Prospective evaluation of Tactile Breast examination by Visually Impaired for early detection of breast cancer in Indian women

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Mandeep Singh Sonal Prakash Supinder Kaur Neha Sharma Deepak Jha Chandrakant S Pandav Frank Hoffman


Introduction: Breast cancer is the most common cancer in women around the world, including India. The peak incidence in India is occurring between the ages of 45 -49 years. The solution to problem lies in early detection. The two important methodologies are tactile examination and radiological assessment in form of Mammography. This study explores the concept of enabling and training visually impaired women known as Medical Tactile Examiners with enhanced tactile sense to perform Tactile Breast Examination (TBE) for early detection of Breast Cancer.

Material & Method: A total 1338 women were enrolled. Tactile Breast Examination included intensive and meticulous examination of every cm of breast by three different touch pressures using specialized strips to guide the visually impaired. It was preceded by recording information around lifestyle habits, pregnancy, lactation, menstruation, family history, etc. The radiological assessment included Ultrasound for women less than 40 years and Mammogram for 40 years and above. Data generated was statistically analyzed.

Results: 2.6% of 1338 women were doing routine breast screening; 16% had Body Mass Index > 30; 3% were into substance abuse; 7% experienced menstrual irregularities; 16% were nulliparous; 15% of the parous women had insufficient lactation. 5% had family history of Hereditary Breast and Ovarian Cancer and 4% had previous history     of Breast Cancer. Tactile Breast Examination findings were normal in 756/1338 (56.5%), amongst which 8/756 (1%) had radiology reports with BIRADS 4 (suspicious for malignancy) findings. Medical Tactile Examiners during the process of TBE identified palpable breast alterations in 582/1338 (43.5%) of the cases, amongst which 29/582 (5%) were identified as BIRADS 4. The statistical analysis suggests Tactile Breast Examination having a high sensitivity (78.3%) and a very high negative predictive value (98.9%)

Conclusion: The process of Tactile Breast Examination by visually impaired appears apt for breast screening as it detects almost any aberration both benign and malignant in breast which is amenable to human touch and misses out in just 1% changes which can be malignant. It has the potential to become vocational avenue for visually impaired women.

Keywords: Tactile Breast examination, breast cancer, breast cancer in Indian women, cancer

Article Details

How to Cite
SINGH, Mandeep et al. Prospective evaluation of Tactile Breast examination by Visually Impaired for early detection of breast cancer in Indian women. Medical Research Archives, [S.l.], v. 11, n. 3, mar. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 19 july 2024. doi:
Research Articles


