The Science Behind the Standard

The MammaCare ®
Method

The recognized skill-based standard for clinicians and women who perform physical breast exams.

Published Research Explore Training
Woman lying on her back with her hand on her breast, performing a breast self-examination

Origin Story

From Braille to Breast Cancer Detection

In the 1970s, our founders observed that many breast lumps were first discovered by women themselves, rather than through mammography. Unfortunately, by the time these lumps were found, they were often large and, if cancerous, more advanced.

Braille demonstrated the remarkable potential of trained touch. Through practice, skilled Braille readers learn to move their fingertips across raised dots, each representing a letter, and rapidly interpret patterns through touch that untrained fingers might struggle to distinguish. Our founders hypothesized that the same principle could be applied to breast examination: Could systematic training teach women to recognize subtle differences in breast tissue and detect small lumps earlier, when treatment could be more effective?

To investigate, Drs. Mark Kane Goldstein, Henry S. Pennypacker, and Calvin Adams assembled a team of University of Florida scientists, engineers, physicians, and surgeons. Together, they conducted the first studies demonstrating that fingers can be trained to reliably detect small suspicious changes in breast tissue.

The team engineered tactile replicas of early-stage breast cancers embedded within silicone breast models and developed systematic training procedures to help learners distinguish them from normal breast tissue. Their work helped transform breast examination into a skill that could be taught, measured, and validated.

Read the full bibliography
1976
First published study on simulated lump detection
50 +
Years of continuous, peer-reviewed research
60 +
Research
NCI/NSF
Early research supported by the National Cancer Institute and National Science Foundation

The technique

The 5 Ps of the MammaCare ® Method

MammaCare's seminal research results in 5 essential components for performing a thorough breast exam:

These components are incorporated into both breast self-exam training and clinical breast exam training programs.

Explore training options

The performance standards

Three measurable skills. One standard

Every MammaCare-trained exam is evaluated against the same three criteria.

Sensitivity

Detecting all palpable abnormalities present.

Sensitivity illustration: finding all abnormalities present in the breast ✓

Specificity

Distinguishing abnormal findings from normal tissue.

Specificity illustration: distinguishing abnormalities from normal breast tissue to minimize false positives ✓

Thoroughness

Systematically examining all breast tissue.

Thoroughness illustration: systematic, complete palpation of all breast tissue ✓

What the research shows

Measured gains, not anecdotes

24% → 83%
Lump detection proficiency, pre-course to post-course, in published studies of MammaCare-trained providers. Smith et al., 1996
59% → 94%
Primary care providers able to detect 60–100% of lumps in test models, before versus after training. Vetto et al., 2002
1980
Cancer publishes Hall et al., documenting improved lesion detection following MammaCare's experimental training protocol. Hall et al., 1980

The bibliography

Research

Selected research on the development, validation, and emerging clinical application of MammaCare training and technology.

