether done by a woman on herself or by a doctor. (You may not have heard about this guideline, because the task force also recommended that most women under age 50 not get regular mammograms—a bombshell so big it nearly obliterated all other breast-related news.)
The conclusions were based on two large studies done in China and Russia, which compared women who were taught and who performed BSE with women who did nothing, and found discouragingly similar death rates from breast cancer. At the same time, the women who performed BSE found more benign tumors requiring painful and expensive biopsies.
Yet “many doctors feel the data supporting the recommendations is flawed,” says breast surgeon Lee Wilke, MD, director of the Breast Center at the University of Wisconsin. After conducting her own BSE study, which was published last year, Wilke concluded, “BSE can be effective for women who are dedicated to performing it.”
Armed with that information—and determined to improve my technique—I ordered the squishy prosthetic and DVD ($49), both produced by MammaCare, the same company that makes the models used to train the Mayo Clinic staff. “We can take someone who may have missed a tumor the size of a Ping-Pong ball and teach her to detect a three-millimeter, pea-size tumor,” says MammaCare cofounder and senior research scientist Mark Kane Goldstein, PhD. That’s one-tenth the size of the average mass found by an untrained individual.
I watched as the DVD instructor explained the “vertical strip” search pattern. I felt my model along a series of parallel lines (like “mowing the lawn,” Goldstein says), using the flat pads of my middle fingers to apply three pressure depths—surface, medium, and deep—at each spot.
Somewhat like a real breast, the model felt fibrous and ropy in places. I immediately detected two small, hard “tumors” on the left side and one on the right. A few minutes later, though, the video informed me that I had missed two others, including a large one deep under the nipple. To feel those, I had to press down much more firmly. If my model had been a water balloon, it would have popped.
When it was time to trade the prosthetic for my own breasts, it was much more difficult to tell what was what—and painful to push down very hard. Discouraged, I called Goldstein, who told me that the more I practiced BSE, the better I’d get. “Just learning your breast geography is a big part of the process,” he said. San Francisco–based breast cancer surgeon William Goodson, MD, gave me more tips: “Don’t look only for lumps. Many cancers feel more like an irregular area where the skin sometimes puckers.”
What all the experts stressed is that cancer detection is as much art as science. And what I realized is that if, as a woman under 50, I’m not getting yearly mammograms, mastering BSE is my best option—and the more I practice, the better I get. As Leigh Hurst, a 39-year-old cancer survivor who found her cancer during a self-exam, says, “We’re lucky that our breasts are on the outside of our bodies—we’re not talking about our lungs here. We have the power to look, to feel, and to learn when something may be wrong.”