Seeing the unseen: Visually impaired MTE use unique sense of touch to improve early detection of bre- The New Indian Express

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Express News Service

Reena Sharma (name changed), a 32-year-old woman from Delhi, hesitantly sought a breast examination at a medical camp earlier this year. The test was with a difference though: instead of a mammography machine, it was conducted by a visually impaired Medical Tactile Examiner (MTE). The practitioner carefully palpated Sharma’s breast to identify any irregularities.

“I couldn’t even tell that Gudia didi was visually impaired once she started examining and discovered a lump,” says Sharma. Although she was reassured that it was not concerning, the MTE gave her instructions on how to self-examine every month.

Gudia is one of the 18 examiners trained to conduct breast cancer screenings in India using their tactile abilities. In a country where a woman is diagnosed with the disease every four minutes, MTEs have a crucial role in early detection. As mammograms are less effective than 40 years, these examiners rely on their highly developed sense of touch to detect lumps as small as 5 mm.

Master trainer Sonal Prakash (right) with 
MTE Meenakshi Gupta

The concept of MTEs was first introduced in 2010 by gynaecologist Dr. Hoffmann, who founded Discovering Hands Germany. It was brought to India five years later by Shalini Khanna Sodhi, the founder of Discovering Hands India and the NAB India Centre for Blind Women and Disability Studies. She led a team of women to receive 40-day training from Dr Hoffmann.

“During the visit, I realised that the blind women were examining in the same manner as medical professionals, but with more focus,” she says. Sodhi came back inspired to identify blind women to train in India. Today India has the highest number of MTEs in the world after Germany. They are employed in hospitals in Delhi and Bengaluru and regularly conduct checkups as part of medical camps across the country.

Neha Suri, who lost her vision at age 43 due to retinitis pigmentosa, joined the NAB centre in 2017 to acquire MTE skills. “ My husband died of bone cancer. I saw him battle with it and wanted to help women avoid the deadly disease,” says Suri, who today examines about 20 patients a month. MTEs use ‘optimal sensory touch’, which involves assessing the breast area temperature and palpating the superficial lymph nodes in the cervical, clavicular and axillary areas for swelling. The area is divided into four zones using five Braille tapes named ‘Docos’.

“During the examination, I move my fingers centimetre by centimetre and apply three types of pressure: superficial, moderate and deep. Superficial focuses on the upper layers of the skin to check for abnormalities. Moderate goes slightly deeper to palpate breast tissue. Deep pressure is used to feel abnormalities near the chest bone,” says Suri.

Need of the hour

According to the Globocan 2020 statistics, breast cancer emerged as a significant health risk in India, comprising 13.5 per cent (178,361) of all reported cancer cases and contributing to 10.6 per cent (90,408) of total cancer-related fatalities. Notably, nearly half of all breast cancer patients are in the premenopausal stage, signifying the prevalence of this disease among younger individuals.

The standard test for breast cancer screening is mammography. Below 50 years of age, however, it can be less effective as younger women have dense breast tissues. An ultrasound is an alternative, but its high cost makes it unaffordable for many. That’s where MTEs step in. They can detect subtle variations in texture, density and shape to identify even the smallest lumps. “The process has been shown to have 
a lower error rate (1-11 per cent) compared to mammography (50 per cent error rate) in research studies,” says Sodhi.

A 2019 study, titled Diagnostic Accuracy of Breast Medical Tactile Examiners, showed the detection rate of MTEs is comparable to mammography. “A gynaecologist and MTE together can detect cancer 20 per cent more effectively,” says Dr Mandeep Singh Malhotra, HOD, Neck & Breast Oncoplasty at Fortis Healthcare, New Delhi.

Challenges and Way Forward

The process of clinical breast examination using tactile medical tape takes approximately 30 to 35 minutes, while a machine does it in five minutes. Because of this, there was resistance from medical professionals. To overcome the challenge, Discovering Hands India conducted several workshops, in collaboration with local healthcare organisations and NGOs, to educate gynaecologists and patients about the importance of early detection. “The MTE system is designed to be foolproof, ensuring that every cm of the breast is covered. Leaving any area unexamined could result in missed abnormalities,” says Sodhi. 

Finding suitable candidates poses a challenge too, as visually impaired individuals often face barriers in studying sciences and English, and may lack access to online classes. The admission process involves specific criteria, including a science background until Class VIII, a 10th-grade passing certificate, and basic knowledge of computers and English.

“We receive around 32 to 50 applications for admission, from which we shortlist 10 to 15 candidates for the final assessment,” says Sonal Prakash, Master trainer at Discovering Hands India.

Currently, eight more women are undergoing training at Discovering Hands India. As the organisation looks ahead to ready more MTEs, its vision includes extending its services to rural communities that do not have access to mammography machines and trained healthcare professionals. 

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