Der Stellenwert der Brustselbstuntersuchung in der Früherkennung des Mammakarzinoms

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.

Literatur

• 1 Alagna S W, Morokoff P J, Bevett J M, Reddy D M. Performance of breast self-examination by women at high risk for breast cancer.  Women Health. 1987;  12 29-46
• 2 Auvinen A, Elovainio L, Hakama M. Breast self-examination and survival from breast cancer: a prospective follow-up study.  Breast Cancer Res Treat. 1996;  38 161-168
• 3 Babrow A S, Kline K N. From “reducing” to “coping with” uncertainty: reconceptualization the central challenge in breast self-exams.  Soc Sci Med. 2000;  51 1805-1816
• 4 Baker L H. Breast Cancer Detection Demonstration Project: five-year summary report.  CA Cancer J Clin. 1982;  32 194-225
• 5 Barron C R, Houfek J F, Foxall M J. Coping style, health beliefs, and breast self-examination.  Issues Ment Health Nurs. 1997;  18 331-350
• 6 Baulch Y S, Larson P J, Dodd M J, Deitrich C. The relationship of visual acuity, tactile sensitivity, and mobility of the upper extremities to proficient breast self-examination in women 65 and older.  Oncol Nurs Forum. 1992;  19 1367-1372
• 7 Baxter N. with the Canadian Task Force on Preventive Health Care . Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer?.  CMAJ. 2001;  164 1837-1846
• 8 Benedict S, Williams R D, Baron P L. Recalled anxiety: from discovery to diagnosis of a benign breast mass.  Oncol Nurs Forum. 1994;  21 1723-1727
• 9 Bennett S E, Lawrence R S, Angiolillo D F, Bennett S D, Budman S, Schneider G M, Assaf A R, Feldstein M. Effectiveness of methods used to teach breast self-examination.  Am J Prev Med. 1990;  6 208-217
• 10 Bondy M, Vogel V J, Halabi S, Lustbader E D. Identification of women at increased risk for breast cancer in a population-based screening programme.  Cancer Epidemiol Biomarkers Prev. 1992;  1 143-147
• 11 Boyle M, Michalek A, Bersani G, Nemoto T, Mettlin C. Effectiveness of a community program to promote early breast cancer detection.  J Surg Oncol. 1981;  18 183-188
• 12 Brewer K M, Baldwin D. The relationship between self-esteem, health habits, and knowledge of BSE practice in female inmates.  Public Health Nurs. 2000;  17 16-24
• 13 Brain K, Normann P, Gray J, Mansel R. Anxiety and adherence to breast self-examination in women with a family history of breast cancer.  Psychosom Med. 1999;  61 181-187
• 14 Burnett C B, Steakley C S, Slack R, Roth J, Lerman C. Patterns of breast cancer screening among lesbians at increased risk for breast cancer.  Women Health. 1999;  29 35-55
• 15 Calnan M W, Chamberlain J, Moss S. Compliance with a class teaching breast self examination.  J Epidemiol Community Health. 1983;  37 264-270
• 16 Calnan M. Women and medicalisation: an empirical examination of the extent of women's dependence on medical technology in the early detection of breast cancer.  Soc Sci Med. 1984;  18 561-569
• 17 Calnan M. An evaluation of the effectiveness of a class teaching breast self-examination.  Br J Med Psychol. 1985;  58 317-329
• 18 Caplan L S, Wells B L, Haynes S. Breast cancer screening among older racial/ethnic minorities and whites: barriers to early detection.  J Gerontol. 1992;  47 101-110
• 19 Carter A C, Feldmann J G, Tiefer L, Hausdorff J K. Methods of motivating the practice of breast self-examination: a randomized trial.  Prev Med. 1985;  14 555-572
• 20 Chalmers K I, Luker K A. Breast self-care practices in women with primary relatives with breast cancer.  J Adv Nurs. 1996;  23 1212-1230
• 21 Clarke V A, Savage S A. Breast self-examination training: a brief review.  Cancer Nursing. 1999;  22 320-326
• 22 Deutsche Krebshilfe .http://www2.krebshilfe.de/ratgeber/ratgeber.asp?Nr=1. 
