Photo of Dianne Feinstein

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

Breast Exam Competence, Finally a Breakthrough

GAINESVILLE, Fla., Jan 17 , 2023  -- The earliest and most frequent sign of breast cancer is a lump or lesion, often self-detected.1, 2, 3 There was however, no known way to measure or confirm whether a patient’s health provider possessed the clinical skills required to palpate and confirm the presence of the self-reported breast lesion or lump. 4, 5, 6 Without verifiable clinical skills the exam is often deferred or conducted haphazardly.

In response, MammaCare® created the first digital technology that automatically calculates, analyzes and corrects the breast exam skills of healthcare providers, nursing and medical students before they begin examining patients. The Clinical Breast Exam Simulator-Trainer instantly measures and documents core competency levels: sensitivity (detecting small suspicious lesions), specificity (false positive detections), thoroughness (percent of tissue examined and missed), and reports the search pattern(s) performed.

In practice, a clinician or student simply logs on to the web portal and begins examining a series of cloud-connected breast models containing replicas of excised breast cancers. The online training program guides the examiner's fingers as they learn to positively identify sub-centimeter breast lumps while learning to avoid false positive detections.

Multiple CBE Simulator Attempts

When performance does not meet built-in standards, the system automatically presents feedback about the deficiency and requests the examiner to try again. The additional practice enables virtually all users to pass each module by the second or third attempt. Data from the first 3000 participants in colleges of nursing, medicine and breast cancer early detection programs verify significant improvement in each of the core breast exam competencies noted above. 

Mark Kane Goldstein, Ph.D. MammaCare Foundation Sr. Scientist reported: "A few hours of practice, using any computer connected to the Trainer will measurably improve a provider's ability to confirm and report suspicious breast lesions for further diagnostic workup." He added: "Strong evidence now indicates that merging the human tactile sensory system with advanced engineering technology supports the early detection of breast cancer." 7, 8

The MammaCare Foundation

(352) 375.0607 MammaCare Lab

Google Scholar

Trained Hands Can Reduce Advanced Breast Cancer Worldwide

GAINESVILLE, Fla., Oct. 15, 2020 -- More than 600,000 women die of advanced breast cancer annually. (1) There is a safe, universally obtainable method to reduce this terrible toll according to MammaCare Foundation scientist Mark Kane Goldstein, Ph.D.: "By producing more skilled hands everywhere," he reported.

Scientific and clinical evidence indicate that properly trained hands can detect small, suspicious, breast tumors before they advance to late, untreatable malignancies. (2) Although breast exams are performed widely, they are not performed well without training and practice. Recognizing the work of renowned inventor Louis Braille who calibrated fingers to read tiny raised dots, MammaCare scientists applied Braille's principles to breast exams by calibrating the sense of touch to the detection of sub-centimeter tumors in complex breast tissues.


With the support of the National Science Foundation, MammaCare created a breast exam training platform and program that works anywhere while connected to Google Chrome's internet browser. Exam performance is converted into a data stream that can be reviewed by instructors who are given remote access.

The portable devices interact with and guide practitioners and students performance while monitoring and shaping their clinical exam skills on connected, tactually accurate, breast models until they reliably detect all suspicious, pea-sized (<0.5cm) tumors present. False positives are reduced by learning to feel and confirm the difference between tumors and normal, lumpy breast tissues also present in the models.

MammaCare deployed the first version of the technology for the Women Veterans Health Program and is now equipping U.S. colleges of nursing and medicine, as well as  Congressionally-sponsored National Breast and Cervical Cancer Early Detection Programs (NBCCEDP).(3) (4) (5)

The worldwide need for skilled hands is demonstrated in MalaysiaAfricaUSIndiaQatar/ PakistanCanada, Goldstein reported, adding that "reproducible, inexpensive technology now allows us to reach out within and across continents to calibrate and validate the essential exam skills of local nurses and practitioners for early detection, helping thereby to bring down the massive global burden of advanced, late stage breast cancer." (6)(7)(8)(9)(10)(11)

Module 1
Module 1
Module 2
Module 2











(3) Women Veterans Health (US -Women Veterans)


(5)Google Scholar MammaCare

(6) (Malaysia)

(7) (Iran)

(8) (India)

(9) (Africa)

(10) (Qatar)/(Pakistan)

(11) (Canada)


Mark Kane Goldstein, Ph.D.

