MedPage today headlined a 25-year Canadian study showing that in certain age groups, mammograms found few more actual breast cancers than manual exams, made some misdiagnoses, and didn't prolong life. This reminds me of some posts from Breast Cancer Action, San Francisco, as recently as October.
This Canadian study seemed, to a layman, well conducted, well designed, and well reported. But this is the real world for my age group and maybe yours today. . .
First, I hadn't had a manual breast exam for years until after my call-back mammos resulted in a biopsy that showed cancer. Then the surgeon did a manual exam that seemed to be in the area where the abnormal cells had been found. By then, surgery seemed to be inevitable. I still haven't asked him if he could detect anything manually!
Second, my in-the-shower breast exams have been hasty or neglected more often than not. Besides manual exams by physicians, the study mentioned "usual care in the community." I'm betting that also included self exams. So mammograms are better than doing nothing.
Third: Who am I comfortable with for a breast and pelvic exam? In CA, I was totally comfortable with my doctor, and I've had reasons to prefer a male doctor, but there are some males I wouldn't be comfortable with giving me a breast or pelvic. With Tamoxifen, I'll have to ask myself that question as soon as I meet a doctor.
Fourth: Mammograms have been almost automatic for so long, do all primary physicians know all there is to know about manual breast exams? I don't know a gynecologist here or in CA - do women go to gynecologists for their pelvics? Do gynecologists even do breast exams?
Who you gonna call?