In an extraordinary programme, blind women in India are assisting in the diagnosis of possible breast cancers, in a country where mammograms are in short supply and where their skills are desperately needed.
Although Meenakshi Gupta has been blind since birth, she can identify what many patients and medical specialists miss: the tiniest lumps in a woman’s breast that could be malignant.
One of 30 blind women from India trained as part of a global project called “Discovering Hands”, Gupta (31), has been working for the past two years as a medical tactile examiner (MTE) at Medanta Hospital in the northern Indian city of Gurgaon.
Introduced in the country in 2017, the programme was rolled out at major hospitals in key Indian cities: Bengaluru, Varanasi, Gurugram and Delhi – where the expertise of these examiners is crucial, reports NPR.
The Discovering Hands project itself first evolved in Germany a decade earlier.
Dr Frank Hoffman, a gynaecologist and founder of the programme, said he was appalled by the sheer numbers of cases of early-stage breast cancer that were being missed, not just in Germany but around the world.
“It occurred to me that we could improve the outcome of the breast examination if we were to specially train others to do it as support staff for doctors,” he said. He decided to focus on training people who were blind; studies that have shown that the brains of blind people can develop a heightened sense of touch.
Like all of the examiners, Gupta was rigorously trained by four sighted trainers who taught her about the female body, in particular the anatomy of the breast.
Her training lasted nine months: a six-month study course, and a three-month internship. She was given mobility training as well – she uses a white cane to make her way independently to the hospital and asks for help to navigate traffic-ridden roads if she needs it. The effort is worth it.
An impressive success rate
“They were so successful that they were 30% better at detecting tissue changes than doctors,” Hoffman said of the trainees. “The MTEs can identify lumps at the very initial stages, even before they show up on imaging scans.”
Over the years, several independent studies have verified this. A pilot study conducted in 2023 by the department of obstetrics and gynaecology at the Erlangen University Hospital in Germany involved 104 patients and concluded that clinical breast examinations by MTEs, who were visually impaired, were as accurate in identifying potentially cancerous tumours as doctors trained in this procedure.
In many cases, a lump in the breast can be non-cancerous. Tests are needed to rule out cancer, and the earlier this is done, the better, said Dr D Pooja, gynaecologist and CEO of Apar Health, who is not affiliated with the Discovering Hands programme.
“An MTE’s work is very empowering, especially in a low-tech setting when not everyone has access to mammograms. It eases the burden on doctors who deal with over-crowded waiting rooms too,” she said.
Examiners like Gupta are proving to be a powerful force for identifying breast cancer and allowing for effective treatment, said Pooja. “However, we need more clinical studies to establish how their work adds value to the healthcare system.”
As an arts graduate who had studied science only in high school, Gupta said it was challenging to learn about breast anatomy and conduct clinical exams.
In their training sessions, the MTEs practise on plastic models with silicone breasts. “One of the first things we learned was how to map the breast,” she said. Using skin-friendly tape, they divide each breast into four zones. Probing gently with fingertips and using varying pressures, they closely examine every centimetre of the breast.
The process takes up to an hour for both breasts. If the MTEs locate a lump, mapping the breast this way helps the doctor locate it quickly and precisely for further examination.
MTEs document their findings to share with doctors, Gupta said. “We examine the consistency of each area of the breast: Is it hard or soft? If we find any lump, we make a note of its location, depth, size and shape. Our duties end with the examination. We’re not authorised to say whether it could be cancerous or not.”
A nervous start
After her training, Gupta began working as an intern at Medanta Hospital.
“To build our understanding and confidence at first, the doctor would ask us to identify the nature of the lump in patients who had already been diagnosed with breast cancer,” she said. They spent months noting down the feel, size, shape and consistency of these lumps, before progressing to examining patients who came in for check-ups.
“I was so nervous that my hands shook when I examined my first patient,” she said. The responsibility weighed on her – she was worried she would miss something.
That anxiety eased within a couple of months, as her experience and confidence grew, and she now sees five to eight patients a day, spending roughly an hour with each. On average, she said, one or two tend to have abnormalities. She records her findings on a laptop and flags the cases for follow-up with the doctor.
Many benefits in India
Two women have been instrumental in establishing the Discovering Hands programme in India and training MTEs. One is Shalini Khanna Sodhi, Founding Director and Secretary of the National Association for the Blind, India’s Centre for Blind Women and Disability Studies in New Delhi.
“Blind women especially were a very forgotten lot,” Sodhi said. “In addition to providing diagnostic support for doctors who are facing severe overcrowding in waiting rooms, these roles give visually impaired women – who often struggle to find jobs – dignity and purpose.”
Sodhi’s efforts were supported by Dr Kanchan Kaur, a surgeon who reconstructs breasts after mastectomies and who is based in Medanta Hospital, where Gupta now works. Both women travelled to Germany to observe and learn the technique.
Kaur said another issue is the lack of ‘breast awareness’ among Indian women, with not all of them having access to annual mammograms.
India’s Ministry of Health and Family Welfare said breast cancer is one of the most common cancers among women, with roughly 75 000 deaths every year. One of the biggest reasons is the lack of access to mammography equipment, especially in rural areas where mammograms are not a part of routine care.
In such a conservative society, women are hesitant to expose their breasts to doctors for medical check-ups. Nearly half of the cases Kaur sees are women who seek treatment at an advanced stage, “when the cancer is very aggressive and the mortality rate is high”, she said.
According to a report by the Indian Council of Medical Research (ICMR), only one of every two women diagnosed with breast cancer in India survives.
Studies have found the disease occurs at a younger age for women in India, (between 45-49) compared with the West, and because of this, survival rates are poor. That’s why it’s critical to catch the disease early, said Kaur.
The fact that breast examinations are being done by blind women has helped ease some of the stigma around going for a check-up, she observed.
This was something that healthcare professionals hadn’t quite thought about when they began the programme in Germany, Hoffman said.
If more MTEs were trained and breast examinations became part of a routine check-up in hospitals across the country, it could save a lot more lives, Sodhi said. However, that’s not a goal that can be easily met.
Currently, the intensive training for each MTE costs around $2 500. “We are funded by private donors and the number of MTEs we train every year would depend on this funding,” Sodhi said.
“But we’re hopeful we can expand soon. If so, Discovering Hands can save many more lives. It’s heartening when you think of how these women, who cannot see themselves, are showing us the way.”
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