Breast Cancer in Young Women 54
  1. Assessment of skills among women of reproductive age group trained in breast self-examination: A quasiexperimental study T Singh , MM Singh , S Rao… - Journal of Family …, 2025 - pmc.ncbi.nlm.nih.gov … Our study …. breast model by MammaCare Foundation [“The overall skills of BSE were found to be inadequate which significantly improved after skill-based training using videos and demonstration.”]
  2. Breast cancer incidence among US women aged 20 to 49 years by race, stage , and hormone receptor status S Xu, S Murtagh , Y Han , F Wan , AT Toriola - JAMA network open, 2024 - jamanetwork.com … Young women are more likely to develop breast cancer with … older women , including larger tumor size, advanced tumor stage , … specific breast cancer risk factors among younger women
  3. Distant- Stage Breast Cancer Incidence Is Increasing in US Women across Age Groups and Race and Ethnicity Groups E Kim, L Moy - Radiology, 2024 - pubs.rsna.org … While research has shown an increase in distant- stage breast cancer incidence in young women , … of distant- stage breast cancer incidence across different ages, including older women . …
  4. Survival outcomes of young -age female patients with early breast cancer : an international multicenter cohort study …, SA Im , Asian Breast Cancer Cooperative Group - Esmo Open, 2024 - Elsevier … Young female patients with breast cancer are expected to … of young Asian female patients with breast cancer across different … of young Asian patients with early- stage breast cancer were …
  5. … Young Women's Breast Cancer Study (YWS)–a multisite prospective cohort study to advance the understanding of breast cancer diagnosed in women aged 40 years … SM Rosenberg, Y Zheng , K Ruddy , PD Poorvu… - BMJ open, 2024 - bmjopen.bmj.com … 1302 women newly diagnosed with stages 0–IV breast cancer … our understanding of breast cancer in young women , gener… Breast cancer is the leading cause of cancer-related deaths …
  6. Global burden and attributable risk factors of breast cancer in young women : historical trends from 1990 to 2019 and forecasts to 2030 by sociodemographic index … M Yuan, Y Zhu, Y Ren, L Chen, X Dai … - Journal of global …, 2024 - pmc.ncbi.nlm.nih.gov … Due to differences in the availability of early- stage screening, … trend of breast cancer in young women remain unclear. Compared with older age groups,
  7. Second primary breast cancer in young breast cancer survivors KD Brantley, SM Rosenberg, LC Collins… - JAMA …, 2024 - jamanetwork.com … of SPBC among young women in the contemporary treatment … enrolled in the Young Women ’s Breast Cancer Study (YWS), 22 … women diagnosed with stage 0-IV BC at age 40 years or …
  8. Increasing incidence of breast cancer in young women over time P Pujol, L Remontet, B Lapôtre-Ledoux, A Rogel… - The Breast , 2025 - Elsevier “Recent publications have shown that the incidence of early-onset breast cancer (EOBC) has been increasing in the US and UK over the past decade [ [1] , [2] , [3] ]. It has also been shown that the overall incidence of breast cancer in Europe has been rising over the same period of time [ 4 ]. This increased incidence, particularly in young women, may reflect important changes in risk factor exposure and lifestyle over time and is a current public and media concern. “
  9. Recent strategies in diagnosis, screening, prevention, and treatment of breast cancer in young women DK Sharma , R Saripilli - Discover Oncology, 2025 - Springer … the current state of breast cancer research in young women , advancements in diagnosis, … 5 Stages of BC The breast cancer staging outlined in Table 2 adheres to the guidelines …
  10. Breast cancer index in premenopausal women with early- stage hormone receptor–positive breast cancer …, S Loi , M Colleoni , CA Schnabel… - JAMA …, 2024 - jamanetwork.com … women younger than 40 years with HR+ breast cancer are at … for 54% of those women younger than 40 years and 59% of … for both younger and older premenopausal women who had …
  11. Update Breast Cancer 2024 Part 2–Patients with Early Stage Breast Cancer W Janni, HC Kolberg, AD Hartkopf … - Geburtshilfe und …, 2025 - thieme-connect.com … with early- stage breast cancer . Most of the clinically relevant changes were the result of using immune checkpoint inhibitors to treat patients with triple-negative breast cancer (TNBC) …
