Meenakshi Gupta is a Delhi-based medical tactile examiner (MTE) and a humanities graduate trained in tactile breast examinations, a specialised form of clinical breast examination. She is blind since birth and has been organising tactile examinations in parts of India to track early-stage breast cancer in women.
It is pertinent to mention that, a blind person’s brain with the absence of visual information can develop heightened sensitivity in hearing, touch and other senses and cognitive functions. Frank Hoffmann, a Germany-based gynaecologist who developed the idea of MTE has found during their extensive examinations that, MTEs can catch lumps as small as 6-8mm.
Also, research claims that it is less than the 10-20mm lumps that many physicians without a visual impairment can find during examinations.
In India, 18 MTEs have been trained since 2017. Some of them are currently working at hospitals in Delhi and Bengaluru and a few are employed by the National Association of the Blind India Centre for Blind Women and Disability Studies (NABCBW), a non-profit in Delhi that also provides training.
How does the testing work?
Meenakshi Gupta, during a test drive in a government-run primary health centre in Vapi, a city in the south-west Indian state of Gujarat tested some women for breast cancer. She begins by displaying a diagram of a woman’s breast with five Braille-marked orientation tapes pasted on it. She then tells the women that she will be pasting the skin-friendly tapes on their breasts to check for any abnormalities.
Dividing the chest into four zones with the tapes, she spends 30 to 40 minutes palpating every centimetre of the breast with varying pressure, before documenting her findings on her computer. Dusing the test Gupta takes note of the medical history of the patients and then she sends the data to a physician for a diagnosis of any abnormalities and advice on further assessment.
Hoffman who is behind the MTE training in India and Europe says, “I always worried that as a gynaecologist I didn’t have enough time to spend on breast examinations and could be missing out on tiny lumps,” he says.
Doctors cannot spend 30 to 40 minutes examinations but a trained non-medical worker with an enhanced tactile sense could be ideally placed to do so. In 2010, Hoffman with a social enterprise based in Germany, started working on MTEs. A research work, “Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study” shows that MTEs’ findings were similar to those of physicians.
In 2017, Discovering Hands expanded to India through the NABCBW, whose staff received training from Germany to train MTEs.
Notably, the standard test for breast cancer screening is mammography, which involves taking an X-ray of the breast. also, below 50 years of age, this test can be least effective and hence there is a need for an alternative. One option is ultrasound, however, due to the high costs of employing radiologists and the ultrasound machines themselves, there are not many resources around it.
Research conducted in 2021, “Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: prospective, cluster randomised controlled trial in Mumbai” claims clinical breast examination carried out every two years by primary health workers could help catch breast cancer at its early stages.
Clinical breast examination screening programmes exist in India, but participation rates are “extremely inadequate”, according to a recent National Family Health Survey, which provides national data on population dynamics and health indicators. Overall, less than 1% of women had undergone breast cancer screening between 2019 and 2021 across India.
Indian MTEs work with surgical oncologists where they examine women coming for routine examinations. Some have been travelling with breast cancer screening camps conducted by NABCBW in rural, semi-urban and urban areas in Mumbai, Delhi, Vapi, and Bengaluru. To date, 14 MTEs have examined a total of more than 2,500 women in camps and approximately 3,000 in hospitals.
In India, a total of 18 MTEs have been trained, though the pressures of the Covid-19 pandemic have meant only six are currently practising. Another eight MTEs, however, are in training in Delhi and Bengaluru and are due to graduate this year.
Shalini Khanna, the director of NABCBW explains to BBC that the number of trainees is small due to the high expense of the training and because most blind women in the programme come from low-income backgrounds, and may have a pressing need to provide for themselves and their families. The length and rigorousness of the training sometimes mean they sometimes prefer to join shorter courses or quit the training midway.
