Breast self-examination

In a multicenter retrospective cohort study of 431 female childhood cancer survivors who developed subsequent breast cancer, survivors faced a 3.5-fold greater mortality risk (95% CI = 2.17-5.57) compared with matched females with first primary breast cancer (N = 344 matched pairs). Survivors were more frequently treated with mastectomy (81% vs 60%) and less likely to receive radiotherapy (18% vs 61%) or anthracyclines (47% vs 66%), reflecting therapeutic tradeoffs due to prior treatment exposures. Despite guideline-concordant treatment rates being similar (94% vs 93%), the excess mortality persisted, underscoring the importance of early detection through self-monitoring in this high-risk group.

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This umbrella review analyzed 19 systematic reviews covering 199 primary studies with approximately 2,460,600 participants. Eight systematic reviews focused on breast cancer self-examination. AMSTAR-2 quality assessment identified 4 high-quality and 2 moderate-quality reviews. Analysis restricted to these 6 higher-quality reviews found low-quality evidence supporting breast self-examination across cancer types. Educational interventions and personalized cancer risk information demonstrated some promise in increasing self-examination frequency and cancer awareness among participants.

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The Hong Kong Cancer Expert Working Group on Cancer Prevention and Screening (CEWG), established in 2002 by the Cancer Coordinating Committee, reviewed local and international scientific evidence on breast cancer prevention. Breast cancer is the most common cancer among women in Hong Kong. After evaluating local epidemiology, emerging evidence, and overseas screening practices, the CEWG concluded that all women should be breast aware and seek timely medical attention for suspicious symptoms. This recommendation applies universally to all women regardless of risk category, as a primary preventive measure alongside other lifestyle modifications.

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In a screening study of 8,278 women over age 42 (median age 50, SD 8 years) screened through the Oman Cancer Association mobile mammography program from 2009 to 2016, logistic regression analysis identified breast self-examination as a significant predictor of mammography screening compliance. Overall compliance with repeat mammography was only 18%. The program achieved a cancer detection rate of 4.1 per 1,000 screened women, with a positive predictive value of 4.7%, sensitivity of 53%, and specificity of 92%. Women who practiced breast self-examination were significantly more likely to return for follow-up screening, suggesting BSE promotes ongoing engagement with early detection efforts.

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A mixed method systematic review searched four scientific databases (CINAHL, Medline, AMED, PsychInfo) and three systematic review databases, identifying 210 papers of which 10 studies met inclusion criteria for women with family history of breast cancer (published January 2004–December 2014). The review identified a clear link between breast cancer risk perception and health-protective behaviour. Professionally-administered screening (mammogram, chemoprevention) showed appropriate adoption rates. In contrast, behaviours requiring high individual input—including breast self-examination and lifestyle changes—were not as appropriately adopted, and the decision process for these behaviours was not as clearly linked to risk perception.

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A case-control study of 122 breast cancer patients (61 cases, 61 controls) at General Hospital Center Dr. M. Djamil Padang (July-December 2013) demonstrated that women with lower knowledge levels had 1.86 times the odds of delaying treatment-seeking compared to those with higher knowledge (OR=1.86, 95% CI 0.68-5.089). The findings indicate that increased breast cancer awareness encourages earlier detection through self-monitoring and screening behaviors.

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Case-control study of 108 breast cancer patients in Indonesia (April–May 2015) using consecutive and convenient sampling. Early detection behavior was the strongest modifiable predictor of screening delay: women who had never performed early detection had an OR of 11.08 (p<0.001) for delayed screening, while those with infrequent early detection had an OR of 5.18 (p=0.032), compared to women practicing regular self-examination. Low knowledge about breast cancer also strongly predicted delay (OR 15.7, p<0.001 for low knowledge; OR 9.5, p=0.011 for moderate knowledge). Lack of information or mass media exposure was independently associated with delay (OR 2.75, p=0.011), and absence of partner or family support increased delay odds (OR 4.35, p<0.001).

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In this quasi-experimental study with non-equivalent control group design using multistage sampling, 40 women aged 30-50 years were divided into treatment (n=20) and control (n=20) groups. The treatment group receiving BSE health education showed significant knowledge improvement from pretest mean 14.55 to posttest mean 17.10, compared to control group change from 14.05 to 14.25. Motivation scores increased from 59.45 to 65.45 in the treatment group versus 59.20 to 59.65 in controls. Mann-Whitney test confirmed significant differences between groups for both knowledge (p=0.001) and motivation (p=0.002) at α=0.05, demonstrating that health education on BSE technique effectively increases women's knowledge and motivation to perform regular self-examination.

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A quasi-experimental non-equivalent control group study with 60 female students assessed the impact of health education on BSE knowledge, attitudes, and practices using paired t-tests and Wilcoxon tests (alpha = 0.05). The treatment group showed statistically significant increases in all three domains — knowledge, attitudes, and BSE practice — while the control group showed no significant changes. Effect sizes (eta squared) were 0.084 for knowledge, 0.352 for attitudes, and 0.062 for practice, indicating a large effect on attitudes and small-to-medium effects on knowledge and practice.

