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MammaCare is a scientifically validated system  for manual breast examination, developed with the support of the National Cancer Institute.  MammaCare was introduced in 1983 and continues to be a valuable tool for research in early detection of breast cancer.   The citations listed below are a few of the references which may be found in the medical and scientific literature.  This list is by no means exhaustive and viewers are asked to supply additional references which we may have overlooked.

Adams, C. K., Hall, D. C., Pennypacker, H. S., Goldstein, M. K., Hench, L. L., Madden, M. C., Stein, G. H., & Catania, A. C. (1976). Lump detection in simulated human breasts. Perception and Psychophysics, 20, 163-176.

Hall, D. C., Goldstein, M. K., & Stein, G. H. (1977). Progress in manual breast examination. Cancer, 40, 364-370.

Madden, M. C., Hench, L. L., Hall, D. C., Pennypacker, H. S., Adams, C. K., Goldstein, M. K., & Stein, G. H. (1978). Development of a model human breast with tumors for use in teaching breast examination. Journal of Bioengineering, 2, 427-435.

Stephenson, H. S., Adams, C. K., Hall, D. C., & Pennypacker, H. S. (1979). Effects of certain training parameters on detection of simulated breast cancer. Journal of Behavioral Medicine, 2(3), 239-250.

Hall, D. C., Adams, C. K., Stein, G. H., Goldstein, M. K., Stephenson, H. S., & Pennypacker, H. S. (1980). Improved detection of human breast lesions following experimental training. Cancer, 46, 408-414.

Thomas, R.G., et al. (1981). Computer aided instruction of breast self-examination. Annals of the World Association for Medical Informatics, 1, 19-22.

Bloom, H. S., Criswell, E. L., Pennypacker, H. S., Catania, A. C., & Adams, C. K. (1982). Major stimulus dimensions determining detection of simulated breast lesions. Perception and Psychophysics, 32(3), 251-260.

Goldstein, M. K., Stein, G. H., & Pennypacker, H. S. (1982). Efficient technology of training breast self-examination. Technical Bulletin, World Health Organization, England.

Goldstein, M. K., Stein, G. H., & Pennypacker, H. S. (1982). On subordination of BSE. American Journal of Public Health, 5(72), 498-499.

Pennypacker, H. S., Bloom, H. S., Criswell, E. L., Neelakantan, P., Goldstein, M. K., & Stein, G. H. (1982). Toward an effective technology of instruction in breast self-examination. International Journal of Mental Health, 11(3), 98-116 [Reprinted in: Public Education about Cancer (1982). UICC Technical Report Series, 72(5), 498-499].

Duer, J. D. (1984). Group dissemination of group breast self-examination training technology. Patient Education Counseling, 7(6), 98-116.

Fletcher, S. M., O'Malley, M. S., & Bunce, L. A. (1985). Physicians' abilities to detect lumps in silicone breast models. Journal of the American Medical Association, 253, 2224-2228.

Saunders, K. J., Pilgrim, C. A., & Pennypacker, H. S. (1986). Improved proficiency of search in breast self-examination. Cancer, 58, 2531-2537.

Fletcher, S. W., O'Malley, M. S., Pilgrim, C. A., & Gonzalez, J. J. (1989). How do women compare with internal medicine residents in breast lump detection? Journal of General Internal Medicine, 4, 277-283.

Fletcher, S. W., O'Malley, M. S., Earp, J. L., Morgan, T. M., Lin, S., & Degnan, D. (1990). How best to teach women breast self-examination. Annals of Internal Medicine, 112(10), 772-779.

Hilt, G. (1990). Selbstuntersuchung der brust: So nehmen sie den frauen dïe angst. Arztliche Praxis, 75(18), 20-21.

Pennypacker, H. S., & Iwata, M. (1990). MammaCare: A case history in behavioural medicine. In D. Blackman & H. Lejeune (Eds.), Behavior analysis in theory and practice: Contributions and controversies (pp. 259-288). Hillsdale, NJ: Lawrence Erlbaum & Associates.

Worden, J. K., Solomon, L. J., Flynn, B. S., Costanza, M. C., Foster, R. S., Jr., Dorwaldt, A. L., & Weaver, S. O. (1990). A community-wide program in breast self-examination training and maintenance. Preventive Medicine, 19(3), 254-269.

Atkins, E., Solomon, L. J., Worden, J. K., & Foster, R. (1991). Relative effectiveness of methods of breast self-examination. Preventive Medicine, 14(4), 357-367.

Campbell, H. S., Fletcher, S. W., Lin, S., Pilgrim, C. A., & Morgan, T. M. (1991). Improving physicians' and nurses' clinical breast examination: A randomized controlled trial. American Journal of Preventive Medicine, 7, 1-18.

Coleman, E. A., & Pennypacker, H. S. (1991). Measuring breast self-examination proficiency. Cancer Nursing, 14(4), 211-217.

Coleman, E. A., & Pennypacker, H. S. (1991). Nursing research to define outcomes of care: Evaluating breast self-examination performance. Journal of Nursing Quality Assurance, 5(3), 65-69.

Coleman, E. A., Riley, M. B., Fields, F., & Prior, B. (1991). Efficacy of breast self-examination teaching methods among older women. Oncology Nursing Forum, 18(3), 561-566.

Pennypacker, H. S. (1991). Perspective on manual breast examination. Administrative Radiology Journal, 10(7), 33-36.

Pinto, B., & Fuqua, W. (1991). Training breast self-examination: A research review and critique. Health Education Quarterly, 18(4), 495-516.

Coleman, E. A., Lord, J. E., Bowie, M., & Worley, M. J. (1993). A statewide breast cancer screening project. Cancer Nursing, 16(5), 347-353.

