MammaCare, the recognized quality-standard for physical examination of the breast, was developed with the support of the National Cancer Institute, the National Science Foundation and medical scientists worldwide.  MammaCare's mission is to provide breast examination proficiency for every clinician who examines women and for every woman.

The contributions of MammaCare scientists and colleagues have been noted in landmark reports on early detection...

Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How?  Journal of the American Medical Association, 1999 Oct, 6: 283(13), 1687-9.  Barton, M.B., Harris, R. & Fletcher, S.W.   "...MammaCare's standards for teaching and practicing effective CBE emerged from an extensive series of laboratory studies measuring lump detection and breast examination skills using tactually accurate breast models embedded with small, simulated lesions."

How best to teach women breast self-examination. A randomized controlled trial.  Annals Intern Med. 1990 May 15;112(10):772-9. Fletcher SW, O'Malley MS, Earp JL, Morgan TM, Lin S, Degnan D.    "Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills. Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills."

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Recent reports confirm that a substantial portion of breast cancer is detected  by clinicians' or  womens' fingers.  Updated July 2012

A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec; 200(6): 712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B. "Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors... resulting in more aggressive therapy."

Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010 Mar; 210(3): 314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AAC. "Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years...)."

Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found? Ann Fam Med. 2006 Nov-Dec; 4(6): 512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T.  "Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit."

Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women. J Womens Health 2011 Aug; 20(8): 1135-9. Roth MY, Elmore JG, Yi-Frazier JP, Reisch LM, Oster NV, Miglioretti DL. “Most women survivors  (57%) reported a detection method other than mammographic examination.”

Measuring performance in clinical breast examination. Br J Surg. 2010 Aug;97(8):1246-52. Wishart GC, Warwick J, Pitsinis V, Duffy S, Britton, PD. "performance measures...could help to identify clinicians who have a lower sensitivity for CBE and who may therefore require feedback and further training."

Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program. J Natl Cancer Inst 2011.Jun 22;103(12):942-50. Epub 2011 May 3 Kirsh VA, Chiarelli AM, Edwards SA, O’Malley FP, Shumak RS, Yaffe MJ, Boyd, NF.  “…77% of these were true interval cancers, detected clinically in the 1–2 year interval between screening examinations…”

Surveillance of women at increased risk of breast cancer using mammography and clinical breast examination: Further evidence of benefit.  Int J Cancer. July 2012  ;131(2): 417-25. Andrew Maurice, D. Gareth Evans, Jenny Affen, Rosemary Greenhalgh, Stephen W. Duffy, Anthony Howell "We reviewed its effectiveness in terms of tumour size, lymph node status and survival in 7,475 women seen over a 22-year period in the Manchester Family History Clinic.  ".... We conclude that screening by annual mammography and CBE between age 35–50 years and 18 monthly from 50 to 60 years may diagnose breast cancer in a less advanced state in terms of size and node status."

Excessive resections in breast-conserving surgery: a retrospective multicentre study. Breast J. 2011 Nov-Dec; 17(6): 602-9. Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten HJ, de Lange de Klerk E, van den Tol P, Meijer S.  "Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%)."

Improved Clinical Breast Examination Competencies Via Intelligent Simulator Training, July 7, 2012   Meeting of the German Society for Senologie, Stugart Goldstein M.K.*, Mehn M.A.*, Pennypacker H.S.*, Brost B.C.** Petersen W.O.**, Nicometo A.M.**,  MammaCare* and Mayo Clinic**  "Two independent trials found that the CBE Simulator produced significant gains in clinical breast examination skills suggesting that this technology may improve the accuracy and quality of breast cancer screening. "

For a review of studies about MammaCare, Google Scholar is useful.

A research bibliography is also available on this website.