Breast self-exam has been the subject of some controversy during the past three years. Two medical research studies, one in Canada and another in China, found that breast self-exam failed to reduce deaths from breast cancer. The Canadian study even showed that breast self-exam created anxiety and led to unnecessary biopsies.

But local breast health experts say when breast self-exam is used in conjunction with mammography and clinical breast exams performed by a health care professional, women can maximize their chances of a tumor being found early. It is that early detection, according to the American Cancer Society, that saves thousands of lives every year.

Many women delay testing, however, out of fear of what might be found. Breast cancer is easily one of the most feared diseases among women. More than 211,000 new cases are diagnosed in this country annually, and more than 40,000 women in America will die of the disease.

Susan Kraenzle is clinical manager of the Breast Health Center at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. She says the No. 1 question women ask when discussing breast self-exam is, "Will I find cancer doing this?"

Kraenzle''s answer is that breast self-exam should not be used solely as a tool for detecting tumors, but with a different goal in mind. Kraenzle wants women to become so familiar with their bodies that they quickly notice any kind of change, and report it to the doctor.

Here are the recommendations for early breast cancer detection, as outlined by the American Cancer Society:

• Women 40 and older should have a screening mammogram every year.

• From 20 to 39, women should have a clinical breast exam every three years.

• After 40, clinical breast exams should be done annually, usually around the time of the mammogram.

• In their 20s, women should be taught breast self-exam, and the discussion should include the benefits and limitations of monthly self-checks.

According to Kraenzle, the best time to perform breast self-exam is around the same time every month. For women still menstruating, that''s usually about a week after their period starts. Notify your doctor quickly of any changes in your breasts, including abnormalities in the appearance of the skin.