When the German government said no women under the age of 50 would be sent for mammograms unless a breast abnormality was detected during routine examination, gynaecologist Dr Frank Hoffman came up with an amazing idea that would help two vulnerable social groups at the same time: the visually impaired and potential breast cancer sufferers.
Knowing that some breast lumps can be very small and difficult to detect in the few minutes he had to spend with his patients, he decided to launch the innovative programme Discovering Hands. His idea was to turn the more acute sense of touch of blind or visually impaired women into a skilled breast tumour detection tool.
The programme now includes 17 medical tactile examiners (MTEs), who are trained and working across Germany. Hoffman has gained enough support to develop an entire curriculum training blind and visually impaired women to become MTEs. And his initiative has found a rather avid supporter in the Ruderman Family Foundation; an organisation based in Israel and Boston that prioritises the inclusion of people with disabilities in the Jewish community.
So much so, that the Foundation’s president, Jay Ruderman, followed Hoffman on a tour of Germany to examine the programme in action at hospitals and clinics. “I don’t know many examples of a Jewish and Israeli funder foundation investing in Germany. It’s not easy with our history,” said Ruderman.
The Ruderman Foundation granted Discovering Hands an initial $72,000 donation in 2013 to help it grow across Germany, and it will offer logistical support to bring the programme to Israel, where initial discussions have taken place with the Hadassah University Hospital-Mount Scopus in Jerusalem.
For women under the age of 40, mammograms are not always “very good at detecting tumours, because the breast density is pretty high at that point and a lot of things are hidden,” said Dr Virginia Kaklamani, an oncologist at Chicago’s Northwestern Memorial Hospital and associate professor of haematology-oncology at Northwestern University Feinberg School of Medicine. But studies have shown that “if nurses are taught how to do self-breast exams and they do them on themselves,” then their exams are much more useful, Kaklamani added.
In the MTE breast examination method, self-adhesive orientation stripes with tactile orientation points are attached to the patient’s breast in various positions, and the breast is divided into zones that allow the examiners to define the precise square centimetre where an abnormality is found. An MTE breast examination takes between 30 and 60 minutes.
Discovering Hands conducted a study in conjunction with the University of Essen, looking at 451 patients that were examined by MTEs. Among these patients, there were 32 abnormal findings that were discovered by the MTEs but not by the doctors. “Women with those findings would have been sent home by the doctors,” Hoffmann said.
Discovering Hands “has a huge medical benefit for the community, but it also has a huge benefit for providing employment and inclusion for blind women,” Ruderman said. Currently in Germany, training to become an MTE lasts nine months and takes place through vocational centres for the blind and visually impaired across Germany. Of the eight such centres in Germany, four are now qualified to train MTEs.
In addition to learning anatomy and breast examination technique, women through Discovering Hands also learn communication and Braille technology skills so they can do their documentation on their own and “don’t need another helping person with them when they are doing their job,” Hoffmann said. After six months of study and a final examination, the women undertake a three-month internship at a clinic.
For the Ruderman Family Foundation, bringing Discovering Hands to Israel is an ongoing process. If the foundation can bring the programme to a hospital and make it a success, the project may get some public attention and induce demand, and then the Israeli government might respond with funding and other assistance, Ruderman said. “I do think that this technology could be influential all around the world. You have to think of all the countries in the world” where mammograms are “either not available or extremely expensive. This is a very low-tech, brilliant idea that could be replicated all over the world,” Ruderman said.
For more than 100 years, Hadassah (www.hadassah-med.com) has been a leader in medicine and nursing in Israel, laying the foundation and setting the standards for the country's modern health care system. The majority of medical breakthroughs in Israel have taken place there. With more than 130 departments and clinics, Hadassah-Ein Kerem provides Israel's most advanced diagnostic and therapeutic services for the local and national population and a significant number of international patients.
iMER (www.imer.biz) is the international patients office of the Hadassah University Hospital in Jerusalem. iMER, with offices in Cyprus, Austria, Germany, Israel, Russia, Ukraine, Azerbaijan and Georgia, in cooperation with Hadassah, offers patients assessment services, the preparation of a medical plan and referral to the appropriate Hadassah units.
