Zusammenfassung
Die Brustselbstuntersuchung ist ein einfaches, nichtinvasives und kostengünstiges Verfahren in der Diagnostik des Mammakarzinoms. In Deutschland wird die Anleitung zur Brustselbstuntersuchung neben der klinischen Brustuntersuchung für Frauen mit Beginn des 30. Lebensjahres entsprechend den Richtlinien des gesetzlichen Krebsfrüherkennungs-Programms empfohlen. Obwohl die Selbstuntersuchung der Brust von vielen Frauen als sehr wichtig eingeschätzt wird, führen diese nur 8 - 40 % der Frauen regelmäßig einmal monatlich durch. Der Wert der Brustuntersuchung wird derzeit kontrovers diskutiert. In Kanada hat kürzlich die „Task Force on Periodic Health Examination“ eine Empfehlung gegen die Propagierung der Brustselbstuntersuchung im Rahmen der Krebsvorsorge ausgesprochen, da die Ergebnisse zweier großer randomisiert-kontrollierter Untersuchungen in Shanghai/China und in St. Petersburg/Russland, eine quasirandomisierte Studie in Großbritannien und eine großangelegte Kohortenstudie in den Vereinigten Staaten keine Reduktion der Brustkrebsmortalität durch die Brustselbstuntersuchung nachweisen konnten. Eine kanadische Fall-Kontroll-Studie hingegen, die einzigartig in der sorgfältigen prospektiven, objektiven Erfassung der Praxis des Selbstabtastens war, konnte für eine bestimmte Technik einen positiven Einfluss auf die Mortalität des Mammakarzinoms zeigen. Diese Studienergebnisse weisen auf die Bedeutung einer ausführlichen Unterrichtung in einer standardisierten und gut evaluierten Technik der Selbstuntersuchung der Brust hin.
Zur Rolle der psychischen Faktoren, insbesondere der Angst, die zur Compliance oder Non-Compliance mit der Brustselbstuntersuchung führen, gibt es eine Reihe von Studien. Über die Auswirkungen der Brustselbstuntersuchung auf die Psyche liegen hingegen kaum Veröffentlichungen vor. Diese werden der weiteren Forschung empfohlen.
Abstract
Breast self-examination is a non-invasive, simple early-screening method for the detection of breast cancer. In Germany clinical breast examination and training for breast self-examination are part of a public early cancer detection program for women 30 years and older. Generally women have accepted breast self-examination as a means for early detection of breast cancer, but only 8 - 40 % of women conduct it once a month. Recently, the Canadian Task Force on Periodic Health Examination excluded breast self-examination instruction from periodic health examinations, because the results of two large randomised controlled trials in Shanghai/China and in St. Petersburg/Russia, a quasi-randomised trial in Great Britain and a large cohort study in the United States have failed to show a reduction of mortality from breast cancer. A Canadian case-control study was unique in its prospective, objective assessment of self-examination practice. Specific aspects of technique were found to be associated with a reduced risk of death from breast cancer. This trial suggests that proper education in a standardized and evaluated breast self-examination technique might be an important factor in breast cancer prevention. Several studies examined the impact of psychological factors on breast self examination practice. They describe that worry and anxiety can motivate and inhibit self-protective behaviour. Few studies have examined the psychological effects of breast self-examination, that might be of particular interest for further research.
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Priv.-Doz. Dr. med. Jael Backe
Frauenärztin und Medizinische Genetik
Domstraße 12
97070 Würzburg
Email: jael.backe@t-online.de
