From the Guidelines
Breast self-exams do not have high sensitivity or specificity for detecting breast cancer, with a sensitivity ranging from 12% to 41% and specificity that is age-dependent 1. Instead, regular mammograms are the most effective screening method, with a sensitivity of approximately 77% to 95% and a specificity of about 94% to 97% for breast cancer 1. While breast self-exams were previously recommended, current evidence shows they do not reduce breast cancer mortality and may lead to unnecessary biopsies 1. However, women should still be familiar with the normal look and feel of their breasts and report any changes to their doctor promptly. The most effective approach for early breast cancer detection combines:
- Regular mammograms
- Clinical breast exams by a healthcare provider, which have a sensitivity of 40% to 69% and a specificity in the range of 88% to 99% 1
- Breast awareness (being familiar with your breasts' normal appearance) This multi-pronged strategy allows for both imaging-based screening and detection of palpable changes, maximizing the chances of finding breast cancer early when it's most treatable. It's essential to note that the USPSTF recommends against teaching breast self-examination (BSE) due to the lack of evidence showing its effectiveness in reducing breast cancer mortality 1. In contrast, mammography has been shown to reduce breast cancer mortality, with the greatest benefits seen in women aged 60 to 69 years 1. Overall, the best approach for breast cancer screening is a combination of regular mammograms, clinical breast exams, and breast awareness, rather than relying solely on breast self-exams.
From the Research
Sensitivity and Specificity of Breast Self-Examination (BSE)
- The sensitivity and specificity of BSE have been studied in various research papers, with varying results 2, 3, 4.
- One study found that the sensitivity of BSE was 58.3% and the specificity was 87.4% 4.
- Another study estimated the sensitivity of BSE to be low, around 20% to 30%, and noted that it is lower among older women 3.
- The potential sensitivity of BSE is thought to be higher, as women can detect small lumps in silicone models, but the actual sensitivity and specificity have not been consistently determined 2, 3.
Comparison to Other Screening Methods
- BSE has been compared to clinical breast examination and mammography, with these methods generally having higher sensitivity and specificity 2, 3.
- However, one study found that BSE detected 6 out of 14 breast cancers, compared to 6 out of 14 detected by MRI and 2 out of 14 by mammography 4.
- The study also found that the sensitivity, specificity, and predictive value of BSE were 58.3%, 87.4%, and 29.2%, respectively, compared to 66.7%, 88.9%, and 34.8% for MRI 4.