How trained blind women are revolutionising breast cancer detection

Think of it like this: There’s a story about six blind women and an elephant.

But, unlike the parable written by American poet John Godfrey Saxe, the blind women in this story aren’t looking for an elephant but for signs of breast cancer. These women aren't guessing randomly; they're trained to make smart decisions.

India among top 3 breast cancer hotspots

In India, breast cancer is a major concern for women. It kills more women than any other cancer. According to the Global Cancer Observatory (GLOBOCAN 2022), there were 192,020 (13.6 per cent) new cases of female breast cancer with a mortality rate close to 98,337 (10.7 per cent). These numbers place India in the top three global breast cancer hotspots.

Early detection significantly improves the chances of surviving the disease and the most common modalities recommended by doctors are breast self-examination, clinical breast examination (CBE), ultrasonography, mammography and magnetic resonance imaging.

To support early detection, a special programme launched by the National Association for the Blind (NAB) in medical tactile examination trains blind women to check for breast cancer using their hands. These women get special training, spanning over nine months, and are certified to work as medical tactile examiners (MTEs) in hospitals alongside clinicians. The programme is gradually gaining popularity and several hospitals in Delhi NCR have shown interest in employing such MTEs.

Discovering Hands programme

At the heart of the NAB Centre for Blind Women and Disability Studies programme is the multi-award winning German programme, Discovering Hands (DH), created by Dr Frank Hoffman. Dr Hoffman claims that DH-trained blind examiners can find changes in the breast tissue better than doctors.

The blind MTEs have found growths as small as 6 to 8 mm, while doctors usually find bigger ones, around 10 to 20 mm.

A 2019 study by a group from Erlangen University in Germany looked at how accurate blind examiners were in finding breast problems. They wanted to see if adding blind examiners to the team could help doctors find breast problems better. The study found that blind examiners were comparable or better than doctors at finding minute breast tissue changes.

Founder and director of NAB, Shalini Khanna Sodhi explains, “The NAB is the only organisation in India offering the Discovering Hands training to visually impaired women at their Centre for Blind Women. The women receive extensive theoretical and practical training on breast anatomy and are certified by the Rehab Council of Germany. So far, there are 37 trained MTEs employed in various hospitals across India and the demand for them is growing.”

Why MTEs are sought after by patients?

“Patients feel comfortable with the blind MTEs as they carry no prejudices based on colour, religion or size and are very meticulous with their examination. They listen to the patient and offer important information on self-breast examination as well”, the NAB director explains further.

A combination of the qualification and ability to empathise with patients make the blind MTEs outstanding candidates as early stage cancer screeners.

Although the science and training of the blind MTEs is rock solid, the acceptance and uptake has had its fair share of challenges. Concerns range from the length of the examination (30 minutes) to the hyper dependence on doctors for patient access and medical supervision.

However, despite the challenges, some hospitals in Delhi-NCR, such as Medanta, CK Birla and Fortis, have opened their doors to provide blind MTEs with internship opportunities and employment.

Why the blind are the best bet?

Blind individuals often have enhanced senses other than sight. The MTE training programme is based on the idea that the blind have a superior sense of touch that enables them to detect the smallest tissue changes in the female breast.

We see the first signs of this ability when blind people read Braille and remember objects or people just by touching them. Congenitally blind Braille readers are very good at reading words and even made-up words through touch. They also seem to hear things better and can tell where sounds are coming from better than people with sight.

When people are born blind or lose their sight early in life, they often develop extra or enhanced senses. Commonly known as neuroplasticity, this phenomenon underlying sensory enhancement remains to be fully understood.

Neuroplasticity is the brain’s ability to change and improve its activity through structural, functional and cellular changes, in order to enhance other senses when one sense, like sight, is missing.

Choosing the right candidate is crucial

Losing sight early in life can make the brain change how it works, even in areas that are normally for sight. Some studies show that the part of the brain that is otherwise supposed to be meant for vision, starts helping with language processing instead.

Other studies have demonstrated increased blood flow to the vision centre in the brain (the occipital lobe) during non-visual simulations such as sound, touch or smell implying that the brain is actively adapting to new sensory inputs.

Normally, the back part of the brain, known as the occipital lobe, helps people with vision. But in congenitally blind individuals, it seems to help with understanding language instead. This is surprising because it means the brain is changing what it does normally – and doing so across different neural areas and functions.

However, it's important to note that not all blind people have these exceptional senses — they vary from person to person. This means that not everyone who is blind may be suited for roles like blind MTEs. Selecting the right candidates for MTE training is crucial.

Potential limitations

In India, the Discovering Hands programme faces several challenges due to legal and medical issues that plague the Indian healthcare ecosystem.

First, blind examiners are not seen as clinical professionals, so they need a doctor present during examinations. Second, their exams alone aren’t considered gold standard-radiation free checks, and, thus, patients would still require taking clinical, and sometimes radiological, tests for validation. Hospitals may see this as extra work for doctors.

Lastly, while prospective studies from the West support the diagnostic value of screenings performed by the blind MTEs, there haven't been any such studies in India comparing the results of the NAB Centre for Blind Women and Disability Studies-trained MTEs to those of doctors and imaging. Differences in clinical practice, available facilities and regulations may yield varying results from the West and, therefore, this has to be independently tested in India.

Not just a medical issue

In India, women often bear a heavy burden of household chores and childcare responsibilities. Their health issues can disrupt the entire household and many are hesitant to seek medical help due to cultural and societal norms. Women's health is often not prioritised, and family finances may not allow for proper care.

Therefore, the role of blind examiners goes beyond just medical tasks — it straddles the line between healthcare and society.

While their skill in finding breast cancer early is evident, they also serve a larger social purpose by creating a safe space for vulnerable women to receive exams and learn about breast cancer and its risks.