Detecting Breast Cancer by Hand: MammaCare Discusses

The MammaCare Foundation recently issued a statement saying that according to recent studies, most breast cancers are found by hand. Mark Kane Goldstein, PhD, a MammaCare Foundation senior scientist stated, “A palpable lump, detected by hand is the most common symptom of breast cancer. Although mammograms—x-rays of the breast—can be useful, their images are masked by breast density in nearly 50% of women. Physical examination, however, is unaffected by density.”

Goldstein took time to answer questions for us about MammaCare and the foundation’s mission to help train every hand that examines a woman, including her own.

Why was the MammaCare Foundation established?

Our research on early breast cancer detection began at the University of Florida and Malcom Randall VA Medical Center because mortality from late stage breast cancer was an epidemic that continues to this day. We reported in a series of studies supported by the National Cancer Institute that properly trained hands will reliably detect small early, 3mm, pea-sized breast cancers (suspicious palpable tumors) without increasing false positive detections. Our original intention was simply to publish and promulgate the evidence and standards knowing they would enable clinicians and women to detect small early cancers.

We assumed, naively, that the training procedure would be integrated into practice because it was an easily teachable skill that could have a meaningful positive impact on women’s morbidity and mortality from breast cancer without the dangers and expense or radiation. Sadly, resistance from the imaging and radiological industries, and surprisingly from public and private women’s health care agencies as well as U.S. Government health agencies impeded training progress for a number of years as data accumulated.

Currently, breast cancers first detected continue to remain 5 to 10 times larger and at a later stage than necessary. So, in response, and with support from scientific agencies, the original research team formed MammaCare to make the skills and standard for breast exam competency universally available.

What is MammaCare’s mission?

MammaCare’s mission is to train every hand that examines a woman for breast cancer. When the team of scientists, physicians, and biomaterial engineers began investigating the capability of fingers to detect breast cancers at the University of Florida, we were surprised that there were no prior evidence-based standards — no published research on the subject existed. We also learned that most women received clinical exams that were random or deficient, incapable of palpating small, suspicious tumors. We were puzzled by opinion and conclusions in the medical literature that the tactile sense was limited to feeling large, late-stage lesions. The only clinical papers published at the time reported that breast cancers discovered by hand and were late stage, large, 3-3.5 centimeters (about the size of a ping pong ball).

Our data from experiments found that with a brief training session using tactually accurate breast models, all hands were able to reliably detect 3-millimeter tumors, 10 times smaller than reported without increasing false positive detections. It was clear that breast cancer detection would be the province of the growing imaging, radiological industry. So, we created MammaCare to assure that a standard for a universal, safe, cost-effective standard of physical examination of the breast would be available.

Fingers feel and read sub-millimeter Braille dots with absolute accuracy.

Many of the reports and studies on MammaCare are here.

Most women—and probably most nurses, female or male—believe that mammograms are the best way to find lumps. What does the MammaCare way offer that regular self-breast exams don’t?

Mammograms and increasing use of radiological imaging are widely available and most often used. It is puzzling, however, to note the evidence that indicates these technologies are not the most likely way breast cancer is first found. Moreover, numerous landmark studies by colleagues such as Joanne Elmore point out in a series of studies that mammography is only as good as the training and experience of the radiologist who reads them with his eyes. The same is true of untrained and trained hands with an important exception — the exam is free of ionizing radiation — an increasing concern — and mammograms often miss palpable tumors. Finally, between 40 and 50% of all women have dense breast tissue that clouds mammograms making interpretation difficult or impossible.

MammaCare training is now being installed in colleges of nursing and medicine providing breast exam skills and standards of practice for thousands of student nurses and physicians across the U.S. and elsewhere as indicated on the student login page.

What should nurses know about MammaCare?

That MammaCare has online and live training and certification programs, recognized continuing education courses and credits, and that new certification courses are conducted via live teletraining at the clinicians’ facility. There is a map on the front page of mammacare.org that should provide access to MammaCare certified nurses and their organizations.

Many of the colleges of nursing (and medicine) in the competency network are employing a new breast exam simulator that teaches and measures exam performance (the MammaCare Simulator Trainer) that was funded in part by the National Science Foundation.