It's the point in many women's physicals when they avoid eye contact, mumble, maybe tell a little fib and feel a little guilty.
It's when the doctor asks, "Do you do monthly breast self-exams?"
A health report released last week says that women don't have to feel too guilty if they don't rigorously perform the exams, because a recent health review shows they don't improve your chances of surviving breast cancer.
But local health professionals say women should not ignore their own bodies, either.
"Get to know what your breast feels like," Dr. Bryan Yingling of May-Grant Obstetrics and Gynecology urges his patients. "If you notice a change, that is an indication to have an exam by a physician."
The recent data on exams comes from an updated review published in the Cochrane Library, a collection of health databases. The review confirms what doctors have been thinking since 2003, when an initial review came out.
The new review examined two studies of women in Russia and China. The women, almost 400,000 of them in all, were divided into two groups: one that was taught and urged to do breast self-exams; one that was not.
The death rates were the same in both groups. However, the self-exam group had twice as many biopsies, with benign results, according to an online abstract of the study (
www.cochrane.org).
Looking at the review, women might conclude that the breast self-exam is a waste of time.
They would be wrong, local health professionals say.
No, you don't have to write an exam date on your calendar or follow a diagram when you do it, or tell your kids not to yell into the bathroom because it's your monthly breast self-exam time, says Dr. Lois Kroenwetter of OBGYN of Lancaster.
Kroenwetter, who counsels women with complex health issues, is married, has four kids, works and knows how busy women's lives can be.
But, she urges women to "poke around" regularly, and become familiar with their bodies.
"If you don't know what normal is, you'll never know what not-normal is," she says.
Women often do find their own cancer. Yingling says studies show about 20 percent of breast cancers are discovered by women themselves.
Michelle Gehman found hers. This 44-year-old West Lampeter Township woman found a lump in her breast four years ago.
"If I had not done my breast self-exam faithfully, I don't believe I would be here today," she says. "I can say personally that it saved my life."
Six months of treatment followed, including a lumpectomy, chemotherapy and radiation for Gehman, who is the general manager of the Hilton Garden Inn.
"It's scary, but I'd rather know," she says of the self-exam. "The more time you have to fight, the better. Time is of the essence."
That is true, says Lynn Fantom, clinical manager of the Suzanne H. Arnold Center for Breast Health at the Lancaster General Health Campus.
One in eight women will be diagnosed with breast cancer at some point in their lives, she notes. With chances that high, why take additional chances, she asks.
And breast cancer does not always present itself as a lump. Sometimes it's a red patch, a dimple, a change in size or shape — changes which will be noticeable to someone familiar with her body.
"The earlier we catch cancers, the more treatable they are," she said.
Staff writer Cindy Stauffer can be reached at cstauffer@LNPnews.com or 481-6024.
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