  12. Young women with early- stage breast cancer treated with upfront surgery: Overview of oncological outcomes L Scardina, B Carnassale, A Di Leone… - Journal of Clinical …, 2024 - mdpi.com … breast -conserving or mastectomy. To our knowledge, there are limited studies surrounding the treatment of young women with early breast cancer … young women with early breast cancer …
  13. Breast cancer in young women : is it different? A single-center retrospective cohort study O Abulkhair, A Omair , D Makanjuola… - Clinical Medicine …, 2024 - journals.sagepub.com … Breast cancer among young women is a crucial problem, and … have revealed that younger women are more likely to present … younger age group were stage 2 (47.9%), followed by stage …
  14. Breast cancer incidence and survival by subtype, stage at diagnosis and socioeconomic deprivation among young women in the Community of Madrid, Spain C Pino‐Rosón, S Ávila‐Arroyo… - … Journal of Cancer , 2026 - Wiley Online Library … Among women , breast cancer is the most common cancer worldwide.In Spain, recent estimations indicate that more than 36,000 cases of breast cancer were diagnosed in 2024 , which …
  15. Challenges with the management of young women's breast cancer in Gulf countries and the Middle East AA Al Ajmi, O Ayaad , S Al Aghbari… - … of Young Womens …, 2024 - journals.lww.com … in the Middle East, including epidemiology, stage and grade distribution, histological subtypes, molecular and genetic profiles, and prognosis and survival outcomes. Clear inclusion …
  16. Risk of second primary cancer in young breast cancer survivors: an important yet overlooked issue X Liang, Y Qin, P Li, Y Mo… - Therapeutic advances in …, 2025 - journals.sagepub.com Currently, female breast cancer (BC) represents the highest incidence of cancer globally. This trend has raised significant attention regarding breast cancer young women (BCYW). With …
  17. Breast cancer risk and prevention in 2024 : An overview from the Breast Cancer UK‐ Breast Cancer Prevention Conference B Stordal , M Harvie , MN Antoniou… - Cancer …, 2024 - Wiley Online Library … vulnerable stages of life can increase the risk of breast cancer . … a young age in Asian populations. A greater reduction in premenopausal breast cancer risk is observed in Asian women …
  18. Tailoring targeted therapies for younger women with ER-positive early- stage breast cancer S Lobo-Martins , SJ Luen , M Piccart, S Loi - Nature Reviews Clinical …, 2026 - nature.com … Updated 6-year data presented at the San Antonio Breast Cancer Symposium in 2024 confirmed that benefit from olaparib is sustained over time across all subgroups, including those …
  19. Prediction model for survival of younger patients with breast cancer using the breast cancer public staging database HYJ Kang , M Ko , KS Ryu - Scientific Reports, 2024 - nature.com … We developed a model to predict all-cause mortality in younger patients with BC using data from the breast cancer public staging database (CPSD) provided by the National Cancer …
  20. Age-specific patterns of breast cancer in Nigerian women unraveled through histological analysis ME Effiong , SN Chinedu , IS Afolabi , KN Ezike … - Scientific Reports, 2025 - nature.com … a one year duration from 2023 to 2024 . Due to 152 the … in younger women , particularly among young adults, who … to the 486 advanced stage of breast cancer . Other factors include …
  21. Descriptive epidemiology of female breast cancer around the world: incidence, mortality, and sociodemographic risks and disparities NA Elhawary , SN Ekram , HA Sembawa… - International Journal …, 2025 - Taylor & Francis … -designated regions (Bray et al. 2024 ), countries with very high … , BC in young women is often detected at later stages , with … in selected breast cancer subtypes of very young women (< …
  22. Navigating Breast Cancer in Young Adults: Diagnostic and Therapeutic Considerations AN Riner , PW Harbour, TY Andraos … - Current Breast Cancer …, 2025 - Springer … prophylactic mastectomy in young women with early- stage breast cancer . Ann Surg Oncol. 2015;22(12):… 2024 ;10(6):718–25. 97. Kim H, Yoon TI, Kim S, Lee SB, Kim J, Chung IY, et al. …
  23. Pregnancy and breast cancer in young women : current updates and future directions S Zhang, SB Guclu, M Lipsyc-Sharf… - … Advances in Medical …, 2025 - journals.sagepub.com … recent advancements in early- stage breast cancer as well as gaps … 2024 . For this review, we prioritized studies published within the last 5 years—January 1, 2020, to December 31, 2024 …