Mary Ann Mehn, Ph.D.



President Jimmy Carter and Early Breast Cancer Detection, an Untold Personal Story

Dear President Carter,                                                                                                                      13 November 2017

Shortly after your Inauguration in 1977, you took notice of events that led ultimately to a life-saving technology for women, known as Mammacare. I have here briefly summarized what followed so that you may take some joy knowing that your personal initiative was a signal event advancing science and leading to a safe, universally available method of early breast cancer detection for all women.     

In the mid 1970’s at the Gainesville, Florida VA Medical Center, a team of medical scientists and engineers were tasked by NCI to find a safe, universally available method to detect early breast cancer. We gathered a team to quantify the sensitivity of tactile mechanoreceptors in fingers and found that women and clinicians could reliably detect, by hand, very small lesions in breast models and in women after a brief training interval and practice. It was also apparent from the results of our basic studies that the tactile receptors in fingers can accurately and reliably discriminate small, (<=3mm) suspicious tumors from normally lumpy breast tissue. Colleagues at the National Cancer Institute had encouraged us to proceed with the work although when we sought the support of HEW in 1976 to validate and refine the findings, we were discouraged.

Soon thereafter, a colleague of yours from Plains Georgia visited our lab and insisted on personally letting you know about the research, an event that was rapidly followed by a letter from HEW. As you might imagine, a series of conflicting explanations emerged from Washington about why the research, previously set aside by our government was “now” considered worthy of support. A small research grant was then awarded although the greatest source of inspiration for the team was knowing that there was intelligent, caring life in the Oval Office.

In the years that followed many studies of our work now known as Mammacare have confirmed its effectiveness, and a recent, massive Canadian national study of  89,000 women over 25 years, demonstrated conclusively that the hands of trained nurses work as well as x-ray mammograms. Curiously, here in the US,  a highly influential federal agency  recommends against teaching women how to perform breast self-exams, although, without reservation, Mammacare continues the mission of teaching the skill to nurses, physicians and to women so they can all competently perform the free, safe potentially life-saving exam.

As a fellow former Naval Officer who holds you in the highest esteem, please accept this long delayed, but never forgotten, gratitude for your service to our country and contribution to women who are unaware that they continue to benefit from your remarkable intervention in this matter.

Mark Kane Goldstein, Ph.D.
Senior Scientist and Director
MammaCare Foundation 


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

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

Breast Cancer Screening: The Way Forward Worldwide

Breast cancer screening can be improved in the US and worldwide by training the hands of women and their practitioners to perform skilled, standardized exams.

The Canadian National Breast Screening Study

The breasts of 89,000 Canadian women were examined either by mammograms (x-ray) or by nurses trained to perform skilled clinical (manual) breast exams and self-exams. The women were randomly assigned to one of these two breast cancer screening procedures and followed  for 25 years. The surprising result disrupted current beliefs because the number of breast cancers detected by the nurses were the same as those detected by radiologists using mammograms. The study also reported that mammograms "overdiagnosed" benign findings as cancer 22% of the time. Although the final report was challenged by radiologists who use mammograms, the results were validated. An update in 2016 found that the rate of false positives, (overdiagnosed) was significantly higher than first observed.

The finding, that skilled clinical breast exams coupled with self-exam training are as effective in detecting breast cancer as mammograms, is disruptive because it contradicts common beliefs, current recommendations and practices.  The evidence from this landmark study challenges the advice of  two associated US  agencies that regularly issue "press releases" seeking to advise women and their practitioners not to perform clinical exams or self exams. Respected medical organizations don't agree

The American College of Obstetricians and Gynecologists (ACOG), reports that self-exams are effective in detecting breast cancer 

 In their current Practice Bulletin, ACOG states “Although breast-self examination is no longer recommended, 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) ”

Evidence also documents that the accuracy of both mammograms and clinical (manual) breast exams depend primarily on the quality of the examiner's skills

Well designed studies also find that breast cancer detection accuracy depends on the competencies of the examiner as well as the method used. Mammograms are read (viewed) by clinicians whose accuracy depends on their training and development of visual discrimination skills whereas the accuracy of clinical breast exams depends on training the sense of  touch and development of palpation skills.

