News - MammaCare Foundation

Dianne Feinstein Got It Right For All Women

Dianne Feinstein is memorialized in the US Congressional Record recognizing that the hands of women and clinicians are the first, effective and affordable method to find and treat the earliest sign of breast cancers.

She insisted therefore that women receive clinical (physical) breast exams within the breast and cervical early detection programs that receive federal funds. It is observed however, that the Congressionally mandated support for early detection often goes directly and exclusively to the imaging industry whose businesses and practitioners do not provide clinical breast exams and essential staff training.

Some intrepid state health departments, recognizing Feinstein’s assessment and the clear requirements of the law, have recently begun to train and verify the hands of all their providers, giving them the skills to perform competent breast exams. Unfortunately for women however, most states including Florida, continue to direct women to private mammography businesses who do not train their providers to perform clinical breast exams and do not perform them.

When a patient finds (palpates) a small early cancer, the tumor may not be visible in an image so the patient is often sent home to wait until it is unavoidably obvious. An image may finally confirm months later what was felt earlier. This is referred to as an "interval" cancer, meaning we missed it because we did not possess the skills required to confirm physically what the patient could. This common but avoidable error results in later stage more invasive, debilitating and costly cancer.

Breast cancer is now the most common cancer with nearly 300,000 new cases each year. Treatment can extend life even at later stages due to a gap in detection, but trained clinical hands can close that gap for millions of women. To her eternal credit, Dianne Feinstein got it right for all women, with sincere personal appreciation from my three wonderful daughters.

Mark Kane Goldstein, Ph.D.
Senior Scientist and Director
The MammaCare Foundation
(352) 375-0607

Google Scholar (Clinical Training)
Research Reports

October 2, 2023

By Mark GoldsteinNews, Uncategorized0 Comments

Sadaf Medical Conducting a breast exam training for JBCP

MammaCare and Sadaf Medical Bring Safe and Effective Breast Exams to Jordanian Women

MammaCare, a global leader in breast exam training and certification, and Sadaf Medical of Jordan, a leading distributor of medical equipment and training resources, have established an exclusive partnership to assure that all Jordanian women have access to safe and effective breast exams by highly skilled hands.

The partnership between MammaCare and Sadaf Medical will revolutionize breast exams for Jordanian women, by assuring that the commonly performed clinical breast exam can detect and/or confirm the earliest signs of breast cancer without increasing false positive alarms.

Since 1974, MammaCare has delivered state-of-the-art technology and training programs for healthcare providers. The scientifically validated training methods enable medical professionals to perform safe and effective breast exams, improving the chances of detecting abnormalities at an early stage.

MammaCare’s web-based training platform is the only known technology that teaches, measures, and verifies breast exam skills. Clinicians are required to meet standards of sensitivity, specificity and thoroughness in order to pass each breast exam.

"We are thrilled to embark on this partnership with Sadaf Medical Supplies," said Zachary DeLand, MammaCare’s COO. "Together, we are committed to ensuring that Jordanian women receive the highest standard of breast exams. Clinicians must be able to accurately and reliably confirm or dispel what their patients report."

"We believe that by combining MammaCare's top-tier clinical training with our distribution network, we can make a significant impact on women's health in Jordan," stated Mr. Mutaz Abu Zaitoon, Managing Director of Sadaf Medical. "Our joint efforts will undoubtedly result in more accurate and effective breast examinations, leading to better healthcare outcomes."

For more information about MammaCare and Sadaf Medical, please visit mammacare.org and sadafmedical.com.

August 16, 2023

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Clinical Breast Exam + US – More Accurate than Mammogram

When a woman or clinician feels or sees an unusual change in the breast, the woman is typically referred for a mammogram (conventional or 3-D) also referred to as a digital breast tomosynthesis (DBT) scan.

It is expected that the radiologist who views the mammogram scans will be able to identify the location of the palpable lump in order to reject it as being a benign observation, or something that requires further investigation.

Unfortunately, mammograms can miss a substantial portion of breast cancers that are present.¹

Automated breast ultrasound (ABUS) and/or magnetic resonance (MRI) may be used following a mammogram to determine if a biopsy is required.