  24. Female Breast Cancer Incidence and Association with Socioeconomic Status in a Population-Based Cohort—China, 2018– 2024 H Bao, L Fang, S Cong, X Guo, Z Fu, X Liu… - China CDC …, 2025 - pmc.ncbi.nlm.nih.gov … Breast cancer has emerged as the most prevalent cancer among women globally and is increasingly affecting younger … more advanced- stage breast cancer presentations and elevated …
  25. Age and Late Recurrence in Young Patients With ER–Positive, ERBB2-Negative Breast Cancer DS Shin, J Lee, E Kang, D Noh , JH Cheun… - JAMA network …, 2024 - jamanetwork.com … expectations, pathologic N stage was not an … N stage and late DR in the univariable analysis. However, survival analyses according to pathologic N stages found that increased N stage …
  26. Presentation of self - detected breast mass in minority women with limited access to care: Can self -examination assist in early cancer detection? Z Zhang, R Rao, VL Mango, P Wilson-Gardner… - Clinical imaging, 2021 - Elsevier … breast cancer patients were African-American or Hispanic women presenting with self - detected breast … who are trained to recognize abnormalities and warning signs in the breast [5]. …
  27. Factors associated with delays in screening of self - detected breast changes in African-American women LM Gibson - Journal of National Black Nurses' Association: JNBNA, 2006 - academia.edu … Sign up for freearrow_forward … Treatment delay of 3 months is a significant factor in breast cancer mortality … by Mary Gullatte on 22 October 2014 . The user has requested enhancement …
  28. Effectiveness of intervention on awareness and knowledge of breast self -examination among the potentially at risk population for breast cancer AN Ali , FJ Yuan, CH Ying, NZ Ahmed - Asian Oncol Res J, 2019 - researchgate.net … required information about breast cancer , its signs , symptoms, … BSE as the tool for early breast cancer detection, 69% thought … clinicians ” based on the frequent incidence of self - detected …
  29. Delays in diagnosis and treatment of breast cancer : a multinational analysis J Jassem , V Ozmen , F Bacanu… - … European journal of …, 2014 - academic.oup.com … first symptoms and the first medical visit (this analysis included only patients with self - detected cancers … The most common first sign of BC detected by self -examination was a breast lump …
  30. Stage at diagnosis and delay in seeking medical care among women with breast cancer , Delhi, India S Pakseresht , GK Ingle, S Garg … - … Red Crescent Medical …, 2014 - pmc.ncbi.nlm.nih.gov … knowledge for early detection of breast cancer . Changes in … the use of breast self -examination, clinical breast examination by … first time they perceived signs and symptoms due to breast …
  31. Factors associated with delayed diagnosis of breast cancer in northeast Thailand A Poum, S Promthet, SW Duffy , DM Parkin - Journal of epidemiology, 2014 - jstage.jst.go.jp … in retrospect may have been a very early sign of breast cancer . This raises the possibility of a … Delay in seeking medical care for self - detected breast symptoms in New Zealand women. …
  32. Diagnosis and surgical delays in African American and white women with early -stage breast cancer P George, S Chandwani, M Gabel… - Journal of women's …, 2015 - journals.sagepub.com … The first symptom or abnormality was detected as either a sign or a symptom by the patient, on a clinical breast … We found that patients who self - detected their cancer were more likely to …
  33. Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies V Ozmen , S Boylu , E Ok, NZ Canturk… - … European Journal of …, 2015 - academic.oup.com … about the way of detecting first signs and symptoms of BC… first symptom discovery and registering for the first medical examination and was calculated only for patients with self - detected …
  34. Reasons for delayed presentation of women with breast cancer F Ayaz, SB Ayaz, M Farrukh - J Islamabad Med Dent Coll, 2016 - distantreader.org … positive symptoms or signs of breast cancer , delayed seeking any medical advice for at … Reasons for delay in treatment of breast cancer detected due to breast self -… 2014 ;4:e004076. …
  35. Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage BA Martinez-Cannon , T Zertuche-Maldonado… - Women's …, 2020 - journals.sagepub.com … insurance have received treatment at HZH since 2014 . … perception of medical errors in diagnostic impressions of the first doctors … present with more self - detected tumors and advanced …
