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Self-examination saved woman's life

Experts maintain that checking yourself can still lead to early detection

By Michael B. Davie
Staff Reporter
Toronto Star - October 3, 2002

Adrienne Winslow credits breast self-examination with saving her life.

And she says women who neglect the procedure are gambling with their health.

"I wouldn't be here today if I hadn't done a breast self-examination," says Winslow, 51, a Burlington mother of two who recently celebrated 30 years of marriage with her husband, Paul, 54.

In May, 1993, Winslow performed a breast self-examination "and I found a lump close to the surface tissue of my left breast."

The next day, Winslow, then 43, underwent a mammogram. The lump was a cyst and cancer was discovered just beneath it.

"Because I found the lump early on, before the cancer spread, I was able to undergo a lumpectomy," Winslow explains. "The lump and cancerous tissue were removed. I underwent 25 follow-up radiation treatments, and that cancer was ended.

"But if I hadn't discovered that lump through a breast self-examination, the cancer might have spread and possibly killed me. The BSE (breast self-examination) saved my life."

A few years later, cancer was again discovered in the same breast and Winslow had a mastectomy. Winslow again credits early detection through a "triad" screening approach — emphasizing BSE, clinical check-ups and mammograms — for finding the cancer.

Today, Winslow is a leading advocate of this triad approach.

Winslow knows that her belief in BSE runs counter to the findings of a study by Dr. Nancy Baxter at the University of Toronto and the Canadian Task Force on Preventive Health Care.

That study, published last year in the Canadian Medical Association Journal, found that BSEs had no benefit and resulted in needless worry through false cancer alarms and scarring from unnecessary biopsies.

However, Winslow and other critics of the study note that it was based on groups of women in Russia and China, countries where health standards, treatment facilities, treatment methods and BSE teaching may differ from those found in Canada. As well, in the Chinese study group there were only five years of follow-up, and in Russia there's no individual teaching of BSE. More importantly, the study focused on BSE in isolation, when in North America, the standard of care is to use BSE along with mammography and clinical breast examination.

Dr. Fei Liu questions whether the BSEs included in the study were performed properly. Liu, chair of the professional advisory committee of the Canadian Breast Cancer Foundation's Ontario chapter, also believes that it's "ludicrous to advise women to depend on technologies such as mammography as a sole modality for breast cancer screening when we have ample anecdotal and statistical evidence indicating mammograms only have an 80 per cent accuracy rate."

Barbara Heft, president of the Canadian Breast Cancer Network, questions the study's finding of unnecessary biopsies. Most doctors will inform a women who finds a lump herself that the odds are that it is not malignant. The next step is a mammogram and further tests to determine if a biopsy is needed.

"I don't know of any biopsies that are unnecessary," says Heft, 57, who credits a breast self-examination for the discovery of her own cancer and for possibly saving her life.

"Biopsies are done to determine whether a tumour is malignant. Not having a biopsy done, because you find it's stressful or might cause scarring, is gambling with your life."

Heft urges women to continue performing BSEs as a core component of the triad approach, "given that your chances of surviving cancer improve dramatically with early detection."

That advice is seconded by the Canadian Breast Cancer Foundation, the largest charitable organization in Canada dedicated exclusively to supporting the advancement of breast cancer research, education, diagnosis and treatment.

The Canadian Cancer Society also recommends routine teaching of BSE.

Adrienne Winslow says the controversial study actually appears to have had a positive impact on the number of women performing BSEs.

"Although it was a negative study, it focused a lot of attention on BSE and a lot of women got their backs up and decided they were going to address their own health by performing a breast self-examination."

When extensive chemotherapy from the second cancer, in 1998, forced her to leave her job as sales supervisor with Nestlé Canada, Winslow joined the staff of Breast Cancer Support Services as outreach and education co-ordinator. She had previously been a long-time volunteer there.

Winslow and her daughters Samantha, 27, and Allison, 25, can be found au naturel illustrating October in the Breast of Canada calendar, which promotes breast cancer awareness and prevention (http://www.breastofcanada.com).

As well, Winslow has developed a breast health workshop, which she presents to companies, organizations and individuals. Last year, more than 2,000 women learned self-examination techniques in her workshops, which use silicone models.

Pamphlets are also used for BSE instruction, and the Thunder Bay Breast Health Coalition has developed one that's very easy to follow.

It uses lots of photos and plain language to get the instructions across clearly, says Jan Lewkin, who helped develop the pamphlet. Copies are available at many Ontario clinics and by contacting the Canadian Breast Cancer Foundation at 416-596-6773 or 1-800-387-9816.