Talk:Breast self-examination

BSE doesn't save lives ?

Why is there no mention of the emerging scientific consensus that BSEs do not save lives? This link to a large randomized trial supports the emerging consensus that BSEs are worthless unless the individual woman is highly motivated and has a strong risk for developing breast cancer. Why is this information being excluded from this page? WhatamIdoing 21:20, 16 August 2007 (UTC)

Whatamidoing also attempted to remove important new studies supportng BSEin order to reflect her biases - — Preceding unsigned comment added by Clinicalbreastexam (talk • contribs) 03:38, 9 August 2011 (UTC)

Sources

The following studies should be included in this article for a complete overview: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1833942/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1228347/ and sites like http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection (American Cancer Society) and http://www.breastselfexam.ca/ and http://www.acog.org/publications/patient_education/bp145.cfm. There is also a document related to the studies already mentioned in this article: www.sogc.org/guidelines/documents/181E-CO-August2006.pdf . Raluca c84 (talk) 19:48, 14 October 2010 (UTC)

Current Research Suggesting Breast Self-Examination Saves Lives

A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec;200(6):712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B. ("Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors... resulting in more aggressive therapy " abstract p1)

Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010 Mar;210(3):314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AAC. ("Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years..." abstract p1)

Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found?Ann Fam Med. 2006 Nov-Dec;4(6):512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T. ( "Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit." p1)

Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women. J Womens Health 2011 Jun 15. [Epub ahead of print] Roth MY, Elmore JG, Yi-Frazier JP, Reisch LM, Oster NV, Miglioretti DL. (“Most women survivors (57%) reported a detection method other than mammographic examination.” p1)

Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program. J Natl Cancer Inst 2011.Jun 22;103(12):942-50. Epub 2011 May 3 Kirsh VA, Chiarelli AM, Edwards SA, O’Malley FP, Shumak RS , Yaffe MJ, Boyd, NF (“…77% of these were true interval cancers, detected clinically in the 1–2 year interval between screening examinations…” p4) — Preceding unsigned comment added by Clinicalbreastexam (talk • contribs) 03:41, 9 August 2011 (UTC)

Any review articles looking at BSE? None of these do... Doc James (talk · contribs · email) 05:02, 9 August 2011 (UTC)

Hi CBE,

My primary concern about the sources you added to the Breast self-exam article is that they're not actually about breast self-exams. They're about lumps being found through any means at all. "Self-detection" is not the same thing as a "Breast self-exam".

Also, Wikipedia isn't a list of studies. A list of studies—especially a list of studies that is cherry-picked to show the "right" answer—isn't an encyclopedia article. WhatamIdoing (talk) 17:11, 9 August 2011 (UTC)

Hi WhatamIdoing

I agree that there is a lot bias in this article. "Some charitable organizations, whose donations depend on promoting fear of breast cancer, still promote this technique as a one-size-fits-all, universal screening approach, even in the low-risk women who are most likely to be harmed by unnecessary invasive follow-up procedures." In this sentence, the writer makes an assumption about the organizations motives, something that is not relevant to wikipedia. The research speaks for itself that Breast self-exam is not effective. Any musings on organizations' motives, are assumptions made by the author without definitive evidence and introduce bias to the article. — Preceding unsigned comment added by 209.144.63.76 (talk) 12:11, 10 October 2011 (UTC)

Okay, so what I'm hearing is that you believe that one of America's leading experts on breast cancer organizations is wrong about what motivates breast cancer organizations. Is that what you meant to say? Or did you not realize that the substance of that sentence is not the invention of a Wikipedia editor, but is an accurate reflection of the published, reliable source written by an expert? WhatamIdoing (talk) 19:56, 7 November 2011 (UTC)

Recent changes

These changes need some clean up, but they do name (sort of) three sources. [1] describes the text that runs "Breast self examination is accurate as mamograpphy and magnetic resonance imaging at detecting new breast cancers in high risk women .(according to American society of breast surgeons ,10th annual meeting,san diego ,california.)"

We may be understating the utility for the small minority of women who are very high risk. It would be interesting to see if anyone has any life-saving (rather than cancer-detecting) data for that subgroup. WhatamIdoing (talk) 05:44, 27 September 2011 (UTC)

Minutes

About this: I don't think that's correct. The abstract says that the second examination took an average of seven minutes, and did not mention any instruction happening. WhatamIdoing (talk) 01:24, 11 May 2013 (UTC)

POV Check

This article is in the scope of {{WikiProject Medicine}} and requires quality medical sources to be complete, and cleanup of non-medical sources.WP:MEDRS

This article has been nominated for a POV check and is scheduled for POV sources cleaned up in favor of direct citations to the pertinent medical studies.

This article has been noted to require additional verification and citations from medical sources.