Stand-Alone Mammogram Less Accurate than Physical Breast Exam with Targeted Ultrasound

Recent evidence from high income national health care programs finds that a physical exam is essential for early diagnoses.² The latest evidence comes from Holland. Dr. Linda Appleman’s team investigated what happens when a lump is immediately followed up by targeted ultrasound rather than a mammogram.³

From September 2017 to June 2019, 1,961 women in Holland reported feeling a lump and enrolled into Appleman’s study. Each woman received a targeted ultrasound (US) to determine if the lump she felt was a harmless water-filled cyst or a solid tumor that required biopsy. With ultrasound (US) as the primary imaging tool, 81% of women received normal (benign) results, and 10% of women received confirmation of a malignant tumor (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT was used after an ultrasound reported negative lump finds to validate ultrasound’s accuracy in order to determine if US could be used as a stand-alone breast imaging modality for assessing lump finds from a physical breast exam.

Dr. Appleman concluded that “[ultrasound] was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints.”

April 24, 2023

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VA Mini Residencies Advance Clinical Breast Exam Skills

The Journal of Women's Health published a landmark report on the 10 year mini-residency training program provided to thousands of VA Primary Care Providers (PCPs). MammaCareⓇ provided the hands-on Clinical Breast Exam CBE Simulator-Trainer for the VA mini-residency program. The PCPs retained and used the performance skills acquired at the mini-residences reporting significantly greater comfort/confidence levels in performing clinical breast exams.

Improving Public Health

The MammaCare CBE Simulator-Trainer was developed and validated with the support of the National Science Foundation and was adopted for clinical training in the Woman Veterans Health Program as well as in CDC's sponsored National Breast and Cervical Early Detection and Prevention Programs (NBCCEDP). The skill-based technology has begun training advanced clinicial students in U.S. colleges of nursing and medicine to advance clinical breast exam skills.

Mini-Residencies Improve Care for Women Veterans: A Decade of Re-Educating Veterans HealthAdministration Primary Care Providers

Linda Baier Manwell, MS, Melissa McNeil, MD, MPH, Megan R. Gerber, MD, MPH, Samina Iqbal, MD, Sarina Schrager, MD, MS, Catherine Staropoli, MD, Roger Brown, PhD, Laure Veet, MD, Sally Haskell, MD, MS, Patricia Hayes, PhD, and Molly Carnes, MD, MS

Background: Many primary care providers (PCPs) in the Veterans Health Administration need updated clinical training in women’s health. The objective was to design, implement, and evaluate a training program to increase participants’ comfort with and provision of care to women Veterans, and foster practice changes in women’s health care at their local institutions.

Methods: The Women’s Health Mini-Residency was developed as a multi-day training program, based on principles of adult learning, wherein knowledge gleaned through didactic presentations was solidified during small-group case study discussions and further enhanced by hands-on training and creation of a facility-specific action plan to improve women Veterans’ care. Pre, post, and 6-month surveys assessed attendees’ comfort with and provision of care to women. The 6-month survey also queried changes in practice, promulgation of program content, and action plan progress

Results: From 2008 to 2019, 2912 PCPs attended 26 programs. A total of 2423 (83.2%) completed pretraining and 2324 (79.3%) completed post-training surveys. The 6-month survey was sent to the 645 attendees from the first 14 programs; 297 (46.1%) responded. Comparison of pre-post responses indicated significant gains in comfort managing all 19 content areas. Six-month data showed some degradation, but comfort remained significantly improved from baseline. At 6 months, participants also reported increases in providing care to women, including performing more breast and pelvic examinations, dissemination of program content to colleagues, and progress on action plans.

Keywords: Veterans health; clinical competence; continuing; curriculum; education; primary health care; women's health.

December 7, 2022

By adminInformation, News, Research0 Comments

Follow the Evidence

Originally published in Memorial University Gazette
Jan. 23, 2019>
BY MARCIA PORTER

Faculty of Nursing professor Dr. Anne Kearney was in the final minutes of supervising an exam when she decided to check her email.Upon reading a message from a friend who sent her a link to a Globe and Mail story, she broke out into a happy dance — at the back of the classroom, where her students wouldn’t notice.

It was news she’d been waiting to hear for more than 15 years: Women don’t need rigid breast screening schedule, stated the headline.

Shared decision-making

The story reported on a long-awaited report by the Canadian Task Force on Preventive Health Care about the use of mammography as a population-based screening tool for women aged 50-74.