• 23 Dorsay R H, Cuneo W D, Somkin C P, Tekawa I S. Breast self-examination: improving competence and frequency in a classroom setting.  Am J Public Health. 1988;  78 520-522
• 24 Engel J, Baumert J, Dirschedl P, Sauer H, Hölzel D. Wirksamkeit der Selbstuntersuchung, Palpation und Mammographie zur Früherkennung des Mammakarzinoms: Erste Ergebnisse der Feldstudie München.  Geburtsh Frauenheilk. 2000;  60 155-164
• 25 Ellerton M L, Smillie C L. Demonstration of a breast self-examination instruction program produced by a nongovernmental organization.  Can J Public Health. 1986;  77 296-300
• 26 Erblich J, Bovbjerg D, Valdimarsdottir H B. Psychological distress, health beliefs, and frequency of breast self-examination.  J Behav Med. 2000;  23 277-292
• 27 Feldman J G, Carter A C, Nicastri A D, Hosat S T. Breast self-examination, relationship to breast cancer at diagnosis.  Cancer. 1981;  47 2740-2745
• 28 Ferro S, Caroli A, Nanni O, Biggeri A, Gambi A. A randomized trial on breast self-examination in Faenza (Northern Italy).  Tumori. 1996;  82 329-334
• 29 Fletcher S W, O'Malley M S, Pilgrim C A, Gonzalez J J. How do women compare with internal medicine residents in breast lump detection? A study with silicone models.  J Gen Intern Med. 1989;  4 277-283
• 30 Fletcher S W, O'Malley M S, Earp J L, Morgan T M, Lin S, Degnan D. How best to teach women breast self-examination. A randomised controlled trial.  Ann Intern Med. 1990;  112 772-779
• 31 Foster R S, Lang S P, Constanza M C, Worden J K, Haines C R, Yates J W. Breast self-examination practices and breast cancer stage.  N Engl J Med. 1978;  299 265-270
• 32 Foster R S, Constanza M C. Breast self-examination practices and breast cancer survival.  Cancer. 1984;  53 999-1005
• 33 Foxall M J, Barron C, Houfek J F. Ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynaecologic cancer screening practices.  Oncol Nurs For. 2001;  28 727-738
• 34 Gastrin G, Miller A B, To T, Aronson K J, Wall C, Hakama M, Louhivuori K, Pukkala E. Incidence and mortality from breast cancer in the mamma program for breast screening in Finland 1973 - 1986.  Cancer. 1994;  73 2168-2174
• 35 Gehrke A W. Breast self-examination: a mixed message.  J Natl Cancer Inst. 2000;  92 1120-1121
• 36 Greenwald P, Nasca P C, Lawrence C E, Horton J, McGarrah R P, Gabriele T. Estimated effect of breast self-examination and routine physician examinations on breast cancer mortality.  N Engl J Med. 1978;  299 271-273
• 37 Hall D C, Adams C K, Stein G H, Stephenson H S, Goldstein M K, Pennypacker H S. Improved detection of human breast lesions following experimental training.  Cancer. 1980;  46 408-414
• 38 Harvey B J, Miller A B, Baines C J, Corey P N. Effect of breast self-examination techniques on the risk of death from breast cancer.  Can Med Assoc J. 1997;  157 1205-1212
• 39 Haughey B P, Marshall J R, Nemoto T, Kroldart K, Mettlin C, Swanson M. Breast self-examination: reported practices, proficiency, and stage of disease at diagnosis.  Oncol Nurs Forum. 1988;  15 315-319
• 40 Hislop T G, Worth A J, Kan L, Rousseau E. Post screen-detected breast cancer within the Screening Mammography Programme of British Columbia.  Breast Cancer Res Treat. 1997;  42 235-242
• 41 Holmberg L, Ekbom A, Calle E, Mokdad A, Byers T. Breast cancer morbidity in relation to self-reported use of breast self-examination. A cohort study of 450, 000 women.  Cancer Res Treat. 1997;  43 137-140
• 42 Howe H L. Proficiency in performing breast self-examination.  Patient Couns Health Educ. 1980;  4 151-153
• 43 Hugueley C M, Brown R L. The value of breast self-examination.  Cancer. 1981;  47 989-995
• 44 Janda M, Obermair A, Haidinger G, Waldhoer T, Vutuc C. Austrian women's attitudes toward and knowledge of breast self-examination.  J Cancer Educ. 2001;  15 91-94
• 45 Kash K M, Holland J C, Halper M S, Miller D G. Psychological distress and surveillance behaviours of women with a family history of breast cancer.  J Natl Cancer Inst. 1992;  84 24-30
• 46 Katz R C, Meyers K, Walls J. Cancer awareness and self-examination practices in young men and women.  J Behav Med. 1995;  18 377-384