It is important to note that one of the major sources disputed in this article is posted from a book authored by Sociology PHD Gayle Sulik (www.gaylesulik.com). This source is not a medical source, nor the author a medical author, nor is the author in a medical field. However, the author cites medical studies in support of her book's sociological premise that BSEs do more harm than good. It is important to cleanup this article as a medical article, and remove the 'middleman' sociology theory source to cite the pertinent medical studies directly. This will remove the cited sociology author's personal opinion bias.

POV bias quote by the author of the work, Gayle Sulik:"Some charitable organizations, whose donations depend on promoting fear of breast cancer, still promote this technique as a one-size-fits-all, universal screening approach, even in the low-risk women who are most likely to be harmed by unnecessary invasive follow-up procedures."

This POV bias was addressed above by ClinicalBreastExam (talk · contribs) but not corrected at that time: "In this sentence, the writer makes an assumption about the organizations motives, something that is not relevant to wikipedia. The research speaks for itself that Breast self-exam is not effective. Any musings on organizations' motives, are assumptions made by the author without definitive evidence and introduce bias to the article." Awolnetdiva (talk) 08:43, 5 January 2014 (UTC)

I'd say that a statement about the behavior of organizations is:

(a) not "medical information" and therefore not subject to WP:MEDRS (according to MEDRS itself), and

(b) exactly the kind of statement that ought to be supported by a scholarly book published by a sociologist.

As for whether the author's extremely well-researched and extensively footnoted book can be accurately described as "assumptions made by the author without definitive evidence"—well, I'd politely assume that ClinicalBreastExam never read the book, or any of the others on this subject, because all the independent scholars (i.e., not the book written by Komen's founder) hold the same opinion about the incentives to the organizations. Have you read any of these scholarly sources? WhatamIdoing (talk) 19:26, January 2014 (UTC)

One sociological work does not a medical study make. The medical studies CITED by and used by the sociology text, are fine, but the sociology text is not germain; it is merely a repository of the medical studies, a 'middleman' citation if you will. The cited work is not expert except as a sociological text, and the author's POV statements have no place on a neutral medical article. It would be fine to list the book as a separate reference, but author POV statements are not appropriate in the body.

Please provide citations to "all the independent scholars hold the same opinions about the incentives of the organizations". All is quite a lot, so 10 or so would support your statement.

This is a medical article, and will keep a NPOV. Separate sociological challenges to the medical approach to BSE can be listed, but NOT POV statements without proof, indicating that the charities only want to make money. That has no bearing on a medical wiki. Please read the wiki guidelines for sources for medical articles. Merely being a scholarly citation does not constitute a medical citation, and medical expert citations are required. All medical citations referring to the efficacy of BSEs or the non-efficacy of BSEs shall remain, but a quote lifted from a sociological text regarding the incentives of charity organizations is not pertinent, is not a medical citation and does not belong in a medical article. Awolnetdiva (talk) 21:27, 5 January 2014 (UTC)

Awolnetdiva, I fully agree with you: sociology is not medicine.

Now can you tell me what part of "Some charitable organizations still promote this technique" sounds like "scientific or biomedical information" to you? WhatamIdoing (talk) 01:09, 6 January 2014 (UTC)

WhatamIdoing If these organizations do, then that would be a fact rather than a person's opinion that these organizations exist only to pad their own pockets, but -- of course a statement that these organizations promote the technique needs a citation also, and a mention of those charitable organizations, (ex: Susan G. Komen Foundation), rather than leaving it uncited and ambiguous. This is why this article also has been singled out for additional citations, as well as neutral POV check. Your POV is not neutral, and your editing has maintained a specific anti-BSE stance, while the article must be neutral. Challenges to the efficacy or 'worthiness' of BSE must be presented as challenges. Are you the author of Pink Ribbon Blues? No matter, the studies the book cites are valid medical references, but the book itself is not. I agree the book should be referenced, but in a section on challenges to BSE efficacy. However, author opinions taken from the work should not be referenced. Awolnetdiva (talk) 17:45, 17 January 2014 (UTC)

• I agree that this is a fact. This fact is not uncited: It is cited to a book published at a highly respectable university publishing house, written by an academic who has spent years researching this issue.
• We can discuss whether details like a laundry list of the dozens of organizations that promote this technique is appropriate, but it seems like WP:TRIVIA to me.
• We do not use "valid medical references" to support claims about what an organization says. "Some charitable organizations still promote this technique" is not "biomedical information". "Web pages like http://www.nationalbreastcancer.org/breast-self-exam exist and contain sentences like 'Adult women of all ages are encouraged to perform breast self-exams at least once a month'" is not "biomedical information". We use WP:Reliable sources to support claims like this. If you would please read the main guideline, WP:Identifying reliable sources, you will find that books published by scholars at university presses are considered highly desirable sources for information like this. WhatamIdoing (talk) 19:35, 17 January 2014 (UTC)