  36. Assessing mode of recurrence in breast cancer to identify an optimised follow-up pathway: 10-year institutional review J Horan, C Reid, MR Boland , GR Daly… - Annals of Surgical …, 2023 - Springer … Breast cancer surveillance programmes ensure early identification of … access to a breast clinic if they develop new symptoms/ signs should be … with a symptom that was self - detected . We …
  37. Assessment of knowledge and awareness about breast self -examination among university female students in Saudi Arabia S Albeshan , N Shubayr , Y Alashban - Breast Cancer : Targets and …, 2023 - Taylor & Francis … need for a breast self -exam or clinical examination by a doctor or nurse … breast masses are self - detected by women (55.2%). Clear recognition of breast cancer signs is critical for early …
  38. Breast cancer screening awareness and practices among women attending primary health care centers in the Ghail Bawazir District of Yemen A Bawazir , N Bashateh, H Jradi, AB Breik - Clinical breast cancer , 2019 - Elsevier … of the curability of the cancer detected early and of the efficacy … answered breast lump as the most common warning sign , … women practice this type if self - detected . Our study revealed …
  39. Factors related to incomplete treatment of breast cancer in Kumasi, Ghana M Obrist, E Osei-Bonsu, B Awuah… - The Breast , 2014 - Elsevier … , and medical oncology/radiology to estimate the cancer … not respond to the prescribed breast cancer treatment (p = 0.0079)… first signs there was something wrong with her body after self -…
  40. Rising Public Health Concern: Breast Cancer Awareness, Attitude, and Screening Practices among Community Members in Addis Ababa AM Fentie , E Mohammed, T Shimels , TG Fenta… - The Ethiopian Journal of …, 2025 - ejhd.org … 90% of BC cases can be self - detected by women. However, … history of breast cancer , awareness of early warning signs , … they had sought medical attention based on breast changes. …
  41. Breast cancer patients' experiences within and outside the safety net OM Fayanju , DB Jeffe , L Elmore… - The Journal of …, 2014 - pmc.ncbi.nlm.nih.gov … present with early -stage or late-stage breast cancer . Accordingly… up signs and symptoms concerning for breast cancer (see … delays while trying to address her self - detected breast mass: …
  42. Women's delay in presenting breast cancer symptoms in Kurdistan-Iraq JK Shakor , AK Mohammed - … Cancer Research and Therapeutics, 2020 - journals.lww.com … [9] Regarding awareness signs , the present study reported that ≥65% of women … Barriers to early presentation of self ‑discovered breast cancer in … World J Clin Oncol 2014 ;5:465‑77. …
  43. Breast cancer , breast self -examination knowledge among female high school students in Riyadh City KM Al-Haji, SA Moawed - MIDDLE EAST JOURNAL, 2009 - researchgate.net … not mean that breast cancer is necessarily self - detected . BSE … the academic year (2013/ 2014 ). The students who were given … know other warning signs of breast cancer such as bloody …
  44. Community-based study on the knowledge, awareness, and practices of females towards breast cancer in Buraimi, Oman VK Chattu , S Kumary … - … Asian Journal of Cancer , 2018 - thieme-connect.com … to sign and symptoms and risk factors of breast cancer and … mean that the breast cancer is necessarily self ‑ detected . BSE … South Asian J Cancer 2014 ;3:101-6. 6. Tabár L, Duffy SW, …
  45. Enterolactone concentrations and prognosis after postmenopausal breast cancer : assessment of effect modification and meta‐analysis P Seibold, A Vrieling, TS Johnson… - … journal of cancer , 2014 - Wiley Online Library … was restricted to early stage breast cancer and to patients … , NACT), mode of detection ( selfdetected , routinely detected), … sented by the sizes of symbols . Horizontal lines indicate 95% …
  46. … as a Nursing Intervention to Enhance Patient Learning: The Impact of Secondary Patient Contact Via Email as it Relates to Breast Self -Exam Teaching in … AE Phillips - 2014 - louis.uah.edu … Background: Breast self -‐exams are not … a breast self -‐exam. Methods: Participants were given a pre-‐test, then a 20 minute demonstration on the mechanics of performing a breast self -…
  47. Analysis of patient-detected breast cancer recurrence T Kapoor, S Wrenn, P Callas , TA James - Breast Disease, 2017 - journals.sagepub.com … a breast cancer recurrence, identified cancers in the earliest … vast majority of breast cancer recurrences were self - detected by … , clinical exam played a significant role in breast cancer …
