The Nottingham breast self-examination project.

The Nottingham breast self-examination (BSE) project forms a part of the British Trial of Early Detection of Breast Cancer which compares mammographic screening, BSE and control areas. Presented here is an analysis of the Nottingham figures. A total of 89,000 women aged 40-64 were invited for lectures in BSE and 28,000 attended (42%); the corrected attendance allowing for register inaccuracies is around 55%. In women invited for education since the scheme began in 1979 (study) 751 cancers have been diagnosed. The 751 cancers occurring in the same health district and age group, working chronologically backwards from 1979 have been identified (control). Prognostic factors (size, node involvement and grade) are improved in the study group; however, at the present time of follow-up the case survival curves do not separate. A case control study shows that women aged 50-65 who attended for education have a relative risk of death from breast cancer of 0.66 (0.45-0.97) in comparison with those who did not attend (p = 0.025). The figure for women aged 40-49 is 0.85 (0.50-1.46). A programme of BSE is cheap to run, may give a survival advantage and should be added to mammographic screening programmes, especially when the interval is beyond 18 months.