By the way, Komen no longer promotes BSEs as a screening tool. They updated their recommendations about six months ago. So if you were going to create a laundry list, you would not want to include Komen on it. WhatamIdoing (talk) 19:51, 17 January 2014 (UTC)

First, MEDRS is a guideline, not a policy. It outlines what a reasonable editor would do if they followed policy, even if they were unaware of the guideline. I do not think however it applies here. If we are writing about procedures to detect breast cancer then MEDRS applies. But if a social scientist writes about whether clinics are following procedures that medical experts consider ineffective, then they are writing within their field of competence. TFD (talk) 22:46, 17 January 2014 (UTC)

I don't think MEDRS applies. However, the sentence arranges facts in a way that constitutes a POV, because it is relies on an argumentative essay as a source and implies causation where (as far as has been evidenced here) there may or may not be causation. So, the POV should be attributed to the author. I think the sentence is also unhelpful as it stands because it doesn't specify how many charities we are talking about. Is it most of them or a few isolated cases? I would guess this can be clarified by referring to the source. On an OT note, the syntax is bad - the first comma should not be there. Formerip (talk) 23:50, 17 January 2014 (UTC)

A 400+ page scholarly book is not generally called "an essay".

If memory serves, the source names a few charities, but the biggest it named was Komen, and they have since changed their advice.

I'd normally agree that it should be attributed, but you'd have to add a lot of names. We happen to list one source, a long book by Gayle Sulik. But you'd have to add Samantha King's Pink Ribbon, Inc and Lerner's Breast Cancer Wars, and probably Ehrenreich's book. Although it doesn't paint the orgs in a purely favorable light, this is the dominant view of the industry. See quotes from these books like:

• "The debates over BSE and breast examinations by physicians were only part of a larger dispute about the "selling" of early cancer detection in the United States. Since its inception, the ACS had been cognizant that its health messages often used alarmist language and the fear of cancer to induce behavioral change."
• "The ASCC's simultaneous emphasis on fear and hope was also self-serving. Cancer society officials carefully tailored their message to maximize donations from the public."

If you're trying to improve health, you need money. If you need money, fear works.

It reminds me of this old question: "What is the first duty of a newspaper?" Answer: To make a profit. Why? Because if you don't bring in money, then you won't be able to print the next newspaper. Similarly, what is the first duty of a charitable organization? To bring in enough donations that it is possible for them to achieve their actual charitable purpose. When the harms (to women) from BSEs were not known, and the benefits (to the organization) from promoting BSEs were obvious (women looking at your logo in the shower every day are more likely to make donations), then of course the charitable organizations wanted to promote BSEs and themselves. It probably seemed like a happy synergy at the time. They weren't evil (well, the Nazi group that promoted BSEs in the late 1930s might have been). They were doing what seemed reasonable to them at the time, and what seemed reasonable to them happened (unintentionally) to harm women's health. WhatamIdoing (talk) 00:18, 22 January 2014 (UTC)

WhatamIdoing, you are starting to drag in too many unrelated examples that are off the track. We have to stick to known facts, general consensus and neutral POV. I would like to suggest that we split the Limitations section into two sections, one of Limitations and one of Challenges. Why don't I take the Limitation section to remove the evident opinion (the opinion/accusation that cancer charities exist just to rip people off), and you form the Challenges section and put all the sources of challenges to the procedure that you remarked on? It gets the scholarly but sociological challenges into the article but does it with a neutral point of view, solving all our difficulties. We just have to remove the author's opinion statements from the factual body, yet you make a decent enough point that the author does challenge the procedure (even if from a sociology standpoint.) Ill let you start by making the Challenges section and won't touch the Limitations section till you have moved the content that you wish. Awolnetdiva (talk) 10:44, 27 January 2014 (UTC)

General questions

Our article gives the impression that BSE is something akin to witchcraft. It seems clear from Googling that there are limitations to relying on it, but Google also gives results from government URLs which seem to indicate otherwise (e.g. [2][3]). Can someone give me a brief explanation as to why this makes sense? Formerip (talk) 00:55, 18 January 2014 (UTC)

TLDR: The science changed faster than the websites.

It's not witchcraft. It provides perceived benefits, but no real ones. It does cause real harms. However, it is very difficult to convince individual breast cancer survivors (including the ones who directly or indirectly control many of the pro-BSE websites) that their BSE didn't actually save their lives, just like it is very difficult to convince them that their zero-symptom/normal-risk screening mammogram didn't save their lives. You can prove statistically that a screening mammogram provides zero benefit to at least four out of five women whose cancer is discovered that way, but all five of them will sincerely tell you that they are "the one".

With Komen finally changing their advice a few months ago, and with no contradictory evidence having appeared, I suspect we'll see more websites getting updated to reflect the evidence-based assessment. WhatamIdoing (talk) 23:20, 21 January 2014 (UTC)