Customer Spotlight: Teaching Through The Tactile Sense

How MammaCare is using Qlik to improve antiquated breast cancer exams.


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According to the World Health Organization (WHO), the rate of women being diagnosed with breast cancer is on the rise. A December 2013 report from the WHO offers the following:

“In 2012, 1.7 million women were diagnosed with breast cancer…since 2008 estimates, breast cancer incidence has increased by more than 20%, while mortality has increased by 14%.”

The obvious conclusion to draw from these statistics is that despite having come a long way in treating cancers, the medical community still has a long way to go. The beginning of every diagnosis is detection and this is a subject that is at the core of MammaCare’s mission. MammaCare is widely regarded as the recognized standard for clinical breast exams and breast self-examination with support from some of the largest scientific institutions and foundations in the world.

Their contention is simple: mammograms and other imaging techniques that are so commonplace today are ineffective or insufficient for many women. Cancers are missed and it is costing lives. MammaCare scientists believe that more accurate and effective outcomes can occur when technology, data and tactile senses are all engaged together.

Improving Breast Cancer Detection

MammaCare was founded in 1974 by Mark Goldstein, Ph.D. and Henry S. Pennypacker, Ph.D at a time when colleges and nursing schools didn’t have a way to teach self-exams. The standard diagnostic methods were too often ineffective. X-ray mammograms offered a picture but they weren’t designed for soft tissue and traditional manual breast exams missed many breast tumors according to Dr. Goldstein. The National Cancer Institute (NCI) realized that increasing numbers of women were dying from advanced breast cancer and asked the researchers to help solve the problem.  Goldstein, realizing the gravity of the challenge, anxiously quipped:

“We knew one thing for sure: we needed some big new ideas. I remember telling the NCI ‘I don’t know the answer right now but give me a few hours!'  The big idea we realized was that our hands may have the answer. They can read tiny Braille dots with precision, so they must be able to detect small breast lumps pretty easily. We just need to figure out how to train those hands!” – Dr. Mark Goldstein, MammaCare

This was the big idea Dr. Goldstein pitched to the NCI and it won them over: President Carter himself expressed interest in the Gainesville team’s work and supported the team’s research proposal.  The results since have gained wide attention in women’s journals and on national television networks.

Calibrating Detection

Goldstein and his colleagues found that palpating the breast with the middle three fingers in a vertical pattern across the entire breast with three levels of pressure at every spot, proved to be significantly  more effective for detection of small tumors than random unspecified patterns.

“Three human fingers have 300 sensors operating within them, all sending information back to our brains enabling us, with practice, to detect very small variations within breast tissue on the order of a small pea (3 millimeters). Women were presenting with golf-ball sized breast lesions that with simple training could have been detected at a far earlier stage. ” – Dr. Mark Goldstein, MammaCare

Five years had passed after the original NCI grant team’s landmark research. Screening by mammograms were creating doubt because women were often sent home with a clean bill of health only to discover a cancer a few months later, by hand.  These “interval” reports represent a substantial proportion of breast cancer that could have been found and treated earlier if only a proper manual breast exam was performed. In the lab at MammaCare, trials with tactually accurate breast models and patient volunteers had documented the best method to detect small suspicious tumors without creating false alarms. Then, with the support of the National Science Foundation, they designed a hands-on, computer-guided trainer to make the technology widely available. The result: a Clinical Breast Exam Simulator–Trainer that now trains doctors, nurses and clinical students to perform competent breast exams.

MammaCare Simulator-Trainer 

The MammaCare Simulator-Trainer (pictured above) acquires tactile sensory data from clinicians and  students including how many small lesions they detect, how many they missed and how many they “felt” that were not really there (false alarms). That data is then fed into a report that is delivered to the trainee upon completion, noting each test they completed and their success rate.  Through muscle memory, the system provides an interactive way for clinicians to refine their breast exam techniques. As more and more tests were completed in university classes the data began to grow and a trend began to show.


Qlik-ing Through The Data


In order to analyze the trends and effectiveness across a large, diverse national training program, MammaCare needed visual analytics to track the success rate of every clinical student using the platform around the country. Through the Corporate Social Responsibility Qlik Software Grant Program, The MammaCare Foundation was granted a license to use Qlik to begin to pull insights out of those trends.  With the help of the Qlik Academic Program, the Foundation could take that analysis to the next level by facilitating the education of thousands of college students about breast cancer detection.


“We implemented Qlik as the visual solution to display the skills achieved by each student, showing performance standards like the number and size of cancers detected as well as missed and false positives.” – Dr. Mark Goldstein, MammaCare


As a result of the new analyses, MammaCare was able to determine which testing attempts were most successful, which tumors were most difficult to detect and how much time it took each trainee and each group of students to acquire the critical skills to meet standards. This allowed the team a unique opportunity to modify the course instruction as needed based on common errors, misses or false positives thereby improving the student success rates and ultimately, for all women, improving early breast cancer detection.


Through education, training with the support of quick hit data analysis and the work done by Dr. Goldstein: his colleagues at MammaCare are saving women’s lives.

Mammacare Performance Results


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