Population-based means that screening is recommended for all women in a targeted age group, not just for women at higher risk.

The big news contained in the report? Clinicians must now engage women in shared decision-making about whether to have mammography screening or not, which acknowledges there is “very low certainty evidence” of effectiveness.

In fact, the task force concluded there is no evidence of mortality reduction overall and good evidence of harm, including over-diagnosis (which results in unnecessary treatment), along with false positives and resulting biopsies.

“I no longer thought the breast screening program was heading in a way that was based on evidence.”— Dr. Anne Kearney

The report’s authors wrote that screening of women aged 50-74 is conditional on primary care providers discussing potential benefits and harms so that women can make an informed decision about whether the benefits outweigh the risks.

That might not sound earth-shattering, but according to Dr. Kearney, who has followed the debate and reviewed the evidence related to the risks of mammography screening for more than 20 years, it’s a significant change.

“There must have been a lively and animated conversation,” she said, noting that the report was almost a full year late. “If something is strongly recommended they would say, ‘We strongly recommend.’ But the screening recommendation is conditional, or weak, which is very important.”

Dr. Kearney described the four main risks associated with mammography screening in a recent Gazette op-ed.

Education lead for breast-screening program

Until the task force published its report in early December, population-based mammography screening had been endorsed by clinicians and stakeholders across the country since the late 1980s.

Dr. Kearney was part of a small group to establish Newfoundland and Labrador’s breast screening program, which launched in 1996. As lead for public and professional education with the program, it was her job to review the most current research on population-based screening.

It was then she began to notice the conflicting reports about effectiveness of mammography screening, the usefulness of clinical breast examination and that breast self-examination was being increasingly questioned by researchers and physicians.

“It was a very confusing time for me,” she said. “I no longer thought the breast screening program was heading in a way that was based on evidence.”

Doctoral work

Dr. Kearney began her PhD in 1998, focusing on breast self-examination, because of the conflicting information she was finding. Her work also included a review of mammography screening effectiveness. She completed her PhD in 2004.

And over the past number of years she has presented and written extensively about breast-screening evidence in an effort to change policy.

“We have it all wrong in my opinion: We should not screen all women of a targeted age with mammography; primary care providers should examine women’s breasts; and women should examine their own breasts.”

Dr. Kearney’s mother died of breast cancer at age 53, so she’s quick to point out that she doesn’t “take this issue lightly.”

Along the way there have been small triumphs, such as winning best poster at the 2016 Applied Research in Cancer Control conference held in Toronto, where she was called “brave” for presenting her work at at a time when not all stakeholders appreciated it.

But with the task force now qualifying their recommendation about mammography screening, Dr. Kearney says she feels vindicated.

There’s still much more work to do, she says, including ensuring that women are informed of potential harms and benefits of mammography screening and changing policy to support clinical breast examination and breast self-examination.

The next task force recommendations, she hopes, will unequivocally recommend against population-based mammography screening for women of any age.

“It is a cost-intensive initiative that causes significant harm without evidence of mortality reduction.”

Marcia Porter is a communications advisor with the Faculty of Nursing. She can be reached at mlporter@mun.ca.

January 31, 2019

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Georgia DPH Deploys New Breast Exam Training Technology to Improve Accuracy

First in Nation to Upgrade Breast Exam Standards

GAINESVILLE, Fla., June 1, 2020 - Women in Georgia will benefit from the breast exam training program developed by MammaCareⓇ scientists with the support of the National Science Foundation. The team of scientists identified the specific breast exam skills required for early detection of small suspicious tumors while reducing false positives. They produced a hands-on, computer-guided simulator technology that validates the performance of these critical skills. In cooperation with the Georgia Department of Public Health Breast and Cervical Cancer Program (BCCP), the MammaCare system will train nurses in each of Georgia’s 159 counties. The training technology is in use by the Women Veterans Health Program and by US colleges of nursing and medicine. Georgia’s DPH is the first BCCP to deploy the training system statewide.

Although nurses and physicians routinely examine women’s breasts for suspicious lesions or tumors, performance and results vary widely. Mary Ann Mehn, Ph.D., MammaCare’s Director of Education, said that Georgia DPH staff public health nurses are now being trained and certified to deploy the system throughout Georgia’s BCCP. Mark Kane Goldstein, Ph.D., MammaCare Senior Scientist explained: “The MammaCare Clinical Breast Exam Simulator-Trainer standardizes critical performance skills with a series of “intelligent” breast models that measure exam accuracy and provide corrective feedback in real time.” “If performance on any one of the breast exam modules does not meet built-in standards of sensitivity, specificity, and thoroughness, the program requires the user to repeat the module before moving on to the next one,” Goldstein added.

