Practice of breast self examination: disease extent at diagnosis and patterns of surgical care. A report from an Italian study. GIVIO (Interdisciplinary Group for Cancer Care Evaluation).

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Abstract
STUDY OBJECTIVE--The aim was to determine whether breast self examination leads to earlier diagnosis and whether this translates into a larger utilisation of conservative surgical procedures. DESIGN--The study was a survey of a cohort of breast cancer patients diagnosed over the period September 1986-July 1988. SUBJECTS--Participants were 1315 women enrolled in a clinical trial testing the effectiveness of two follow up regimens by 30 general hospitals throughout Italy. MEASUREMENTS AND MAIN RESULTS--Overall, 511 patients (39%) reported some breast self examination practice, but only 109 (8%) did this regularly and in a way deemed correct by their physicians. Breast self examination practice was positively associated with patients' education and past history of benign breast disease and negatively with age. Self examiners were found to have a significantly greater chance of being diagnosed with a primary tumour coded as pT1 according to the 1982 TNM classification (odds ratio = 1.42, 95% CI = 1.13-1.79). This protective effect was mostly evident in the subgroup of optimal performers (odds ratio = 1.54, CI = 1.01-2.34). Nearly half the patients (319/655) eligible for conservative surgery still had an unnecessary radical procedure. CONCLUSIONS--Premorbid breast self examination seems to have a modest effect on the extent of disease at diagnosis. The still widespread use of radical surgery suggests that a careful reanalysis of priorities among possible public interventions is needed before launching massive educational campaigns targeted exclusively at consumers.