Breast cancer screening guidelines in both Canada and the United States no longer recommend women of any age do a regular breast self-exam. As an otherwise healthy woman with no known risk factors who was diagnosed with breast cancer at age 46, I have a huge problem with this.

As I continue my Breast Cancer Awareness Month series, today I discuss how I discovered a lump that turned out to be an aggressive form of breast cancer. Thanks to early detection, I’m still here to tell my story. If I had followed the screening guidelines, the outcome could have been very different.

This post was originally published in October 2021 and updated in August 2023.

What the guidelines say

The guideline published by the Canadian Task Force on Preventive Health Care says “We recommend not advising women to practice breast self-examination to screen for breast cancer.”

Similarly, the American Cancer Society’s screening guideline says “Breast self-exam is also no longer recommended as an option for women of any age.”

Both guidelines apply to women of average risk. A woman is considered average risk if she:

• Has no family history of breast cancer in a first degree relative (mother, sister or daughter).
• Doesn’t have an inherited gene mutation like BRCA1 or BRCA2.
• Has no personal history of breast cancer.

By way of explanation, both guidelines say that there is no evidence that breast self-exams reduce the death rate from cancer.

To make things just a little bit more confusing, the American guidelines say:

“However, it is very important for women to be aware of how their breasts normally look and feel and to report any changes to a health care provider right away. This is especially important if a woman notices a breast change at some point in between her regular mammograms.”

This feels like a bit of a mixed message to me.

My story

At the time of my cancer diagnosis, I was 46. I was still four years away from the age when routine screening starts in Ontario. Even if I had been eligible for a screening mammogram, my dense breast tissue meant that it might not have detected the cancer.

Before my diagnosis, I did breast self-exams. But I’d be lying if I said I did them faithfully every month. One morning in the shower, a little voice popped into my head and reminded me it had been a while since I did a self-exam. So, I checked and discovered a lump in my left breast.

Naturally, I was shocked and upset and a little bit in denial. Trying to convince myself it was probably nothing, I waited a few weeks before contacting my doctor. When I went to the doctor, he said it was likely nothing to worry about but sent me for a mammogram and ultrasound “just to be sure”.

Well, it turned out that it was something to worry about. A couple of days after the mammography appointment, I got an urgent call from the doctor’s office saying he needed to see me right away. A few days later, I had a biopsy, and within a week, I heard those dreaded words “You have cancer.” And so, my cancer journey began.

A few weeks later, at my first appointment with the oncologist, she asked me what led to my diagnosis. When I told her how I found the lump, she commented how astute that was on my part and that it could have saved my life.

I am living proof that breast self-exams can make a difference to women of average risk. That’s what makes the guidelines so puzzling to me.

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Why these guidelines do a disservice to all women

We hear so much about the importance of awareness and early detection. Yet, the experts responsible for setting clinical guidelines advise against the one tactic that is available to every woman, regardless of socioeconomic status.

Like me, most women diagnosed with breast cancer have no known risk factors. There is nothing in my family or personal history that would make me high risk. Had I not discovered the lump myself, my cancer likely wouldn’t have been diagnosed until it was much further advanced.

The guidelines say that women should be aware of how their breasts normally look and feel. Isn’t a regular breast self-exam the best way to achieve this? In other areas, we are told to take control of our health. Why is breast screening any different?

One of the arguments that is put forth against breast self-exams is they can lead to unnecessary screening, increased anxiety from medical tests, and possibly unnecessary treatment of slow-growing, low-risk cancers. Okay, but what about the fast-growing, high-risk cancers like mine that would also not be detected and treated?

I also find it baffling that the there is so much inconsistency between countries when it comes to breast screening guidelines. In the UK, the NHS recommends that women check their breasts. Guidelines in Australia suggest women should be aware of how their breasts normally look and feel but they don’t specifically recommend against BSE.

Many experts don’t agree with the guidelines

Shortly after my breast cancer diagnosis, I discovered Breastcancer.org. This site is one of the world’s most credible sources of information about everything to do with breast cancer. It was founded by Dr. Marisa Weiss, a breast oncologist and breast cancer survivor. Here’s what the site has to say on this subject of Breast Self Exams:

We recommend that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy.

Breastcancer.org

And other medical experts also aren’t on board with the guidelines. This report from Global News says the guidelines are based on outdated research and cites concerns from many medical experts.

In my mind, there’s no question of the value of breast self-exams for all women.

How to do a breast self exam

My personal history now puts me in a high-risk group. In addition to annual mammograms, I will continue to do a monthly breast self-exam.

Ultimately, you need to do what you think is best for your body. I firmly believe this simple thing that takes just a few minutes each month saved my life. It could also save yours. I urge you to make monthly breast exams part of your self-care routine.

Check out the Breast Self Exam page on Breastcancer.org for step-by-step instructions. Your life could depend on it.

What do you think of these guidelines? Tell us below.