The Breast Self-Examination Controversy: What Providers and Patients should Know

Tiffany L. Allen; Brittany J. Van Groningen; Debra J. Barksdale; Regina McCarthy


Journal for Nurse Practitioners. 2010;6(6):444-451. 

In This Article

Abstract and Introduction


Breast cancer is the second leading cause of cancer-related deaths in women. The efficacy of breast self-examination in decreasing cancer mortality is being questioned because of some recent evidence. This finding has led to various and controversial recommendations by key health organizations. This article explores this controversy and provides resources that nurse practitioners can use for discussions with patients and to help patients make informed decisions about the role of breast self-examination in their health care.


Breast cancer is a concern for many women in America. It is the second leading cause of cancer-related deaths in women, second only to lung cancer (Table 1).[1] Genetics, obstetric and gynecologic history, and environmental factors are probable contributors to the development and progression of breast cancer. Early detection, aided by screening, greatly decreases the mortality associated with this cancer[2] and allows for more treatment choices if breast cancer is found.

Over the years, a variety of methods including mammography, breast ultrasound, magnetic resonance imaging (MRI), clinical breast examinations by a health professional, and breast self-examinations (BSE) have been used to screen for breast cancer. However, none of these screening tests is 100% sensitive in detecting breast cancer. Therefore, it is often recommended that a combination of these techniques be used in the screening process. Opinions vary as to which combinations of screening techniques are the most effective for identifying breast cancer.

The BSE is the only procedure that medical clinicians teach their patients (who are often nonmedically trained individuals) to perform. Recently, the effectiveness of BSE in detecting breast cancer has been questioned; however, most providers cannot even entertain the idea that BSE may be unnecessary.

In the past 20 years, there has been a great deal of controversy about the necessity of teaching and performing BSE.[3] The literature identifies both positive and negative outcomes of BSE, which poses a dilemma in creating clinical guidelines. Both novice and expert healthcare professionals, such as nurse practitioners, should base their practice on the best clinical evidence. The lack of a consensus regarding a standard recommendation for BSE is problematic and confusing, especially for patients (Table 2).


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