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Teaching Breast Self-Exam to Teens Can Do More Harm Than Good, Expert Says.

NEW ORLEANS -- Breast self-exams serve no purpose in teenage girls and may possibly do some harm, according to Dr. Patricia Simmons, medical director of pediatric and adolescent gynecology at the Mayo Clinic, Rochester, Minn.

"The most compelling data show such a low risk of there being carcinoma of the breast in adolescents that to me that can't justify teaching them the breast self-exam," Dr. Simmons said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

She noted that it is common for physicians to instruct teens on how to perform the exam.

Dr. Simmons outlined her research with the Olmstead County, Minn., database, which shows that the incidence of carcinoma of the breast is zero in a million among girls under age 20, and 20 cases per million in women aged 20-25.

"We should all challenge ourselves about what we're doing and try to make a data-driven decision about teaching this exam," she told this newspaper.

"Some people argue that even if it doesn't catch breast cancer in this group, it makes the girls more comfortable with future breast exams. But does it? Maybe it makes them worry unnecessarily. Even adult women overestimate their risk of this disease. Or maybe it will lead to an unnecessary surgery or a biopsy of a benign lump," she said.

"As far as imaging goes, it is rarely necessary, because it is usually clinically obvious. If you need additional information, it should be from ultrasound," rather than mammography, she said.

Aside from the fact that young breasts have more fiber and less fat than older breasts, making them very difficult to view on mammogram, teen breasts are also often too small to fit properly into a mammogram machine.

"An unsuccessful and probably painful attempt to mammogram these teens may end up discouraging them from pursuing the investigation further," she added.

Clinical warning signs of a problem include particularly large or growing masses, bloody nipple discharge, changes of the skin overlaying the breast, or general illness, Dr. Simmons said.

"Cancer in the breast of a young person is not going to be carcinoma. It is going to be metastatic, meaning you will see other signs of illness," she explained.

In the rare case of teens whose first-degree relatives were diagnosed with breast cancer at a young age, Dr. Simmons does not advocate routine breast self-exam or mammographic screening before age 20.

"The current recommendation is to start screening a person 5 years before the age when their first-degree relative was diagnosed, but I don't see the value of this before she is 20," she said.

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Publication:Family Practice News
Date:Sep 1, 1999
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