Research studies also document  wide variations in the accuracy among  interpretations of mammograms. Training and experience are found to improve radiologists' diagnostic accuracy although the rates of false positive and false negative readings remain considerable. Similarly, studies of  clinicians (and women) trained to perform manual breast exams demonstrate significantly greater accuracy in detecting small suspicious breast tumors and fewer false positive "detections" than those who are untrained.

Why evidence is ignored

In science and medicine a period of resistance typically results when evidence contradicts established doctrines and beliefs even when the practices are inaccurate, ineffective or worse. This was dramatically demonstrated when an effective new treatment for stomach ulcers was rejected for nearly a decade by experts and  by US health officials. In the present, far more potentially deadly case of breast cancer screening.

Resistance to the discovery that mammograms are not superior to trained hands in Canada can be expected from practitioners who are invested in their approach. One notion advanced by radiologists to explain the absence of discrepancy between the value of mammograms and manual exams in detecting breast cancer is that Canadian mammography machines are older than those in the US.  But this argument lacks credibility because the image quality and resolution of x-ray mammography has not changed in more than 50 years. Moreover, images produced by newer digital mammograms do not improve the resolution or clarity of film x-ray.

So what should nurses and doctors and women and health agencies that screen women for breast cancer do?

Begin training the hands of women and their practitioners to perform skilled breast exams using valid performance  standards that produce reliable detection of small suspicious breast lesions  while eliminating  or reducing false positives and insuring  thorough coverage of all breast tissue.*

*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.




MammaCare Medical Mission for the Women of Uganda

The epidemic of breast cancer became a death sentence for many women in Uganda according to a series of revealing reports. Epidemics expand in the absence of knowledge and training and Ugandan women desperately needed both. They needed a way to identify and report the signs of early breast cancer, a way that could be easily learned and shared among all their sisters and countrywomen. The reports documented that misinformation, delayed detection and lack of knowledge led to advanced, deadly cancers.

Two women, a Ugandan public health professional and an American nurse knew just what to do and how to do it. The MammaCare Method of Breast Self-Examination (BSE) is taught to women’s groups throughout Chicago by Ruth Todd, RNC, BSN, Certified MammaCare Specialist. Mirika Sentongo, MPH, PBT (ASCP), Public Health Professional, attended one such session and was impressed by the thoroughness and accuracy of the skills being taught.

The Todd-Sentongo connection sparked a revolutionary, transcontinental breast cancer program for the women of Uganda. The two clinicians launched a hugely successful fundraising campaign using social media channels, family networks, and partnering with the Uganda Community In Greater Chicago (UCIGC) to raise nearly $7,000 for training Ugandan women to competently perform MammaCare BSE.

In April 2015, the MammaCare Mission team traveled to Kampala, Uganda and surrounding sub-urban communities with 30 sets of MammaCare breast models and materials for training women and workshop facilitators. Over the course of nine days, the team trained 400 women in self-exam and 37 health workers as workshop facilitators.

Ruth Todd, the MammaCare Specialist who directed training and taught BSE at each location, emphasized the importance of making networks with healthcare providers in the area for post-screening care. “Accessing free services is challenging,” says Todd, “We spoke with policy leaders about navigation for getting women into services for treatment and were able to leave the 30 sets of MammaCare breast models with DVDs for continuing education.”

MammaCare Medical Mission 2015 Team (L) Ruth Todd, RN, BSN, CMS, CN-BN, Breast Health Navigator at Alexian Brothers Medical Center Cancer Institute (R) Mirika Sentongo, MPH, PBT (ASCP) Public Health Professional

To learn more about this trip and its outcomes, click the link below for the PDF.