• 47 Kelly P T. “High risk” women: Breast cancer concerns and health practices.  Front Radiat. 1983;  17 11-15
• 48 Kline K N. Reading and reforming breast self-examination discourse: claiming missed opportunities for empowerment.  J Health Commun. 1999;  4 119-141
• 49 Kline K N, Mattson M. Breast self-examination pamphlets: a content analysis grounded in fear appeal research.  Health Commun. 2000;  12 1-21
• 50 Larkin M. Breast self-examination does more harm than good, says task force.  Lancet. 2001;  357 2109
• 51 Lee E C, Maguire G P. Emotional distress in patients attending a breast clinic.  Br J Surg. 1975;  62 162
• 52 Le Geyte M, Mant D, Vessey M P, Jones L, Yudkin P. Breast self-examination and survival from breast cancer.  Br J Cancer. 1992;  66 917-918
• 53 Lerman C, Trock B, Rimer B K, Boyce A, Jepson C, Engstrom P F. Psychological and behavioural implications of abnormal mammograms.  Ann Intern Med. 1991;  114 657-661
• 54 Lerman C, Trock B, Rimer B K, Jepson C, Brody D, Boyce A. Psychological side effects of breast cancer screening.  Health Psychol. 1991;  10 259-267
• 55 MacFarlane M E, Sony S D. Women, breast lump discovery, and associated stress.  Health Care Women Int. 1992;  13 23-32
• 56 Mant D, Vessey M P, Neil A, Mc Pherson K, Jones L. Breast self-examination and breast cancer stage at diagnosis.  Br J Cancer. 1987;  55 207-211
• 57 Mayer J A, Frederiksen L W. Encouraging long-term compliance with breast self-examination: the evaluation of prompting strategies.  J Behav Med. 1986;  9 179-189
• 58 McCaul K D, Schroeder D M, Reid P A. Breast cancer worry and screening: some prospective data.  Health Psychol. 1996;  15 430-433
• 59 McCaul K D, Branstetter A D, O'Donnell S M, Jacobson K, Quinlan K B. A descriptive study of breast cancer worry.  J Behav Med. 1998;  21 565-579
• 60 Miller A B, Baines C J, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 - 59 years.  CMAJ. 1992;  147 1477-1488
• 61 Muscat J E, Huncharek M S. Breast self-examination and extent of disease: a population-based study.  Cancer Detect Prev. 1991;  15 155-159
• 62 Nekhlyudov L, Fletcher S W. Is it time to stop teaching breast self-examination?.  CMAJ. 2001;  164 1851-1852
• 63 Newcomb P A, Weiss N S, Storer B E, Scholes D, Young B E, Voigt L F. Breast self-examination in relation to the occurrence of advanced breast cancer.  J Natl Cancer Inst. 1991;  83 260-265
• 64 Newcomb P A, Sharon J O, Roberts F D, Storer B E, Love R R. Assessing breast self-examination.  Prev Med. 1995;  24 255-258
• 65 Northouse L L, Jeffs M, Cracciolo-Caraway A Q, Lampman L, Dorris G. Emotional distress reported by women and husbands prior to breast biopsy.  Nurs Res. 1995;  44 196-201
• 66 Paepke S, Schubert R, Hüttner C, Blohmer J U, Lichtenegger W. Informiertheit und Brustkrebsvorsorgeverhalten der weiblichen Bevölkerung in Berlin und Hildesheim - Ergebnisse einer Querschnittsuntersuchung von 2110 Frauen.  Geburtsh Frauenheilk. 2000;  60 620-624
• 67 Paepke S, Schwarz-Boeger U, Minckwitz von G, Schultz-Zehden B, Kaufmann M, Beck H, Meden H, Kiechle M, Beckmann M W. Brustkrebsfrüherkennung. Kenntnisstand und Akzeptanz in der weiblichen Bevölkerung.  Deutsches Ärzteblatt. 2001;  98 2178-2186
• 68 Pearlman D N, Rakowski W, Ehrick B, Clark M A. Breast cancer screening practices among black, Hispanic, and white women: reassessing differences.  Am J Prev Med. 1996;  12 327-337
• 69 Persson K, Johansson I, Ek A C. Breast self-examination among Swedish women.  J Cancer Educ. 1995;  10 163-167
• 70 Romsaas E P, Malec J F, Javenkoski B R, Trump D L, Wolberg W H. Psychological distress among women with breast problems.  Cancer. 1986;  57 890-895
• 71 Ross J A, Severson R K, Davis S, Stanford J L, Potter J D. Seasonal trends in the self-detection of breast cancer: indications from the Cancer and Steroid Hormone (CASH) study.  Breast Cancer Res Treat. 1997;  42 187-192
• 72 Rosvold E A, Hjartaker A, Bjertness E, Lund E. Breast self-examination and cervical cancer testing among Norwegian female physicians. A nation-wide comparative study.  Soc Sci Med. 2001;  52 249-258