MammaCare, the recognized standard for clinical and personal breast exams, began in 1974 as a National Cancer Institute project to determine the smallest palpable breast tumor that is reliably detectable by hand. MammaCare training technology and certification courses are available at http://mammacare.org.

The MammaCare Clinical Breast Exam Simulator-Trainer standardizes critical performance skills with a series of ‘intelligent’ breast models that measure exam accuracy and provide corrective feedback in real time.

Contact

Mary Ann Mehn, Ph.D.,

training@mammacare.org

Mark Kane Goldstein, Ph.D.

markgoldstein@mammacare.org

Cell: 352.256.4573

Office: 352.375.0607

CBE Simulator-Trainer Video

October 17, 2018

By adminNewsBCCP, CBE Simulator-Trainer, Georgia, press release, simulatorComments Off

Breast Cancer Screening Guidelines

While there are wide differences of opinion among prominent organizations about preferred breast cancer screening guidelines, most breast cancer is first detected bythe hands of women or their health care providers. The American College of Obstetricians and Gynecologists (ACOG) notes that self-exams are effective in detecting breast cancer for a majority of women although this finding conflicts with the United States Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS). These two organizations jointly recommend against teaching women how to perform self-exams of their breast and discourage screening by the hands of nurses and physicians.

In their current "Practice Bulletin” the American College of Obstetricians and Gynecologists states:

“Although breast-self examination is no longer recommended [by USPSTF ], evidence of the frequency of self-detection of breast cancer provides strong rationale for breast self-awareness in the detection of breast cancer. Approximately 50% of cases of breast cancer in women 50 years and older and 71% of cases of breast cancer in women younger than 50 years are detected by women themselves. (40, 41). For example, 43% of the 361 breast cancer survivors who participated in the 2003 National Health Interview Survey reported detecting their cancer themselves (42). Additional evidence of the important role of breast cancer self- detection comes from a study of low-income women who received breast cancer care through California’s Breast and Cervical Cancer Treatment Program. Of the 921 women in the cohort, 64% detected their breast cancer (43)”.

Although well-intentioned, organizations differ in their opinions and the data selected to support them, issuing press releases may be a disservice to women worldwide. More than 500,000 women die each year from breast cancer and there is little disagreement that most women find their own cancer and at a late stage. Discouraging women and their healthcare providers from learning to perform a thorough, skilled breast exam has a global impact that is unlikely to improve the outcomes for the vast majority of women.

Progress in BSE and CBE

Many of the studies that inspired criticism of breast self-examination (BSE) and clinical breast exams (CBE) were conducted before it was known how to perform the exam effectively and before the advent of advanced breast cancer treatment options. Women and researchers relied on pamphlets and video demonstrations as teaching devices that failed to address the central question of the tactile sense: what does a lump actually feel like? To improve tactile breast exam skills, the National Science Foundation supported development and validation of a hands-on computer- guided training technology that is now in use teaching students in colleges of medicine and nursing as well as obgyn residents and advanced practice nurses. The platform trains hands to perform accurate clinical breast exams and validates acquisition of the requisite skills. The results of training are reported in terms of sensitivity, specificity and percent of tissue examined as trainees advance through a series of increasingly complex palpation modules.

Annotated bibliography: Physical Examination of the Breast

A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec;200(6):712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B. “Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors… resulting in more aggressive therapy ”

Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010 Mar;210(3):314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AAC. “Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years…” abstract p1

Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found? Ann Fam Med. 2006 Nov-Dec;4(6):512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T. “Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit.”

Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women. J Womens Health 2011 Jun 15. [Epub ahead of print] Roth MY, Elmore JG, Yi-Frazier JP, Reisch LM, Oster NV, Miglioretti DL. “Most women survivors (57%) reported a detection method other than mammographic examination.”

Measuring performance in clinical breast examination. Br J Surg. 2010 Aug;97(8):1246-52. Wishart GC, Warwick J, Pitsinis V, Duffy S, Britton, PD. “performance measures…could help to identify clinicians who have a lower sensitivity for CBE and who may therefore require feedback and further training.”

Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program. J Natl Cancer Inst 2011.Jun 22;103(12):942-50. Epub 2011 May 3 Kirsh VA, Chiarelli AM, Edwards SA, O’Malley FP, Shumak RS , Yaffe MJ, Boyd, NF “…77% of these were true interval cancers, detected clinically in the 1–2 year interval between screening examinations…” p4

Improved Clinical Breast Examination Competencies Via Intelligent Simulator Training, July 7, 2012 Meeting of the German Society for Senologie, Stuttgart Goldstein M.K.*, Mehn M.A.*, Pennypacker H.S.*, Brost B.C.** Petersen W.O.**, Nicometo A.M.**, MammaCare* and Mayo Clinic** "Two independent trials found that the CBE Simulator produced significant gains in clinical breast examination skills suggesting that this technology may improve the accuracy and quality of breast cancer screening."

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. " "Our recommendation incorporates practices from the Mammacare method, because its components have been validated in independent investigations of CBE technique"

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.

Narod, S.A. (2014). Reflections on screening mammography and the early detection of breast cancer. Current Oncology, 21(5), 210-214.

Vaz-Luis, I., et al. (2014). Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study. Journal of Clinical Oncology, 32(20), 2142-2150.

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.

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.

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May 8, 2018

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Breast Self-Exams Work – Find Breast Cancer Missed on Mammograms Women Report

Women self-detect breast cancer with their hands, cancer that was missed by mammograms according to women and research. At first this may seem to contradict or even disrupt traditional practices, but biological and clinical evidence supports the women. Hundreds of touch receptors in our fingers comprise an exquisitely sensitive network that improves with practice by establishing new neural pathways (tactile maps) that recognize complex textures as well as the presence of unusual changes within them. By applying this knowledge to the detection of small breast tumors, MammaCare scientists, with the support of the National Cancer Institute and National Science Foundation, began the process of training every hand that examines a woman, including her own.

I actually found the lump a year earlier while doing a self-breast exam but was told two separate times it was only a cyst. So imagine my surprise when I met with a plastic surgeon at Johns Hopkins in Baltimore for a consult to remove the “cyst” only to be told later it was cancer. -WUSA9 ...Like many young breast cancer patients, Sliwerski was blindsided by her diagnosis. She was just 33, the first-time mother of a 3-month-old, Penelope, when she noticed a lump in her left breast. A month later, she learned she had invasive breast cancer. - Chicago Tribune Harris said early detection of breast cancer is key. She is a fitness enthusiast and was familiar with her body when she noticed a lump that turned out to be cancerous. - MRT Knight had recently been screened but noticed a painful lump during a self-breast exam in early February. She put off seeing the doctors for a couple of weeks, expecting it to be benign like the others she had found….Knight urges everyone, especially those with family history, to seek regular screenings, conduct breast exams and act quickly when something doesn't feel right. - Lancaster Reagle Gazette As Amber Pritchett was doing a breast self-examination in early spring, she found a lump…The 33-year-old human resources employee at Mercer University didn’t think much of it since no one in her family had breast cancer...“It’s probably nothing to worry about. Probably just dense breast tissue,” the doctor told her….Her malignant tumor was four to five centimeters, or nearly two inches in diameter, when she was diagnosed Aug. 28. - Miami Herald Findings published in the Journal of Women’s Health: “Despite increased use of screening mammography, a large percentage of breast cancers are detected by the patients themselves. Patient-noted breast abnormalities should be carefully evaluated. - NCBI I had a mammogram seven months before I found the lump, and it was all clear,” the Seneca Falls resident remembered. “I was getting ready for a trip to Honduras. I brushed (the lump) off. It wasn’t painful, so I went on the vacation. - Fit Times Although Stewart was only 35 and had no family history of breast cancer, the conversation with her daughter encouraged her to do a self-exam. The lump she found in her left breast was cancerous." - The Pilot Turns out she was thirty-seven when she first felt the lump in her breast. She made an appointment with her local doctor, who passed it off as nothing, and continued to say it was nothing for two years—even though it kept getting bigger. - New Yorker The speaker at Monday’s Breast Cancer Awareness Ceremony urged others to regularly do self-breast exams. In Vicki Mathess’ case, her self exam – done in between her yearly mammograms – led to her diagnosis of stage two breast cancer. “I had a mammogram two months before and the mammogram was negative,” she said. “In two months, through a self exam, I discovered a lump. - The Record Delta I actually found the lump a year earlier while doing a self-breast exam but was told two separate times it was only a cyst. So imagine my surprise when I met with a plastic surgeon at Johns Hopkins in Baltimore for a consult to remove the “cyst” only to be told later it was cancer. - WUSA9 I had found a mass in my right breast due to my favorite bra didn't fit. I hand wash all of my bras so I know it wasn't cause my bra had shrunken. By doing a self-exam I found a golf size lump in my breast, said Edwards - KGUN9 Three weeks ago, I was diagnosed with breast cancer. I could only feel the lump whilst lying down and it completely disappeared [when I was] standing up. - Self

