Christine Kanetzki takes almost an hour to check the patient for breast cancer.
She gently feels each centimetre of her breasts and the lymph nodes under her arms, on her neck and near her collarbone.
The inspection gives her an overview of the temperature, shape and tissue firmness.
Kanetzki, who is blind, has been working as a medical tactile examiner (MTE) for nearly 10 years, at gynaecologists' practices.
Employed as a specialist for the early detection of breast cancer, she currently works at the Paracelsus Hospital in Reichenbach, Germany and practices in other towns too.
Not being able to see has enabled her to develop a unique sense of touch, she says. "As blind people, that sense is something we depend on every day."
Kanetzki found the work through Discovering Hands, which has trained almost 60 blind or visually impaired people in MTE since 2011.
The firm was founded by obstetrician Frank Hoffmann who says often, by the time a patient comes to a gynaecologist with a lump, it may already be 1 to 2 centimetres in size.
In his daily work in his surgery, he often found he did not have as much time as he needed for breast exams.
But specially-trained blind staff can detect changes as small as 0.6 centimetres, his studies show.
People long doubted whether blind people and their sense of touch could actually help in cancer screening, Kanetzki says. Now, doctors trust her, and take action when she feels small changes, she says.
Such checks are recommended once a year in Germany, says Kanetzki, who for a long time was the only MTE in her state. "Many women come to me regularly. Even former breast cancer patients use this kind of further screening."
Sometimes tissue changes in the breast are normal, she says, adding she can differentiate between these and more worrying lumps through her sense of touch.
MTEs are like medical assistants who pass on their findings to a doctor who then makes a diagnosis and decides on further treatment, says Hoffmann.
The approach should be used among a range of cancer detection tests, says Susanne Weg-Remers from the German Cancer Research Centre in Heidelberg, who cautions against excessively high expectations.
"Unfortunately, there is no scientific evidence that the method can reduce the mortality of breast cancer patients in the context of screening examinations," she says, adding that also applies to palpation by gynaecologists.
A cancerous growth has to reach a certain size before you can feel it, she says, which is why the work of the MTEs, known as tactilography, is only recommended as an additional service for women between the ages of 50 and 69.
It cannot replace a mammogram, which has been proven to reduce breast cancer mortality, according to Weg-Remers.
Blind or visually impaired women working with Discovering Hands are trained for 10 months under medical supervision before qualifying, Hoffmann says.
Most public and all private health insurance companies in Germany now cover the examination costs.
When it comes to breast cancer screening, Weg-Remers says the German Cancer Research Centre advises regular examinations, but notes that no screening method is perfectly reliable. "All of them bear the risk of false alarms," she says.
Subsequent invasive examinations like a biopsy carry additional risks, potentially leading to bleeding or infection. Furthermore not all tumours are malignant or would necessarily develop aggressively, according to the expert.
However, all patients then undergo cancer therapy, although it is not always clear whether it would have been necessary. Weg-Remers underlines that it is therefore up to each patient to decide which screenings and tests they want to take. – dpa