  48. Correlating Fine Needle Aspiration Cytology Results of Mammary Malignancy with Corresponding Ultrasound BIRADS Score M Khaleel - Asian Pacific Journal of Cancer Care, 2022 - waocp.com … breast lump means cancer as it can characterize a sign for … of definite breast cancer according
  49. Health beliefs and breast cancer screening practices among African American women in California CM Davis - International quarterly of community health …, 2021 - journals.sagepub.com … and breast self -examination (BSE). Although breast cancer detection practices eg mammograms, BSE, and clinical breast self -examination (CBE) are vital tools for early detection and …
  50. Knowledge and practices of breast self -examination amongst women attending a surgical outpatient clinic , Cameroon BJ Alegbeleye - International Medicine, 2019 - academia.edu … early signs of breast cancer [Table 4]. The women's knowledge of breast cancer early warning signs … the time of self - detected breast abnormality" [15,26]. "To fight against the scourge of …
  51. Presentation, diagnosis and treatment delays in breast cancer care and their associations in Sri Lanka, a low-resourced country SA Hewage , S Samaraweera, N Joseph , S Kularatna … - Clinical Oncology, 2022 - Elsevier … self - detected or screening/incidentally detected suspicious breast lesion until a definitive diagnosis of breast cancer … where early detection of breast cancer through the means of clinical …
  52. Husbands' knowledge of breast cancer and their wives' attitudes and practices related to breast cancer screening in Saudi Arabia: Cross-sectional online … AA Sabgul, AMN Qattan , R Hashmi … - Journal of medical Internet …, 2021 - jmir.org … proportion of breast cancer cases are self - detected [8]. Thus, … of knowledge on breast cancer signs and preventive … Asian Pac J Cancer Prev 2014 ;15(19):8115-8119 [FREE Full …
  53. Circulating 25‐hydroxyvitamin D and postmenopausal breast cancer survival: influence of tumor characteristics and lifestyle factors? A Vrieling, P Seibold, TS Johnson… - … journal of cancer , 2014 - Wiley Online Library … in 512 early breast cancer patients was the first to report that … disease, to have a self - detected tumor, and to be a current … represented by the size of symbols . Horizontal lines indicate …
  54. Delays in diagnosis and treatment of breast cancer : a safety-net population profile K Jaiswal, M Hull, AL Furniss, R Doyle, N Gayou… - … Comprehensive Cancer …, 2018 - jnccn.org … In the interval from diagnosis to first treatment, we measured the time from … that patients with symptomatic, self - detected cancer had 2 times the odds of … J Clin Oncol 2014 ;32:735–744.
Research on the MammaCare Method 57
  1. Smith, R. L., Hanchak, N. A., Bloom, H., Leibfreid, D., Xuan, S., & Schlackman, N. (1996). The effectiveness of postgraduate education on the clinical breast examination skills of primary care physicians. American Journal of Managed Care , 2, 989–995.
  2. Vetto, J. T., Petty, J. K., Dunn, N., Prouser, N. C., & Austin, D. F. (2002). Structured clinical breast examination (CBE) training results in objective improvement in CBE skills. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education , 17(3), 124–127.
  3. Corbelli, J., Bonnema, R., Rubio, D., Comer, D., & McNeil, M. (2014). An Effective Multimodal Curriculum to Teach Internal Medicine Residents Evidence-Based Breast Health. Journal of Graduate Medical Education , 6(4), 721–725.
  4. Aliabadi-Wahle, S., Ebersole, M., Choe, E. U., & Beech, D. J. (2000). Training in clinical breast examination as part of a general surgery core curriculum. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education , 15(1), 10–13.
  5. Goldstein, M. K., Mehn, M. A., Pennypacker, H. S., Brost, B. C., Petersen, W. O., & Nicometo, A. M. (2012, July 7). Improved Clinical Breast Examination Competencies Via Intelligent Simulator Training. Meeting of the German Society for Senologie, Stuttgart.
  6. Baier Manwell, L., McNeil, M., Gerber, M. R., Iqbal, S., Schrager, S., Staropoli, C., Brown, R., Veet, L., Haskell, S., Hayes, P., & Carnes, M. (2022). Mini-Residencies to Improve Care for Women Veterans: A Decade of Re-Educating Veterans Health Administration Primary Care Providers. Journal of Women's Health , 31(7), 991–1002.
  7. Callies, D., Schievelbein, D., Elverson, C., & Osae-Larbi, J. (2024). Clinical breast exam training using tactually accurate computer simulation among healthcare providers in Ghana. International Journal of Africa Nursing Sciences , 20, 100716.

