Breast self-examination practices and breast cancer survival

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Abstract
To determine the relation between breast self-examination and survival of breast cancer patients, the authors studied 1004 newly diagnosed invasive breast cancer patients in Vermont general hospitals from 1 July 1975 to 31 December 1982. More frequent breast self-examination was associated with a greater likelihood of the patient's detecting her own cancer, less delay from first symptom to histologic diagnosis, earlier clinical stage, smaller pathologic tumor size, and fewer axillary node metastases. At a median follow-up time of 52 months (maximum follow-up, 92 months), 14% of the breast self-examination performers had died of breast cancer versus 26% of the nonperformers (P < 0.001 based on chi-square). The product limit survival curve for breast self-examination performers (N = 424) was significantly better (P < 0.001 by log-rank test) than for breast self-examination nonperformers (N = 411). Survival at 5 years was 75% for breast self-examination performers versus 57% for the nonperformers. The significant survival differences persisted after adjusting for any combination of the covariates age, method of detection, family history of breast cancer, and delay in treatment (P < 0.002). Lead-time would have to be at least 3 years to negate the apparent beneficial effects of breast self-examination on survival. The authors conclude that in this population of breast cancer patients, breast self-examination was related to earlier detection and improved survival.