The reason that clinical and self breast exam are addressed the way they are in the ACS guidelines, and also not mentioned in the USPSTF guidelines just published, is that the strength of evidence used to evaluate the screening approach and frequency was the effect on disease related mortality.  There is no evidence that breast exam adds to reduction in mortality. They did not specifically evaluate impact of self or clinical breast exam in terms of misuse of resources per se.   If you look at the data behind the USPSTF guidelines, there was actually better reduction in mortality in younger women with more frequent screening, and the main difference was an increase in "unnecessary" testing among younger women.  I think there is potentially more emphasis in the task force guidelines on cost reduction.  The problem comes when insurance companies decide what they will cover based upon these guidelines and the task force recommendations basically leave the decision up to the patient in the younger age group.  They also state that their guidelines are not meant to address high risk women, but provide no recommendations for that group of women

The issue of cost reduction and adopting other countries model is without a doubt of what has occurred, however we need to address popu!ation studies more closely related to African American, Sub-Sahan women and Hispanic women relatec to mammography.  Early detection does save lives, I have mixed messages because the BSE and Clinical Breast Exam do not have a cost. So without any type of pre diagnostics the only avenue will be the mammogram. The problem is utilization is lower.