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A community screening programme conducted in Khanpur Kalan and surrounding villages in Haryana taught breast self-examination to women through nursing personnel. The sample survey identified multiple breast-related conditions among participants, including fibroadenosis, adenocarcinoma, axillary lumps, galactorrhoea, fibrocystic disease, and mastitis. The programme demonstrated that screening in asymptomatic women with clinically significant but undetected manifestations is essential to reduce the burden of breast cancer. Culturally appropriate education delivered by trained nurses improved women's engagement with screening and timely treatment-seeking behaviour.

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In a prospective nationwide cohort of 173,797 female breast cancer patients from the Netherlands Cancer Registry (1999-2012), five-year relative survival reached 100% for tumours ≤1 cm in the 2006-2012 cohort. Mortality increased significantly with tumour size beyond 1 cm (T1c vs T1a: hazard ratio 1.54, 95% CI 1.33-1.78), but no significant difference existed for invasive cancers up to 1 cm (T1b vs T1a: HR 1.04, 95% CI 0.88-1.22). Patients in 2006-2012 had smaller tumours at diagnosis (≤T1: 65% vs 60%, P<0.001) and more lymph node-negative disease (N0: 68% vs 65%, P<0.001). Overall five-year relative survival improved to 96% in the later cohort.

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In this randomized controlled trial of 89,835 women aged 40-59 across 15 Canadian screening centres followed for 25 years, annual mammography did not reduce breast cancer mortality compared to physical examination alone. During the screening period, 180 deaths occurred in the mammography arm (n=44,925) versus 171 in controls (n=44,910), with a hazard ratio of 1.05 (95% CI 0.85-1.30). Over the full study period, cumulative breast cancer mortality was nearly identical (500 vs 505 deaths; HR 0.99, 95% CI 0.88-1.12). Additionally, 22% (106/484) of screen-detected invasive cancers were over-diagnosed, representing one over-diagnosed cancer per 424 women screened.

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Case-control study of 48 fertile-age women (24 case, 24 control groups) selected by simple random sampling. Chi-square analysis showed perceived threat was significantly associated with practice of early breast examination (p = 0.013) and perceived barriers were also significantly related (p = 0.021). Only 22.4% of breast cancer patients in Indonesia are diagnosed at early stages, while 68.6% present at advanced stages. Perceived benefit was not significantly associated with early examination practice (p = 0.348). Women with higher perceived threat of breast cancer and fewer perceived barriers were more likely to engage in early breast examination behavior.

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The matched case-control study (n=76, 38 cases and 38 controls) at Sanglah Hospital demonstrated that breast disease history carried a bivariate OR of 13.5 (95%CI: 3.21-56.77) and breast infection history was the sole significant multivariate predictor with OR=43.19 (95%CI: 8.79-212.27). The study authors specifically recommended increased health promotion about early detection and screening, as well as improved access to mammography facilities as national policy. These findings support patient-initiated breast self-examination as a frontline strategy for identifying breast changes early, particularly given that prior breast disease so dramatically elevates cancer risk.

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A cluster RCT randomized 60 female college students into two groups of 30 each to evaluate health education methods on BSE attitudes. Health education significantly improved attitudes about BSE across both methods (95% CI, p<0.001). The education method variable showed a strong positive effect on BSE attitudes (b1=9.15, 95% CI 6.82 to 11.48, p<0.001). Knowledge was an independent significant predictor of positive BSE attitudes (b2=0.37, 95% CI 0.32 to 0.71, p=0.019). A significant interaction between education method and knowledge on BSE attitudes was observed (95% CI, p=0.030), indicating that the combination of effective education delivery and higher baseline knowledge produces the strongest positive attitudes toward regular breast self-examination practice.

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In a non-randomized interventional study using the Solomon Model, 79 nurses were divided into experimental and control groups to assess breast cancer awareness training. Initial clinical breast examination practice scores were low at 12.5 out of 30 (41.6%). After an abbreviated training intervention, practice scores improved significantly to 26 out of 30 (86.6%, p=0.003). Knowledge scores improved from 18 out of 25 (72%) to 22 out of 25 (88%, p<0.001). The study demonstrated that even brief structured training in breast examination techniques produces significant measurable improvement in detection skills, supporting the value of breast self-examination as a screening practice in resource-constrained settings where formal screening programs may be limited.

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This systematic review analyzed studies on detection methods for local recurrence and second breast cancers. Mammographically detected local recurrences and those detected by women themselves demonstrated better survival outcomes than recurrences detected by clinical examination during routine follow-up visits. The review included cohort studies with long-term follow-up examining recurrence detection methods. Women who had breast cancer maintain an increased risk of second primary breast cancer for at least 20 years compared to the general population, emphasizing the importance of ongoing self-surveillance beyond the typical 5-year hospital-based follow-up period.

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