India: Blind women use touch to find and fight breast cancer

New Delhi resident Meenakshi Gupta is blind from birth. Every morning, she joins thousands of commuters on the Delhi metro and travels 90 minutes to a hospital where she starts another day of saving lives.

Her job is to detect breast cancer in women. Many of her patients are skeptical about being examined by a blind person, but more than a few have called her an inspiration.

"As a blind woman trained to help in detecting breast cancer, I am able to catch the smallest of the lumps that can be crucial in helping save a life," Gupta told DW.

In the past eight months, the 31-year-old has performed more than 100 screenings as a Medical Tactile Examiner (MTE). The job is a new, specialized role for blind and visually impaired women. Studies have shown that people with blindness develop a superior sense of touch.

MTE spreads across continents

Medical tactile examination was originally developed by German gynecologist Frank Hoffmann. In 2011, Hoffmann started "Discovering Hands" as a social initiative, under which blind and visually impaired women are trained to become MTEs.

"Earlier, I used mammography for detecting breast cancer, but now my patients can get malignance detected by the MTEs, which has no risk of radiation involved and is cost-effective," Hoffmann said.

So far, more than 50 people have been trained as MTEs in Germany. The program was extended to other countries including Austria and Switzerland, but also India, Columbia and Mexico. The latter two were forced to suspend the program since the outbreak of the COVID-19 pandemic.

In India, the initiative was introduced by the National Association of the Blind India Centre for Blind Women and Disability Studies (NABCBW) in 2017. Located in the Indian capital of Delhi, the center has trained 18 MTEs and is currently training another eight. 

"Initially, we had our doubts about how blind women can perform such a complex task but I was convinced once I saw how meticulously the blind women in Germany were examining each centimeter," Shalini Khanna, the director of NABCBW, told DW.

Candidates have to complete a medical internship

The NABCBW has been conducting breast cancer screening camps across different parts of India since December, and the MTEs trained at the center have screened more than 1,000 women.

According to a 2019 study, clinical breast examinations done by MTEs had an accuracy level similar to that performed by physicians.

The program requires the women to go through a rigorous 9-month-long training which includes a 3-month-long internship at a medical facility.

During the training, they are taught English, as well as computers science, fundamentals of human anatomy and physiology focusing on breast cancer. They learn about types of breast cancers and the kinds of treatments and therapies prescribed by gynecologists and oncologists.

"The education system for blind students in India is one of the biggest challenges we face in implementing this program because most of the blind children don't get to study science in high school," NABCBW chief Khanna said.

In multilingual India, medical sciences are taught in English, so "the women also have to be taught English first."  

Is MTE an alternative to mammography? 

Early detection is crucial for breast cancer. When lumps are detected in early stages, chances of successful treatment could be as high as 90%, explains Mandeep Malhotra, director of Oncology at CK Birla Hospital in Delhi.

Unfortunately, in India, nearly 60% of cases of breast cancer are diagnosed at stages III and IV, which is in contrast to many developed countries in the West where most breast cancer cases are diagnosed at early stages of I and II.

Experts suggest that women should get themselves screened at least once per year. However, due to various factors including a lack of awareness and overburdened doctors, participation in clinical breast examinations remains poor.

Breast tissue can be examined by ultrasound and mammography but those methods have certain limitations. 

"Mammography is not effective in younger women so it is not advisable for women aged below 45 years," Malhotra said.

More precise than mammograms

Additionally, the higher breast density found among Indian women when compared to the Western population also makes mammography less suitable for the Indian population.

"We do not have the infrastructure or medical talent to run mass screening programs with mammograms in India as it is done in the West," said Kanchan Kaur, senior director of breast surgery at Medanta Hospital in Gurugram.

"The next best thing is a clinical breast examination by women who are specifically trained to do this," she added.

The doctor noted that MTE is not a replacement for mammogram or ultrasound, but serves to complement those technologies.

Researchers have found that MTEs were able to detect lumps with diameters as small as 6-8 mm (around ¼ of an inch). A recent study that was headed by Malhotra recorded Tactile Breast Examinations on 1,338 women and found that MTEs had a missing rate of only 1% — significantly lower than the missing rate of mammograms which stands at 20%.

The results have fueled hopes that this program would take off on a larger scale, help battle breast cancer all across India and the world, and provide jobs for hundreds of women like Meenakshi Gupta.