1. Globocan 2020-
2. Gupta A, Shridhar K, Dhillon PK. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit?. Eur J Cancer. 2015;51(14):2058-2066. doi:10.1016/j.ejca.2015.07.008
3. Anonymous. National Cancer Registry Programme 2007— 2011. Indian Council of Medical Research (ICMR), Bangalore, India 2013
4. Bhattacharyya GS, Doval DC, Desai CJ, Chaturvedi H, Sharma S, Somashekhar SP. Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective. JCO Global Oncology. 2020;(6):789-798. doi:10.1200/go.20.00033
5. Leong SP, Shen ZZ, Liu TJ, et al. Is breast cancer the same disease in Asian and Western countries?. World J Surg. 2010;34(10):2308-2324. doi:10.1007/s00268-010-0683-1
6. Alkabban FM, Ferguson T. Breast Cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 7, 2021.
7. Harford JB. Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol. 2011;12(3):306-312. doi:10.1016/S1470-2045(10)70273-4
8. Mittra I. Breast cancer screening in developing countries. Preventive Medicine. 2011;53(3):121-122. doi:10.1016/j.ypmed.2011.06.010
9. Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomised controlled trial. The Lancet. 2006; 368(9552):2053-2060. doi:10.1016/s0140-6736(06)69834-6
10. Moss SM, Wale C, Smith R, Evans A, Cuckle H, Duffy SW. Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years’ follow-up: a randomised controlled trial. The Lancet Oncology. 2015;16(9):1123-1132. doi:10.1016/s1470- 2045(15)00128-x
11. Agarwal G, Ramakant P. Breast Cancer Care in India: The Current Scenario and the Challenges for the Future. Breast Care (Basel). 2008;3(1):21-27. doi:10.1159/000115288
12. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement [published correction appears in Ann Intern Med. 2016 Mar 15;164(6):448]. Ann Intern Med. 2016;164(4):279-296. doi:10.7326/M15-2886
13. Dinshaw KA, Shastri SS, Patil SS. CANCER CONTROL PROGRAMME IN INDIA: CHALLENGES FOR THE NEW MILLENNIUM. Health Administrator Vol: XVII, Number 1: 10-13,pg. (
14. Goldreich D, Kanics IM. Tactile Acuity is Enhanced in Blindness. The Journal of Neuroscience. 2003;23(8):3439-3445. doi:10.1523/jneurosci.23-08-03439.2003
15. Goldreich D, Kanics IM. Performance of blind and sighted humans on a tactile grating detection task. Perception & Psychophysics. 2006;68(8):1363-1371. doi:10.3758/bf03193735
16. Seiteninhalt International. Accessed May 27, 2022.
17. Lux MP, Emons J, Bani MR, et al. Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study. Breast Care. 2019;14(1):41-47. doi:10.1159/000495883
18. Castro SM, Tseytlin E, Medvedeva O, et al. Automated annotation and classification of BI- RADS assessment from radiology reports. Journal of Biomedical Informatics. 2017;69:177-187. doi:10.1016/j.jbi.2017.04.011
19. News, I., 2022. Almost one in 10 women aged 15 & above a tobacco user: NFHS | India News - Times of India. [online] The Times of India. Available at: [Accessed 17 May 2022].
20. Gupta A, Shridhar K, Dhillon PK. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit?. Eur J Cancer. 2015;51(14):2058-2066. doi:10.1016/j.ejca.2015.07.008
21. Haakinson, DJ, Leeds, SG, Dueck, AC, Gray, RJ, Wasif, N, Stucky, CCH, Northfelt, DW, Apsey, HA & Pockaj, B 2012, 'The impact of obesity on breast cancer: A Retrospective review', Annals of surgical oncology, vol. 19, no. 9, pp. 3012- 3018.
22. Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA Cancer J Clin. 2017;67(5):378-397. doi:10.3322/caac.21405
23. Hamajima N, Hirose K, Tajima K, et al. Alcohol, tobacco and breast cancer—collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer. 2002;87(11):1234-1245. doi:10.1038/sj.bjc.6600596
24. Apter D, Vihko R. Early menarche, a risk factor for breast cancer, indicates early onset of ovulatory cycles. J Clin Endocrinol Metab. 1983;57(1):82-86. doi:10.1210/jcem-57-1-82
25. Goldberg M, D'Aloisio AA, O'Brien KM, Zhao S, Sandler DP. Pubertal timing and breast cancer risk in the Sister Study cohort. Breast Cancer Res. 2020;22(1):112. Published 2020 Oct 27. doi:10.1186/s13058-020-01326-2
26. Olsson H, Landin-Olsson M, Gullberg B. Retrospective assessment of menstrual cycle length in patients with breast cancer, in patients with benign breast disease, and in women without breast disease. J Natl Cancer Inst. 1983;70(1):17-20.
27. H. Olsson, J. Ranstam & M. Landin Olsson (1987) The Number of Menstrual cycles Prior to The First Full Term Pregnancy an Important Risk Factor of Breast Cancer?, Acta Oncologica, 26:5, 387 389, DOI: 10.3109/02841868709104365
28. Atashgaran V, Wrin J, Barry SC, Dasari P, Ingman WV. Dissecting the Biology of Menstrual Cycle Associated Breast Cancer Risk. Front Oncol. 2016;6:267. Published 2016 Dec 26. doi:10.3389/fonc.2016.00267
29. Britt K, Ashworth A, Smalley M. Pregnancy and the risk of breast cancer. Endocr Relat Cancer. 2007;14(4):907-933. doi:10.1677/ERC-07-0137
30. Opdahl S, Alsaker MD, Janszky I, Romundstad PR, Vatten LJ. Joint effects of nulliparity and other breast cancer risk factors. Br J Cancer. 2011;105(5):731-736. doi:10.1038/bjc.2011.286
31. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet. 2002;360(9328):187-195. doi:10.1016/S0140-6736(02)09454-0
32. Chaudary MA, Millis RR, Hoskins EO, et al. Bilateral primary breast cancer: a prospective study of disease incidence. Br J Surg. 1984;71(9):711-714. doi:10.1002/bjs.1800710924
33. Londero AP, Bernardi S, Bertozzi S, et al. Synchronous and metachronous breast malignancies: a cross-sectional retrospective study and review of the literature. Biomed Res Int. 2014;2014:250727. doi:10.1155/2014/250727
34. Barnard ME, Boeke CE, Tamimi RM. Established breast cancer risk factors and risk of intrinsic tumor subtypes. Biochim Biophys Acta. 2015;1856(1):73-85. doi:10.1016/j.bbcan.2015.06.002
35. Brewer HR, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ. Family history and risk of breast cancer: an analysis accounting for family structure. Breast Cancer Res Treat. 2017;165(1):193-200. doi:10.1007/s10549-017-4325-2
36. Colditz GA, Willett WC, Hunter DJ, et al. Family history, age, and risk of breast cancer. Prospective data from the Nurses' Health Study [published correction appears in JAMA 1993 Oct 6;270(13):1548]. JAMA. 1993;270(3):338-343.
37. Slattery ML, Kerber RA. A comprehensive evaluation of family history and breast cancer risk. The Utah Population Database. JAMA. 1993;270(13):1563-1568.
38. Oualla. Occult Primary Breast Cancer Presenting With Axillary Nodal Metastasis: Report of 3 Cases. Journal of Clinical Gynecology and Obstetrics. Published online 2012. doi:10.4021/jcgo42w
39. Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average- Risk Women. Obstet Gynecol. 2017;130(1):e1-e16. doi:10.1097/AOG.0000000000002158
40. Myers ER, Moorman P, Gierisch JM, et al. Benefits and Harms of Breast Cancer Screening: A Systematic Review [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1615-1634. doi:10.1001/jama.2015.13183
41. Fenton JJ. Screening Clinical Breast Examination: How Often Does It Miss Lethal Breast Cancer? Journal of the National Cancer Institute Monographs. 2005;2005(35):67-71. doi:10.1093/jncimonographs/lgi040
42. Hoff SR, Abrahamsen AL, Samset JH, Vigeland E, Klepp O, Hofvind S. Breast Cancer: Missed Interval and Screening-detected Cancer at Full-Field Digital Mammography and Screen- Film Mammography— Results from a Retrospective Review. Radiology. 2012;264(2):378-386. doi:10.1148/radiol.12112074
43. Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017;13(4):289-295. doi:10.1111/ajco.12661
44. Trevethan R. Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Frontiers in Public Health. 2017;5(307). doi:10.3389/fpubh.2017.00307