About 180,000 American women develop breast cancer each year. The disease kills an additional 46,000 women. Every women is a potential victim and about 12% of women will develop breast cancer at some time in their lives. In addition to loss of life, victims of breast cancer often undergo disfiguring surgery that may physically and emotionally disable them.
Early detection of a malignant tumor in the breast is a major weapon in the fight against breast cancer. At present, doctors do not know how to prevent breast cancer, but early detection significantly improves a woman's chances of survival. Importantly, the victims of the disease are almost always the first ones to detect the tumor. In most cases, however, women only detect the tumor after the cancer has reached an advanced stage. Regular and proficient self-examination by young women could substantially improve the detection of small tumors. Early detection would dramatically increase survival and lower the likelihood of disfiguring surgery.
Surprisingly, a study by Baxter (2001) based on a summary of the literature concluded that teaching breast self-examination (BSE) to women 40-49 years old has no benefits (in terms of detection or lowering death) and is actually harmful because women are constantly going to doctors based on false readings. The conclusions of this study are controversial (Larkin, 2001), but could be accurate in terms of the breast self-examination programs included in the review. Often BSE programs use pamphlets, posters and films to teach the requisite skills, but these teaching aids alone are not enough. There is reason to believe, however, that a strict behavioral program of BSE would fare much better.
Dr. Henry S. Pennypacker (Figure 13.10) and his associates at the University of Florida have developed a behavioral program called MammaCare to teach women effective
self-examination of their breasts (Hall et al., 1980; Pennypacker et al., 1982). He began to work on this program because:
like many before me, I took a degree in classical experimental psychology and began an academic career. I rapidly became uncomfortable with the hypocrisy inherent in my position: I was an "expert" in learning using none of my expertise in my work. My interest turned to education at all levels, partly because of the critical role it plays in the survival and evolution of the culture and partly because it looked like an easy place to make a contribution. How wrong I was! . .. [W]ith hindsight... I have a better understanding of the problems we face and general strategies needed to solve them. MammaCare is a step in that direction. (Pennypacker, personal communication, February 22, 1989)
The MammaCare program is based on the assumption that women often are unable to detect small tumors simply because they have not been trained to do so. The pressure receptors of the fingertips allow for subtle discrimination of surface contour (e.g., from smooth to bumpy), as is clearly demonstrated by blind people who read Braille. It follows that women may be trained to detect small lesions in the breast related to cancerous tumors. An effective program must teach women to tell the difference between small tumors and the normal lumpiness of the breast itself.
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