Why Self-Exams Don’t Work

Dr. Susan Love directs the Revlon/UCLA Breast Center and co-founded
the National Breast Cancer Coalition. When she became a surgeon in
1980 there were almost no women surgeons working with breast cancer
patients. In the new edition of her groundbreaking work, Dr.
Susan Love’s Breast Book
(Addison-Wesley, 1995), she questions
the importance of breast self-exams. National Public Radio’s Terry
Gross recently asked her to elaborate.

Susan Love: The breast self-exam is wishful thinking. We
wish the self-exam worked in terms of early detection but it really
doesn’t work very well, and it distracts us from moving forward to
find something that really does work.

Terry Gross:Why doesn’t it work?

Love: Because the notion of early detection isn’t
entirely right. We’ve sold it as if every cancer goes from a grain
of sand to a BB to a pea to a grape to a lemon to a grapefruit, and
if you just do your breast self-exam you can find the grain of sand
and life will be great.

The problem is that what you’re feeling when you feel a cancer
is not the cancer cells; it’s the reaction those cells incite
around them. In some people the cancer shows up as a grape, in
others as a grapefruit. And this notion that if you just examined
yourself you would find it at a smaller size isn’t true. Some
people are lucky and they do have lumps that are found
really early. But not everybody.

Gross:How are most lumps discovered?

Love: Most women find their own lumps, but they don’t
find them doing breast self-exams. They find it in the shower. Or
they’re rolling over in bed, or their lover finds it. It’s not
because they stood in front of the mirror and did a whole song and
dance. Most women in fact don’t do self-exams; they’re too
scared.

Most importantly, I think the hype about self-exams alienates
women from their bodies. Instead of thinking of your breast as a
nice friendly part of you, it becomes the enemy, and your job is to
find the hidden land mine that’s going to do you in.

Breast self-exam was invented at a time when women really didn’t
touch themselves ‘down there,’ which meant below the chin. Nowadays
many more women are more aware and they are [familiar with their
bodies]. But they feel they need to catalog every grain of sand and
go on a search-and-destroy mission. That isn’t necessary.

Gross:Do you think I’m going to get a lot of phone
calls from gynecologists saying that what you have just said is
irresponsible?

Love: No. It’s not evil for people to be doing breast
self-exams. I just think we shouldn’t be putting so much money into
promoting it. We should be putting the money into finding a really
good way of early detection. Maybe a blood test.

Reprinted with permission of Fresh
Air/WHYY,
Philadelphia, PA 19106.

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