October 27, 2017

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Science of Self-Exams Taught at Blessing Breast Center

Sheila Hermesmeyer, oncology nurse and MammaCare BSE Instructor, has many roles at Blessing Breast Center, where she has worked for 38 years. Hermesmeyer is Blessing Hospital’s Breast Center Navigator, helping patients understand their diagnoses, addressing barriers to care, coordinating the monthly lymphedema screening clinic, and shepherding women through the often-complicated process of breast cancer diagnosis and treatment. She summarized her multiple clinical and support activities modestly, “I wear many hats.” Her community outreach is one more hat.

As a MammaCare certified instructor, Sheila organized outreach to the community that has stimulated buy-in from physicians. Oncologists and internal medicine physicians now encourage their patients to participate in her classes, “The oncologists put up MammaCare posters in the exam rooms and inform patients about my MammaCare classes,” says Sheila, whose Introduction to MammaCare BSE class is held four times a year. Flyers about the classes inform internal medicine physicians at the clinic and are even distributed by outreach nurses who walk at the community mall to boost the program’s visibility.

Sheila explains how she learned the science behind breast self-exams. “I was mimicking my doctor’s technique before I went to the MammaCare training in Chicago.” The women who participate in her MammaCare classes report that learning the procedure directly from an instructor is most helpful. “One women was 37 when she was diagnosed and brought all her girlfriends to the MammaCare class.”

Blessing Hospital hosts many events for Breast Cancer Awareness Month. A speaker series was hosted by Sheila Hermesmeyer and Blessing Hospital, commemorating the 40th anniversary of the movie “Pretty in Pink” with a special showing of the film. The event included a representative from the 3D breast center and a dietitian to answer questions followed by the movie screening. Throughout the month, the hospital and breast center also participate in a T-shirt drive to raise funds that support the cost of mammograms and breast care for indigent women in the Quincy, Illinois community. For more information on Sheila Hermesmeyer, Blessing Breast Center, and Breast Cancer Awareness Month at Blessing Hospital, please visit https://www.blessinghealth.org/treatments/breast-center.

October 12, 2017

By adminNews, Self-Detection, UncategorizedBSEComments Off

Women and Clinicians Learn Breast Exams Skills Despite “Prohibition”

Antique US Government policies continue to resist safe, low-cost breast cancer screening leaving women and their healthcare providers in a confusing and costly screening fog.

Informed clinicians and women are constrained by an influential US agency recommendation against teaching women how to perform breast self exams and against breast cancer screening exams by the hands of trained healthcare providers. Although the recommendations are based on outdated reports, poorly trained hands and limited treatment options, the agency's position exerts a strong, international influence over healthcare policy and practices. Their curious edict to not teach or learn breast exam skill was first issued in 2002 and is repeated to the present day, The plain take-home for the half million women who die every year is that they would be better off not being taught by their provider to correctly perform a self-exam or even receive screening by skilled clinicians.

Naturally, without learning, exams performed by women and their providers will generate higher rates of false positives and more missed tumors. Yet the agency, in reissuing their recommendation, ignores strong evidence that the standards for proficient performance of clinical and personal breast exams are known, free and safe alternatives to the practice of mass, x-ray mammograms.

Equally troubling is the exclusion or insubstantial consideration of landmark evidence that contradicts the agency's reports and media releases. Although their edict has had mass impact in effectively discouraging women and their practitioners from learning and teaching how to perform skilled exams, independent regional and national evidence indicates that the long hiatus is lifting or should be despite USPSTF discouragements.

