Question:

Is it really worth doing self breast exams once a month? My breasts are very lumpy, and I don't think I could feel a mass.

Answer: Admittedly, it's pretty tough to find a small mass growing in the midst of "lumpy-bumpy" fibrocystic breast tissue. While the American Cancer Society recommends a monthly self-exam, both the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care now consider them to be optional.

This may seem odd, but there is a good deal of evidence that monthly self exams do not reduce the death rate from breast cancer. Breast tissue is difficult to examine, and even the most experienced non-clinicians have a very hard time identifying a cancer until it is of considerable size.

Nonetheless, I still see value in monthly exams, which give a woman the opportunity to "learn" her breast tissue and gain more experience in finding a new lump among the old lumps. This, of course, is done in conjunction with other preventive health strategies such as annual mammography, ultrasound and/or MRI.

Hormonally, the best time for a premenopausal woman to perform a self breast exam is one week after her period.

Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.