Do Breast Self-Exams Do Any Good?

I don’t really know what to think about this article from Time, which argues that conducting regular self breast exams may actually be worse for women than not. They argue that while self exams do lead to early detection – they frequently lead to the detection of benign cysts, resulting in unnecessary biopsies, scarring from these unnecessary treatments, and emotional scars from the imagined scare.

What this seems to indicate (to me at least) is that women need to be educated as to what they’re looking for – not just that they need to do an exam. In gyne instruction, we were trained to teach doctors to teach patients to look for anything that changes from month to month – and to not necessarily panic at every little lump and bump. Healthy breasts are full of all kinds of nodules and other weird-feeling bits of tissue, fiber, and ductwork. They change from day to day, month to month. Being aware of these normal changes will make it easier to notice when something abnormal pops up.

The results of this study also point to a trend towards overtreatment. I’m not sure what I can say about that, so I’ll just let it stand.

Regardless, I feel like it’s really irresponsible to discourage women from doing a simple, painless, easy thing that might lead to early detection. As the daughter and granddaughter of breast cancer survivors, and also as the daughter of an oncologist, and also as a former gyne instructor, I think I know what I’m talking about.

hands down

It is totally, exceptionally beautiful out today, and I’m sitting on the back patio at Aroma in a tank top, skirt, and kneesocks. The high today is 71 – 71 in MARCH. Ridiculous – but I’m not going to complain.

This morning, following a week of great trepidation, I performed my first pelvic exam. I was lucky to have a very particular and detail-obsessed instructor walk me through everything, which was really helpful, and I impressed her by not cross-contaminating at any point in the exam (this sounds horrifying to any woman, I’m sure, but believe me, we’re WAY more careful than most).

We use a technique called ‘wet hand dry hand’ to make sure that at no point in the exam do either the woman or the room become contaminated with things from the other. In practice this is frequently called ‘clean hand dirty hand’, which is interesting to me. In class the other day we talked about how everything is political, even things like birth control, which are nominally empowering to women, but which still require a male-dominated industry to dole them out. The terminology of ‘clean hand dirty hand’ is problematic in the same respect – which do you think is the clean hand? The one that is touching the woman’s body in the most intimate and private places? Or the hand that is touching the equipment, the sheets, or the lights?

The ‘dirty’ hand is the one that touches the body.

As a woman, I don’t want to be told that my body is ‘dirty’. As an instructor (or, thinking as a doctor), I don’t want to be introducing anything ‘dirty’ into a woman’s body. ‘Wet hand dry hand’ is much more straight forward and apolitical – the ‘wet hand’ touches the woman (and NOTHING else), and the ‘dry hand’ touches the equipment. There is no cross-contamination, and no politics or offense.

I expressed earlier that I was intimidated and unsure about this program, but the more I think about it, the more empowering and important I believe it is. This is an opportunity for women to advocate for themselves, for their physical health, and for the appropriate, polite, and caring treatment of other women. This is a way to be an advocate and to celebrate our bodies as women that isn’t just raising a fist to the sky and celebrating our gynecology. I am proud to be a part of it.