Original Research on MammaCare

  1. Adams, C. K., Hall, D. C., Pennypacker, H. S., Goldstein, M. K., Hench, L. L., Madden, M. C., Stein, G. H., & Catania, A. C. (1976). Lump detection in simulated human breasts. Perception and Psychophysics , 20, 163–176.
  2. Artmann, A., Heyne, M., Kiechle, M., & Harbeck, N. (2005, June 20 Suppl.). Breast self-examination training and counseling as motivation strategies for breast awareness and participation in breast cancer screening programs (ASCO Annual Meeting Proceedings, Part 1). Journal of Clinical Oncology , 24(18S), 1027.
  3. Atkins, E., Solomon, L. J., Worden, J. K., & Foster, R. (1991). Relative effectiveness of methods of breast self-examination. Preventive Medicine , 14(4), 357–367.
  4. Barton, M. B., Harris, R., & Fletcher, S. W. (1999). Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? Journal of the American Medical Association , 282(13), 1270–1280.
  5. Benincasa, T. A., King, E. S., Rimer, B. K., Bloom, H. S., Balshem, A., James, J., & Engstrom, P. F. (1996). Results of an office-based training program in clinical breast examination for primary care physicians. Journal of Cancer Education , 11(1), 25–31.
  6. Bloom, H. S., Criswell, E. L., Pennypacker, H. S., Catania, A. C., & Adams, C. K. (1982). Major stimulus dimensions determining detection of simulated breast lesions. Perception and Psychophysics , 32(3), 251–260.
  7. Campbell, H. S., Fletcher, S. W., Lin, S., Pilgrim, C. A., & Morgan, T. M. (1991). Improving physicians' and nurses' clinical breast examination: A randomized controlled trial. American Journal of Preventive Medicine , 7, 1–18.
  8. Campbell, H. S., McBean, M., Mandin, H., & Bryant, H. (1994). Teaching medical students how to perform a clinical breast examination. Academic Medicine , 69(12), 993–995.
  9. Chalabian, J., Formenti, S., Russell, C., Pearce, J., & Dunnington, G. (1998). Comprehensive needs assessment of clinical breast evaluation skills of primary care residents. Annals of Surgical Oncology , 5(2), 166–172.
  10. Coleman, E. A. (1991). Practice and effectiveness of breast self-examination: A selective review of the literature. Journal of Cancer Education , 6(2), 83–92.
  11. Coleman, E. A., & Pennypacker, H. S. (1991). Measuring breast self-examination proficiency. Cancer Nursing , 14(4), 211–217.
  12. Coleman, E. A., & Pennypacker, H. S. (1991). Nursing research to define outcomes of care: Evaluating breast self-examination performance. Journal of Nursing Quality Assurance , 5(3), 65–69.
  13. Coleman, E. A., Riley, M. B., Fields, F., & Prior, B. (1991). Efficacy of breast self-examination teaching methods among older women. Oncology Nursing Forum , 18(3), 561–566.
  14. Coleman, E. A., Lord, J. E., Bowie, M., & Worley, M. J. (1993). A statewide breast cancer screening project. Cancer Nursing , 16(5), 347–353.
  15. Duer, J. D. (1984). Group dissemination of group breast self-examination training technology. Patient Education and Counseling , 7(6), 98–116.
