ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Wednesday, March 5, 1997 TAG: 9703050097
SECTION: NATIONAL/INTERNATIONAL PAGE: A-4 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: Associated Press
RESEARCHERS SAY public health programs should put even more emphasis on mammography.
A rigorous program to train more than 133,000 women to routinely examine their breasts for lumps has not reduced breast cancer deaths after five years, a study shows.
Final answers from the study done in China, where few women ever have breast X-rays, are another five years away. But experts say the preliminary findings suggest that public health programs should put even more emphasis on mammography and less on breast self-examination.
The research suggests that even a vigorous program of instruction in breast self-examination is not successful in early detection of breast cancer or in reducing deaths, said Dr. David B. Thomas of the Fred Hutchinson Cancer Research Center in Seattle, first author of the study.
In comparing 133,000 Chinese women who received intensive training in breast self-examination and a similar number who did not, ``we found there was no difference'' in either cancer deaths or in cancer detection, Thomas said.
``So far, we don't have a hint that it does any good,'' Thomas said. ``But in order to get a final word on this, we will have to follow this group for five more years.''
A report on the study will be published today in the Journal of the National Cancer Institute.
Some public health groups push self-examination and have proposed starting large-scale programs to widely train women in techniques, Thomas said. Private companies even sell self-exam products and instruction videos.
If in five years the final Chinese study results confirm that self-exam does little good, he said, ``then those kinds of efforts would need to be re-evaluated'' and ``scarce public health resources probably be better used for some other purpose.''
Robert A. Smith, an epidemiologist at the American Cancer Society, said his group would continue to recommend breast self-examination as part of a program that includes regular medical exams and periodic mammography.
``Breast self-examination's value is not so much as a screening technique, but as a means of raising awareness of changes that could be abnormal in the breast,'' he said. Self-exam, said Smith, ``doesn't offer nearly the potential to prevent death as mammography does,'' but it can still save lives.
``For a small percentage of women, their cancer can grow and be detected between mammographies,'' Smith said. ``Breast self-examination gives them the chance to become aware of changes that are abnormal and bring those to the attention of a doctor.''
In the study, Thomas and his co-authors organized a self-exam program at the Shanghai Textile Industry Bureau.
X-ray screening is not common among these women, the researcher said, and the study was designed to test the value of self-exam for a group without mammography.
The effort enrolled 267,000 women. About half, 133,375, were enrolled in an intensive self-examination instruction program. The other half were given other health instructions.
In addition to initial training, the self-exam enrollees practiced the technique under the eye of a health care worker every six months. The technique of those women also was tested periodically using a plastic breast model with lumps. The tests showed they were more successful in detecting the lumps than were women who had received no instruction.
Despite that, ``the cumulative breast cancer mortality rate was not appreciably lower for women who received the ... [self-exam] instruction than for those who did not,'' the study said.
Among women who received the instructions, there were 1,436 breast cancer deaths, about 1.1 percent. Among those in the control group, there were 1,648 breast cancer deaths, or 1.2 percent.
Self-examining women found about twice as many benign tumors as did women in the control group, Thomas said. But the number of cancers detected was almost the same: 331 for those who did self-exams and 322 for those who did not.
LENGTH: Medium: 78 linesby CNB