For more information about the Uganda Community in Greater Chicago and to view additional photos, visit

Great thanks go out to: the Uganda Community in Greater Chicago (UCIG) who hosted the trainings, Mirika Sentongo whose fundraising and coordination made the trip possible, the 10 Ugandan communities who provided training space and recruited participants, the Mother’s Union throughout Uganda whose initial spark encouraged the large-scale training, and all donors, participants, facilitators, and hosts.

Bringing MammaCare to Nigeria – Balancing Research and Community Needs

When education and opportunity intersect, young people often take their skills to big cities where access to modern technology and amenities make life easier. Not Stella Oluwabukola. Pursuing her Ph.D. at the University of Ibadan, Nigeria, Stella knew her calling was to bring her education back to the rural communities that needed her skills the most.

“As a research associate, I met women in the community asking me to teach them how to do Breast Self-Examination (BSE) and to help examine their breasts … I wasn’t confident I could perform this,” says Stella. Ms. Oluwabukola works with the Healthy Life for All Foundation, a not-for-profit NGO located at the University College Hospital in Ibadan, Nigeria. Her work brings her into contact with women from all walks of life, and she wanted to make a greater impact on breast cancer detection with these women.

In addition, Stella Oluwabukola is working on her Ph.D. thesis in breast cancer epidemiology. Her dissertation project required teaching nurses to perform clinical breast examination. “I wanted to learn an effective and scientific way of performing clinical breast examination and detecting breast lumps in women,” she said.

During an exchange sponsored by the NIH D43 scholarship grant at the University of Chicago, Stella was certified as a MammaCare Specialist. “The MammaCare CBE Simulator training session really improved my lump detection skills,” says Oluwabukola, “After the training I feel confident that I can really differentiate a lump from normal breast tissue.” Her MammaCare Trainer, Pat Riedy, was impressed by Stella’s commitment to bring MammaCare both to the breast cancer research project at the University of Ibadan and to lay women in the community.

Recently returned to Nigeria, Stella will use her MammaCare Specialist certification to train nurses to perform MammaCare Clinical Breast Examination, as well as teaching women BSE skills. While the research is just beginning, she has wasted no time putting her skills to good use, “I have taught some colleagues at my workplace how to perform BSE using the MammaCare Method and they found it very interesting and helpful.”

Breast Exams Performed By The Hands Of Nurses And Doctors About To Get Better

National Science Foundation grant establishes Clinical Breast Exam Competency Network

April 7, 2015 - GAINESVILLE, Fla. -- Breast exams are about to get better because the National Science Foundation awarded MammaCare a Phase llB project grant. The grant establishes a “Clinical Breast Exam Competency Network” (CBECN) to document the palpation skills of clinical students on a national scale. In Phase II, MammaCare simulator-trainer technology demonstrated significant improvement in breast tumor detection skills while reducing false positive alarms. In Phase IIB, collaborators from Capgemini and Qlik will contribute large data analytics technology that captures and reports student's exam results from all participating universities.

Mark Kane Goldstein, Ph.D., the project’s principal investigator and MammaCare Senior Scientist said, “the absence of breast exam performance standards allowed antique, ineffective exploratory examination practices that miss small cancers and generate false alarms.” The American Cancer Society (ACS) acknowledged that a palpable lump is most often the first sign of breast cancer and a new landmark study of 89,000 women supports the ACS report. “Science and medicine developed quality-standard protocols for detection of disease and we applied these standards to clinical breast exams,” Goldstein added.

The MammaCare simulator-trainer technology enables students to master breast exam palpation skills using a standard series of tactually accurate breast models that replicate the properties of normal, nodular breast tissue. The models contain small, hidden breast tumors engineered to match the characteristics of breast cancers. The system measures and reports each true positive detection, false positive detection and breast tissue coverage in three dimensions. In practice, the computer's program advances students through successively more complex examination tasks only after they have mastered the preceding task. The data from each student’s breast exam is added to the CBECN database.

Dr. Mary Ann Mehn, MammaCare’s Director of Training, said “the ultimate benefit will be realized by our nation’s women whose clinical breast exams will be performed by skilled hands that measure up to quality standards.”

Media Contact
Mark Kane Goldstein, Ph.D.