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

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

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.

MammaCare Graduates Celebrate Breast Cancer Awareness Month

Join MammaCare in recognizing Breast Cancer Awareness Month this October!

Programs around the country are providing expanded screening and outreach services to women in honor of Breast Cancer Awareness Month. While most women are aware that screening is an important part of their health care routine, heightened coverage during the month of October serves as a reminder to make an appointment and access these important services. Recently, two graduates of MammaCare programs have become recertified to continue providing screening and education to women in their communities.

RESIZED_Grismondi-Crook_Liliana_profilephotoIn North Carolina, Liliana Gismondi-Crook is the Breast Health Community Outreach Coordinator/Educator at Carolinas Medical Center NorthEast. Recertified as a MammaCare BSE Instructor, Ms. Gismondi-Crook will hold several “Mammogram Parties” at the Breast Health Center at CMC NorthEast for the month of October. These events bring together friends, families, and coworkers for breast health education and screening services. For the parties, the Breast Health Center schedules mammogram appointments back-to-back and provides a relaxed atmosphere for women to learn MammaCare Breast Self-Examination.

“It’s like bringing an exercise buddy to the gym,” says Gismondi-Crook, “Even though cancer is something serious, here is a way to make [screening] a little bit more fun!” The mobile mammography unit at CMC NorthEast serves five counties surrounding Charlotte, NC and makes stops to rural communities, bringing important services to the women where they live. In addition to community outreach activities, Gismondi-Crook and the staff at the Breast Center at CMC NorthEast target hospital employees with “Pink Day” specials, like lunchroom appointment scheduling, educational activities, and refreshments. Of her recent recertification, Ms. Gismondi-Crook says, “It is a good time to talk to the MammaCare Trainer about new guidelines and questions you may have had after implementing the program.”

RESIZED_Williams_Angelia_profilephotoIn Texas, Ms. Angela Williams, RN, upgraded her MammaCare CBE certification to become a MammaCare Specialist. Williams is the Project Coordinator for the UNTHSC North Texas Breast Cancer Prevention and Education Program. Funds for the program are provided by the Cancer Prevention Research Institute of Texas (CPRIT). “The Mammacare CBE and Specialist Certification program has expanded the depth of our project and contributes to the sustainability of routine prevention, screening and early  detection of breast cancer in the communities we serve,” says Williams.

An estimated 5,000 people live with breast cancer in Dallas County and the numbers are increasing yearly. This October, the UNT Health Science Center (Fort Worth) for Community Health will provide potentially life-saving clinical breast exams, mammography screening and breast health education with a special event happening on October 15th.

Explore MammaCare for additional resources to support your organization’s Breast Cancer Awareness Month activities