The importance of early detection

It is estimated that there will be at least 268,000 new cases of breast cancer, along with another almost 63,000 cases of in situ breast cancer cases diagnosed this year in the United States. Breast cancer is the second leading cause of cancer death in American women. However, death rates decrease significantly the earlier a woman is screened, diagnosed, and treated for the disease.

Science has developed many ways of screening for breast cancer. A mammography is one of the most common ways to determine the presence of tumors or other abnormalities in a woman’s breast. However, the test has a 7-12% chance of producing a false-positive result. Moreover, the chance of receiving a false positive is higher for women younger than 50 and increases to about 50-60% after ten yearly mammograms.

Despite the increased use of mammograms to screen for breast cancer, a large percentage of breast cancers are still detected by manual breast self-examination or by a healthcare professional during a routine visit. Considering the potential for a faulty mammogram result, it is essential that clinicians maintain and enhance their assessment skills.

Many clinicians lack adequate haptic skills

In a 2014 TedMed talk, Dr. Carla Pugh discussed the need for clinicians to develop haptic skills. Dr. Pugh is a surgeon and former clinical director of the University of Wisconsin (UW) Health Clinical Simulation Program and former director of patient safety and education at the UW Hospital and Clinics. Dr. Pugh described haptics as “the art and science of touch. Knowing how to touch something. Knowing how things are supposed to feel.”

In the context of breast cancer screenings, haptic skills can help clinicians identify abnormalities or determine if the patient’s breasts are healthy through manual examination alone. A clinician experienced with haptic skills can save the patient from undergoing a far more invasive procedure, and the emotional distress a false positive result can cause.

However, Dr. Pugh points out that clinicians do not have a good way of learning this skill or determining their competency in this skill. An accurate breast examination involves advanced psychomotor skills, but most medical schools offer their students only cursory training. In many instances, breast examinations are taught by having the learner palpate the breasts under the supervision of a trained clinician.

A visual assessment alone is not always the best method to determine skill acumen.  Particularly when it comes to a tactile procedure, the clinician/instructor is limited in their ability to determine if the learner has used enough pressure to detect a mass or other abnormality.

Moreover, the practical and ethical limitations of training on a live patient make competency assessment more difficult. Learning during clinical hours happens as patients and ailments present themselves, meaning a student can go through their clinical rotation without ever having an opportunity to perform a breast exam.

Conversely, a patient might refuse to be used as a test subject for an inexperienced clinician. Considering the importance of an accurate and early diagnosis of breast cancer has on a patient’s health outcome, it is vital to have an experienced person perform the exam.           

Therefore, clinicians need tools to develop haptic skills, practice procedures, and to evaluate objectively their performance. Simulation-based training can provide students with both the visual and tactile feedback they need without the risk of harming a real patient.

Using simulation to learn and develop breast examination skills

Breast examination skills trainers can be a vital tool for teaching essential haptic skills. Since these skills trainers realistically mimic the feel and density of breast tissue, students can practice applying a systematic palpation pattern to ensure they examine all of the breast tissue and become familiar with what feels normal and what feels abnormal.

Participants can even practice more invasive procedures using real equipment. For example, a core needle biopsy is a definitive way to diagnose breast cancer. Participants can use a real ultrasound and needle to master this procedure before moving on to an actual patient.  

Furthermore, these skills trainers can be equipped with a variety of interchangeable breasts, each with its own pathology. The supervising clinician knows what mass or abnormality the learner should be able to identify through accurate palpation. Thus, they have a tool to evaluate the learner’s performance and measure their acumen in haptic skills.

Breast exams are a vital part of women’s healthcare. As Breast Cancer Awareness Month continues to draw attention to the importance of regular breast examinations, clearly the role that haptic skills play in early detection and diagnoses cannot be understated.

Learners in a clinical training environment can benefit from the repeatability, consistency, and unlimited practice opportunities simulation-based training offers. By learning and developing haptic skills through simulation-based training, clinicians will have the ability to accurately perform a breast exam and potentially diagnose an abnormality early enough to ensure a positive outcome for their patients.