Blind women are screening patients for breast cancer – is it fake science or serious medicine?

Neetu Garg has screened nearly 850 women for breast cancer during her five years as a medical examiner. It’s quite the achievement – one made more impressive by the fact that she is completely blind.

“Once we locate a lump, we try to find out its shape, size and depth,” says the 42-year-old. The details of this assessment are then passed on to a doctor, who will determine whether further examination is required.

The approach works on the assumption that blind people have a more acute sense of touch than the sighted, as demonstrated by several studies over the years.

“I can detect even the tiniest masses, the smallest of lumps that can be significant in saving a life,” says Garg.

Garg is one of several blind women working at a centre in Hauz Khas, a neighbourhood in South Delhi, which is dedicated to breast cancer detection.

Every day, a long queue of women forms outside the clinic, run by the National Association for the Blind (NAB), before they’re ushered in, one-by-one, for assessment.

Braille-marked orientation tapes are placed on the breasts of the patients, which help guide Garg and her colleagues as they carry out the examination.

“We divide the breast in four parts with the Braille-marked tape and use the nipple as zero-point,” says Garg. “Then we spend the next 40 minutes examining the breast with our fingertips by palpating every centimetre with varying pressure.” 

The centre in South Delhi has screened more than 4,500 women since opening its doors six years ago, of whom 1,347 were found to have breast cancer. A second site, in Bangalore, also provides examinations. So far, 18 blind women have been trained by NAB.

The unique approach to breast cancer screening was first adopted in 2017 after centre director Shalini Khanna travelled to Germany to review a health initiative, called ‘Discovering Hands,’ which trained blind and visually-impaired women as medical tactile examiners (MTEs).

“We were sceptical about the success of the programme,” says Ms Khanna. “It was unbelievable that blind women can perform such a complex task but when we visited Germany and saw how they were able to examine every centimetre of breasts and detect the tiniest lumps, we thought this is the programme that can help India in a great deal.”

Proponents of this novel – but disputed – technique argue that India needs all the help it can get. Unlike in the West, access to mammograms, a type of X-ray imaging which identifies cancerous growths, is limited in large parts of India.

Indeed, between 2019 and 2021, less than 1 per cent of Indian women underwent breast cancer screening, according to the National Family Health Survey. This means the vast majority of those with the condition won’t be aware of their illness before it’s too late.  

Early identification is vital as it can boost treatment success rates to as much as 90 per cent, says Iqbal Saleem, a professor of surgery at Government Medical College in Srinagar.

In nearly 60 per cent of cases in India, Prof Saleem adds, breast cancers are diagnosed at an advanced stage, greatly decreasing the chances of survival.

Overall, the nation reported roughly 180,000 new cases of breast cancer and 90,000 deaths in 2020, according to figures from the World Health Organization, giving India a far greater mortality rate than many western populations.

Unscientific practice

Although services like the one provided by Ms Khanna and her team in South Delhi are attempting to make up for the nation’s severe screening shortages, not all are convinced of their value.

“It is nonsense,” says Prof Saleem. “I don’t understand when we can detect 0.5mm lumps through thermography, why do we need to follow an unscientific practice of screening the patients by blind women.” 

Others, however, point to studies and research which suggest the practice may not be as unscientific as it seems.

A paper published in March by Mandeep Malhotra, a surgical oncologist from Delhi, revealed that routine screening examinations conducted by medical tactile examiners on 1,338 women with breast cancer missed just 1 per cent of abnormalities.

Meanwhile, research shows that mammography isn’t always as accurate as assumed. According to the American Cancer Society, screening mammograms miss about one in eight breast cancers.

Then there’s the fact that India doesn’t have the infrastructure or skilled workers to run these types of high-cost programmes on a nationwide scale, said Dr Malhotra. 

Routine breast cancer screening conducted by trained blind women in rural communities and workplaces, where mammograms and ultrasound machines are unavailable, could therefore provide a cheaper – and reliable – alternative option, he added.

Kamini Mehra, a breast cancer survivor, believes she would have died had she not attended the NAB centre in South Delhi.

“They detected a lump in my left breast which was later diagnosed as cancerous at an early stage,” she says.

“The blind MTEs bring reliability and precision in detecting small tumours, bridging the affordability gap in screening among diverse population groups facing disparities in cancer care.”

Many of the blind women who take part in the initiative are school dropouts and have little scientific knowledge. As such, the examiners undergo nine months of training, including a three-month internship at a hospital where they are taught about the anatomy and physiology of the breasts.

Ms Khanna admits there are difficulties in implementing the programme throughout India, but says “there is a great urge among the blind women to learn, which brings us the success”. 

One of the main challenges is encouraging women to come forward for screening in the first place.

“Some are not comfortable getting their breasts checked and others fear what [will happen] if a lump is found in their breast,” says Sonal Prakash, Programme Manager at NAB’s Discovering Hands centre in South Delhi.

“We really needed to make some changes to emphasise the value of a breast check-up because women in India still don’t view it as a crucial aspect of their health,” she said.

To counter this, NAB has launched several community engagement programmes and social media campaigns to improve awareness in the population.

But while figures like Dr Malhotra are keen to grow the practice of medical tactile examinations, there is an acknowledgement that “they are not meant to replace doctors or mammograms”. 

Instead, he says, the aim should be “to work alongside medically-trained teams as a first step for accurate routine breast cancer screening examinations, available even in areas with limited access to electricity.”

Ms Khanna echoes this sentiment. “It is a preventive check-up,” she says. “It is a bridge between a lay person and a breast cancer specialist.”

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