  16. Fletcher, S. W., O'Malley, M. S., & Bunce, L. A. (1985). Physicians' abilities to detect lumps in silicone breast models. Journal of the American Medical Association , 253, 2224–2228.
  17. Fletcher, S. W., O'Malley, M. S., Earp, J. L., Morgan, T. M., Lin, S., & Degnan, D. (1990). How best to teach women breast self-examination. Annals of Internal Medicine , 112(10), 772–779.
  18. Fletcher, S. W., O'Malley, M. S., Pilgrim, C. A., & Gonzalez, J. J. (1989). How do women compare with internal medicine residents in breast lump detection? Journal of General Internal Medicine , 4, 277–283.
  19. Goldstein, M. K., Stein, G. H., & Pennypacker, H. S. (1982). Efficient technology of training breast self-examination. Technical Bulletin, World Health Organization , England.
  20. Goldstein, M. K., Stein, G. H., & Pennypacker, H. S. (1982). On subordination of BSE. American Journal of Public Health , 5(72), 498–499.
  21. Hall, D. C., Adams, C. K., Stein, G. H., Goldstein, M. K., Stephenson, H. S., & Pennypacker, H. S. (1980). Improved detection of human breast lesions following experimental training. Cancer , 46, 408–414.
  22. Hall, D. C., Goldstein, M. K., & Stein, G. H. (1977). Progress in manual breast examination. Cancer , 40, 364–370.
  23. Hilt, G. (1990). Selbstuntersuchung der brust: So nehmen sie den frauen die angst. Ärztliche Praxis , 75(18), 20–21.
  24. Hilt, G. (2005). Bessere infos, mehr früherkennung. Ärztliche Praxis Gynäkologie , 6, 22.
  25. Hilt, G. (2006). Frauen zur Selbstkontrolle motivieren. Ärztliche Praxis Gynäkologie , 5, 24.
  26. Jacob, T. C., Penn, N. E., Giebink, J., & Bastien, R. (1994). A comparison of breast self-examination and clinical examination. Journal of the National Medical Association , 86(1), 40–45.
  27. Kotke, T. E., & Trapp, M. A. (1998). Implementing nurse-based systems to provide American Indian women with breast and cervical cancer screening. Mayo Clinic Proceedings , 73(9), 815–823.
  28. Leight, S. B., Deiriggi, P., Hursh, D., Miller, D., & Leight, V. (2000). The effect of structured training on breast self-examination search behaviors as measured using biomedical instrumentation. Nursing Research , 49(5), 283–289.
  29. Madden, M. C., Hench, L. L., Hall, D. C., Pennypacker, H. S., Adams, C. K., Goldstein, M. K., & Stein, G. H. (1978). Development of a model human breast with tumors for use in teaching breast examination. Journal of Bioengineering , 2, 427–435.
  30. McDermott, M. M., Dolan, N. C., Huang, J., Reitler, D., & Rademaker, A. W. (1996). Lump detection is enhanced in silicone breast models simulating postmenopausal breast tissue. Journal of General Internal Medicine , 11, 112–114.
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The Clinical Case for Physical Exam (Selected Reports) 13
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  2. Haakinson, D. J., Stucky, C. C., Dueck, A. C., Gray, R. J., Wasif, N., Apsey, H. A., & Pockaj, B. (2010). A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. American Journal of Surgery , 200(6), 712–718.
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