Self-examination in the early detection of breast cancer: memorandum from a WHO meeting.

Breast self-examination is of interest for the early detection of breast cancer, especially in areas where mammography and regular physical examination of the breasts are not practicable as public health policies. At present, there is insufficient evidence that breast self-examination is effective in reducing mortality from breast cancer. To determine its effectiveness, this method should be applied in a comprehensive programme that provides teaching and guidance on practice of the technique, and facilities for self-referral and diagnosis (when any abnormality is detected) as well as treatment, taking into account the background (economic, social, and cultural) of the country or area concerned. Once the programme has been developed, its effectiveness in reducing breast cancer mortality will have to be assessed in carefully designed research studies. The favoured design for assessment is a randomized controlled trial. Other types of studies, such as quasi-experimental comparisons or a case-control study, are less satisfactory, but may be conducted under strictly specified conditions. Until the effectiveness of breast self-examination has been established, it cannot be recommended as a public health measure for control of breast cancer.