Reasoned researcher Dr. Pennypacker, "If you could teach fingers to read braille, you could teach fingers to detect lumps smaller than golf balls."

In fact, women can easily learn to feel lumps as small as peas. The Mammacare kit consists of a lifelike silicone breast with five types of lumps in it, a 45 minute video, and a 30 page manual. It is designed to teach you the life long skill of good breast exam. Learning this skill may be one of the most valuable investments you make in your health.

Untrained woman can detect lumps that are one and half inches in diameter, (4 cm) women trained in the usual BSE can detect lumps three quarters of an inch (2 cm) in diameter and woman trained in this technique can detect lumps between one quarter and three eights in diameter (between .3 cm and one cm). In fact, women trained in this method are capable of developing a greater sensitivity than doctors in detecting lumps. One study showed the women's sensitivity to be 59 percent versus 44 percent for the doctors.

• ANNUAL PHYSICAL EXAM OF THE BREAST: This cannot be stressed enough. Have your breasts thoroughly examined once a year by a doctor or nurse that has been competently trained in breast examination.

Mammacare has also developed a kit to train physicians in correct breast exam, a skill that is often not taught adequately in medical school.

• EMOTIONAL DEFENSE: The best defense is to learn to express your emotions, especially anger and to avoid investing all your energy in one person or one project. It is also important to learn how to overcome depression and negative emotions.

In general, I have noticed that breast cancer patients are "too nice." They sacrifice their own needs and even their own health to look after everyone else's needs. They nourish everyone, except themselves. Writer Susan Gibson feels that breast cancer gave her an unparalleled opportunity to break out of a self-defeating life pattern and begin anew. She feels that women have been socially and culturally trained to serve others and that this "servers' disease syndrome" is one of the root causes of breast cancer.

Dr. Lawrence Le Shan, a psychologist who has worked with cancer patients for over 35 years (author of two highly recommended books, YOU CAN FIGHT FOR YOUR LIFE; EMOTIONAL FACTORS IN THE TREATMENT OF CANCER and CANCER AS A TURNING POINT) has studied the emotional and mental attitudes of cancer patients and found:

1. A loss of a sense of purpose of life had occurred.

2. The individual had difficulty expressing anger and tended to suppress hostile feelings.

3. There were unresolved feelings around the death of a parent.

4. The person was not involved in meaningful work that excited them or inspired them.

Future Trends

Although controlled trials have not proven the benefit of self exam, women aged 40 or over should be taught good self exam using the Mammacare model. Learning occurs best in small groups, independent from cancer societies, in an educational context that reduces fears around both breast self exam and breast cancer, provides information about cancer prevention and empowers women in getting to know their own bodies. One such project, the Burlington Breast Cancer Support Group, successfully trained 800 women, and was unable to meet the demand. Similar types of projects are recommended by the Status of Women report, Breast Cancer, The Unanswered Questions. As Pat Kelly, breast cancer activist, commented. "Too many doctors assume that breast self exam is just this feeble silly thing that women are doing." Instead family doctors could be promoting competent breast self exam both as a screening and educational tool.

Only 25 percent of women have predictable breast cancer risk factors. A more important risk factor may be increasing age. A bigger risk factor may be chemical residues in our fatty tissues, accumulating over time as well as chronic exposure to low levels of radioactivity both from nuclear testing and nuclear spills.