• 73 Ruchlin H. Prevalence and correlates of breast and cervical cancer screening among older women.  Obstet Gynecol. 1997;  90 16-21
• 74 Rutledge D N. Sensitivity and specificity of lump detection in breast model.  Am J Prev Med. 1992;  8 314-318
• 75 Rutledge D N. Effects of age on lump detection accuracy.  Nurs Res. 1992;  41 306-308
• 76 Salazar M K. Breast self-examination beliefs: a descriptive study.  Public Health Nursing. 1994;  11 49-56
• 77 Scott D W. Anxiety, critical thinking and information processing during and after breast biopsy.  Nurs Res. 1983;  32 24-28
• 78 Semiglazov V F, Moiseyenko V M. Breast self-examination for the early detection of breast cancer: A USSR/WHO controlled trial in Leningrad.  Bull World Health Organ. 1987;  65 391-396
• 79 Semiglazov V F, Moiseyenko V M, Bavli J L, Migmanova N Sh, Seleznyov N K, Popova R T, Ivanova O A, Orlov A A, Chagunava O L, Barash N J, Matitzin A N, Dyatchenko O T, Kozhevnikov S Y, Alexandrova G I, Sanchakova A V, Musayev B T. The role of breast self-examination in early breast cancer detection (Results of the 5-years USSR/WHO randomized study in Leningrad).  Eur J Epidemiol. 1992;  8 498-502
• 80 Semiglazov V F, Sagaidak V N, Moiseyenko V M, Mikhailov E A. Study of the role of breast self-examination in the reduction of mortality from breast cancer. The Russian Federation/WHO Study.  Eur J Cancer. 1993;  29 2039-2046
• 81 Semiglazov V F, Moiseyenko V M, Protsenko S A, Bavli I L, Orlov A A, Ivanova O A. Preliminary results of the Russia (St. Petersburg)/WHO program for the evaluation of the effectiveness of breast self-examination.  Vopr Onkol. 1996;  42 49-55
• 82 Semiglazov V F, Moiseyenko V M, Protsenko S A, Kharikova R S, Manikhas A G. Breast self-examination for the early detection of breast cancer. Russia/WHO controlled trial in St. Petersburg.  Breast Cancer Res Treat. 1998;  50 509
• 83 Semiglazov V F, Moiseyenko V M, Manikhas A G, Protsenko S A, Kharikova R S, Ivanov V G, Barash N J, Seleznev I K, Migmanova N Sh, Ivanova O A, Orlov A A, Popova R T, Chagunava O L. Role of breast self-examination in early detection of breast cancer: Russia/WHO prospective randomised trial in St. Petersburg.  Cancer Strategy. 1999;  1 145-51
• 84 Stefanek M E, Wilcox P. First-degree-relatives of breast cancer patients: screening practices and provision of risk information.  Cancer Detect Prev. 1991;  15 379-384
• 85 Steggles S, Lightfoot N, Sellick S M. Psychological distress associated with organized breast cancer screening.  Cancer Prev Control. 1998;  2 213-220
• 86 Strickland C J, Feigl P, Upchurch C, King D K, Pierce H I, Grevstad P K, Bearden J D, Dawson M, Loewen W C, Meyskens F L. Improving breast self-examination compliance: a southwest oncology group randomised trial of three interventions.  Prev Med. 1997;  26 320-332
• 87 Tang T S, Solomon L J, McCracken L M. Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older.  Prev Med. 2000;  31 575-583
• 88 Thomas D B, Gao D L, Self S G, Allisen C J, Tau Y, Mahloch J, Ray R, Quin Q, Presley R, Porter P. Randomized trial of breast self-examination in Shanghai: methodology and preliminary results.  J Natl Cancer Inst. 1997;  89 355-365
• 89 Trial of Early Detection of Breast Cancer Group U K. First results on mortality reduction in the UK trial of early detection of breast cancer.  Lancet. 1988;  2 411-416
• 90 Trial of Early Detection of Breast Cancer Group U K. 16-year mortality from breast cancer in the UK trial of early detection of breast cancer.  Lancet. 1999;  353 1909-1914
• 91 US Preventive Services Task Force .Report. Screening for breast cancer.  Guide to Clinical Preventive Services. 2nd ed. Baltimore; Williams & Wilkins 1996: 73
• 92 Vacek P M, Mickey R M, Worden J K. Reliability of self-reported breast screening information in a survey of lower income women.  Prev Med. 1997;  26 287-291
• 93 Wardle J, Steptoe A, Smith H, Groll-Knapp E, Koller M, Smith D, Brodziak A. Breast self-examination: attitudes and practices among young women in Europe.  Eur J Cancer Prev. 1995;  4 61-68
• 94 Woolf S H. United States Preventive Services Task Force recommendations on breast cancer screening.  Cancer. 1992;  69 1913-1918