O'Malley, M. S. (1993). Cost-effectiveness of two nurse-led programs to teach breast self-examination. American Journal of Preventive Medicine, 9(3), 139-145.

Pennypacker, H. S., & Pilgrim, C. A. (1993). Achieving competence in clinical breast examination. Nurse Practitioner Forum, 4(2), 85-90.

Pilgrim, C. A., Lannon, C., Harris, R. P., Cogburn, W., & Fletcher, S. W. (1993). Improving clinical breast examination training in a medical school: A randomized controlled trial. Journal of General Internal Medicine, 8, 685-688.

Pinto, B. M. (1993). Training and maintenance of breast self-examination skills. American Journal of Preventive Medicine, 9(6), 353-358.

Somkin, C.P. (1993). Improving the effectiveness of breast self-examination in the early detection of breast cancer. Nurse Practitioner Forum, 4(2), 76-84.

Campbell, H. S., McBean, M., Mandin, H., & Bryant, H. (1994). Teaching medical students how to perform a clinical breast examination. Academic Medicine, 69(12), 993-995.

Jacob TC, Penn NE, Giebink J, Bastien R. (1994). A comparison of breast self-examination and clinical examination. Journal of the National Medical Association, 86(1), 40-45.

Stratton, B. F., Nicholson, M. E., Olsen, L. K., Mahoney, B. S., & Warland, R. H. (1994). Breast self-examination proficiency: Attitudinal, demographic, and behavioral characteristics. Journal of Women's Health, 3(3), 185-195.

McDermott, M. M., Dolan, N. C., Huang, J., Reitler, D., & Rademaker, A. W. (1996). Lump detection is enhanced in silicone breast models simulating postmenopausal breast tissue. Journal of General Internal Medicine, 11, 112-114.

McDermott, M. M., Dolan, N. C., & Rademaker, A. W. (1996). Effect of breast-tissue characteristics on the outcome of clinical breast examination training. Academic Medicine, 71, 505-507.

Smith, R. L., Hanchak, N. A., Bloom, H., Leibfreid, D., Xuan, S., & Schlackman, N. (1996). The effectiveness of postgraduate education on the clinical breast examination skills of primary care physicians. American Journal of Managed Care, 2, 989-995.

Kotke, T. E., & Trapp, M. A. (1998). Implementing nurse-based systems to provide American Indian women with breast and cervical cancer screening. Mayo Clinic Proceedings, 73(9), 815-823.

Barton, M. B., Harris, R., & Fletcher, S. W. (1999). Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? Journal of the American Medical Association, 282(13), 1270-1280.

Pennypacker, H. S., Naylor, L., Sander, A. A., & Goldstein, M. K. (1999). Why can't we do better breast examinations? Nurse Practitioner Forum, 10(3), 122-128.

Trapp, M.A., Kottke, T.E., Viekrant, R.A., Kaur, J.S., & Sellers, T.A. (1999). The ability of trained nurses to detect lumps in a test set of silicone breast models. Cancer, 86, 1750-6.

Leight, S. B., Deiriggi, P., Hursh, D., Miller, D., & Leight, V. (2000). The effect of structured training on breast self-examination search behaviors as measured using biomedical instrumentation. Nursing Research, 49(5), 283-289.

Mehn, M. A., Goldstein, M. K., & Pennypacker, H. S. (2001). Women with disabilities learn proficient breast self-examination using Adaptive MammaCare. Proceedings of the Conference Promoting the Health and Wellness of Women with Disabilities. San Antonio, TX, August 2-5, 1999. Atlanta, GA: Centers for Disease Control and Prevention.

Mehn, M. A., Goldstein, M. K., Pennypacker, H. S., Kanuck, K. T., & Thomas, S. J. (2002). Women age 50 and older who are blind or visually impaired learn proficient skill-based breast self-examination. Proceedings of the Fourth Meeting of National Leaders in Women’s Health Research [Successful Aging: Women’s Health and Well-being in the Second 50 Years], University of Florida, Health Science Center, March 9-11, 2001, Gainesville, Florida.

Saslow, D., Hannan, J., Osuch, J., Alciati, M. H., Baines, C., Barton, M., Bobo, J. K., Coleman, C., Dolan, M., Gaumer, G., Kopans, D, Kutner, S., Lane, D., Lawson, H., Meissner, H., Moorman, C., Pennypacker, H., Pierce, P., Sciandra, E., Smith, R., & Coates, R. (2004) Clinical breast examination: Practical recommendations for optimizing performance and reporting. CA: A Cancer Journal for Clinicians, 54(6), 327 -344. This article can be viewed at http://caonline.amcancersoc.org/cgi/content/abstract/54/6/327?etoc

McDonald, S., Saslow, D., & Alciati, M. H.. (2004). Performance and Reporting of Clinical Breast Examination: A Review of the Literature. CA: A Cancer Journal for Clinicians, 54(6): 345-361. This article can be viewed at http://caonline.amcancersoc.org/cgi/content/abstract/54/6/345

Hilt, G. (2005). Bessere infos, mehr früherkennung. Ärztliche Praxis Gynäkologie, 6, 22.

Artmann, A., Heyne, M., Kiechle, M., & Harbeck, N. (2006, June 20 Suppl.). Breast self-examination training and counseling as motivation strategies for breast awareness and participation in breast cancer screening programs (ASCO Annual Meeting Proceedings, Part 1). Journal of Clinical Oncology, 24(18S), 1027.

Hilt, G. (2006). Frauen zur Selbstkontrolle motivieren. Ärztliche Praxis Gynäkologie, 5, 24.

Yang, Jui-Chen. (2007). The effects of a breast self-examination education program in Taiwanese women: A triangulation study. Unpublished doctoral dissertation. National Taiwan University.