For example:

Physicians and scientists at the University of Washington’s Department of Global Health reported this year that most women receiving care at an urban clinic in Peru detected their own breast cancer finding nearly half of the cancers at early stages. Published in May, in the American Medical Association journal JAMA Onclology, women who received a previous clinical breast exam by the hands of trained practitioners were the most likely to find their own breast cancer in its earliest stages. These results add support to the recent, massive Canadian National Health Service study of 89,000 women reporting that physical (clinical) examination by trained nurses coupled with self-exam instruction detects the same number of breast cancers as do mammograms. This twenty five year study of 89,000 Canadian women was reported in the prestigious British Medical Journal.

The annotated findings below provide additional, compelling evidence in support of a change in US policy for teaching women and for training clinicians how to perform skilled exams and how to teach women.

Breast cancer presentation and diagnostic delays in young women. Cancer. 2014 Jan 1;120(1):20-5. doi: 10.1002/cncr.28287. Nov 11. 2014 Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, Winer EP, Partridge AH

Most young women detect their own breast cancers… Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010 Mar;210(3):314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim A Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years… Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women. J Womens Health. 2011Aug; 20(8): 1135-9. Roth MY, Elmore JG, Yi-Frazier JP, Reisch LM, Oster NV, Miglioretti DL Conclusion: Most women survivors (57%) reported a detection method other than mammographic examination. A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec; 200(6): 712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B. Results: Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors… resulting in more aggressive therapy.” Twenty-five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014 Feb 11;348:g366. doi: 10.1136/bmj.g366. Miller, A. B., Wall, C., Baines, C. J., Sun, P., To, T., & Narod, S. A. Upon finding that most cancers were palpable at mammography screening visits, Miller et; al. concluded: From this we infer that if there is benefit from a mammography only screening programme, it is derived through cancers detectable by a thorough breast physical examination. Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found? Ann Fam Med. 2006 Nov-Dec; 4(6): 512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T. Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit. Measuring performance in clinical breast examination. Br J Surg. 2010 Aug;97(8):1246-52. Wishart GC, Warwick J, Pitsinis V, Duffy S, Britton, PD. Performance measures…could help to identify clinicians who have a lower sensitivity for CBE and who may therefore require feedback and further training. Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program. J Natl Cancer Inst 2011.Jun 22;103(12):942-50. Epub 2011 May 3 Kirsh VA, Chiarelli AM, Edwards SA, O’Malley FP, Shumak RS, Yaffe MJ, Boyd, NF. …77% of these were true interval cancers, detected clinically {clinical breast exams} in the 1–2 year interval between screening examinations… Excessive resections in breast-conserving surgery: a retrospective multicentre study. Breast J. 2011 Nov-Dec; 17(6): 602-9. Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten HJ, de Lange de Klerk E, van den Tol P, Meijer S. Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%). Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How? Journal of the American Medical Association, 1999 Oct, 6: 283(13), 1687-9. Barton, M.B., Harris, R. & Fletcher, S.W. …MammaCare’s standards for teaching and practicing effective CBE emerged from an extensive series of laboratory studies measuring lump detection and breast examination skills using tactually accurate breast models embedded with small, simulated lesions. How best to teach women breast self-examination. A randomized controlled trial. Annals Intern Med. 1990 May 15;112(10):772-9. Fletcher SW, O’Malley MS, Earp JL, Morgan TM, Lin S, Degnan D. Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills. Improved Clinical Breast Examination Competencies Via Intelligent Simulator Training, July 7, 2012 Meeting of the German Society for Senologie, Stuttgart Goldstein M.K.*, Mehn M.A.*, Pennypacker H.S.*, Brost B.C.** Petersen W.O.**, Nicometo A.M.**, MammaCare* and Mayo Clinic** Two independent trials found that the CBE Simulator produced significant gains in clinical breast examination skills suggesting that this technology may improve the accuracy and quality of breast cancer screening.

M.K. Goldstein, Ph.D.

Senior Scientist and Director

The MammaCare® Foundation

Lab: (352) 375-0607

markgoldstein@mammacare.org

Supported in part by:

Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How? "Our recommendation incorporates practices from the Mammacare method, because its components have been validated in independent investigations of CBE technique" JAMA 283(13), (p. 1276), Barton, M.B., Harris, & Fletcher, S.W.

September 7, 2017

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