Knowledge regarding breast cancer and breast self-examination amongst urban females of North India: A cross-sectional study

Priya Bansal; Anurag Chaudhary; Sangeeta Girdhar; Tiber Jain; Sarit Sharma; Mahesh Satija; Vikram Kumar Gupta; Pranjl Sharma; Surinder Pal Singh

doi:10.4103/JME.JME_115_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 4 | Issue : 1 | Page : 18-22

Knowledge regarding breast cancer and breast self-examination amongst urban females of North India: A cross-sectional study

Priya Bansal, Anurag Chaudhary, Sangeeta Girdhar, Tiber Jain, Sarit Sharma, Mahesh Satija, Vikram Kumar Gupta, Pranjl Sharma, Surinder Pal Singh
Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission	02-Sep-2022
Date of Decision	22-Sep-2022
Date of Acceptance	17-Nov-2022
Date of Web Publication	23-Feb-2023

Correspondence Address:
Dr. Priya Bansal
Department of Community Medicine, Dayanand Medical College and Hospital, Old Campus, Civil Lines, Ludhiana, Punjab
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JME.JME_115_22

Abstract

Introduction: In this era of epidemiological transition where noncommunicable diseases are on a significant rise, cancer is a major public health problem globally. Out of all cancers, breast cancer is the most common female cancer worldwide. Aim: To determine the knowledge of breast cancer and its risk factors and breast self-examination (BSE) practice amongst urban women of North India. Patients and Methods: A cross-sectional study was carried out amongst 370 women aged between 20 and 60 years of age using pretested self-administered questionnaire. The collected information was entered into Microsoft Excel sheet and analysed using SPSS. Results: Mean age of the study participants was 40.3 ± 12.1 years and majority of the study participants (87%) were married. It was seen that the proportion of women who were aware increased as their literacy status increased, and this was statistically significant (P = 0.00). About 18.4% of the participants were aware regarding BSE. The most mentioned reason for not practicing BSE amongst those who were aware was that they considered themselves healthy (63.2%). Conclusions: In the current study, half of the women were aware of breast cancer and few were aware of BSE and very few were practicing BSE. It was seen that women with a higher level of education had better knowledge regarding breast cancer than women with low educational status. For the prevention of breast cancer, women are the most important stakeholder. There is a need to sensitise women regarding risk factors of breast cancer and preventive practices like BSE.

Keywords: Breast cancer, breast self-examination, knowledge, urban females

How to cite this article:
Bansal P, Chaudhary A, Girdhar S, Jain T, Sharma S, Satija M, Gupta VK, Sharma P, Singh SP. Knowledge regarding breast cancer and breast self-examination amongst urban females of North India: A cross-sectional study. J Med Evid 2023;4:18-22

How to cite this URL:
Bansal P, Chaudhary A, Girdhar S, Jain T, Sharma S, Satija M, Gupta VK, Sharma P, Singh SP. Knowledge regarding breast cancer and breast self-examination amongst urban females of North India: A cross-sectional study. J Med Evid [serial online] 2023 [cited 2023 Jun 3];4:18-22. Available from: http://www.journaljme.org/text.asp?2023/4/1/18/370392

Introduction

In this era of epidemiological transition where noncommunicable diseases are on significant rise, cancer is a major public health problem globally. Out of all cancers, breast cancer is the most common female cancer worldwide representing nearly a quarter (23%) of all cancers in women.^[1] The International Agency for Research on Cancer reported 2,088,849 new breast cancer cases diagnosed globally in 2018 alone which constituted 11.6% of all cancers.^[2] The global burden of breast cancer is expected to cross 2 million by the year 2030, with growing proportions from developing countries.^[3] The age-standardised incidence rate of breast cancer amongst Indian women is 25.8/100,000 women and the mortality rate is 12.7/100,000 women.^[4]

Mortality due to breast cancer can be reduced by the early detection of disease, as well as by early treatment initiation. If the cancer is detected early, the 5-year survival can reach up to 85% with early detection whereas later detection decreases the survival rate to 56%.^[5] According to the American Cancer Society recommendations, women should know how their breasts normally feel and report any physical changes promptly to their health-care providers.^[6]

Breast self-examination (BSE) is an important tool for breast cancer screening where access to clinical breast examination and mammograms is limited. It is simple non-invasive, requires little time and has no medical cost.^[7] With this background, the present study was planned to determine the knowledge of breast cancer and its risk factors and BSE practice amongst urban women so that appropriate interventions can be undertaken accordingly for the promotion of practice of BSE.

Methodology

Study type, settings and study population

A cross-sectional study was carried out at Urban Health Centre under the Department of Community Medicine of Dayanand Medical College and Hospital. The information was collected using a pretested questionnaire from women aged between 20 and 60 years of age.

Exclusion criteria

The women not willing to participate, pregnant, lactating, having dementia and who have undergone mastectomy were excluded from the study.

Sampling method

The study was conducted for 3 months i.e., from July to September 2021 and all females aged between 20 and 60 years who had come for general care or maternity or child care at the urban health centre were included after their verbal informed consent.

Data collection process

The structured questionnaire contained basic demographic details i.e., age, marital status, education, occupation, husband education and his occupation. The participants were also asked regarding risk factors and symptoms and signs of breast cancer. The questionnaire also assessed the knowledge and awareness of participants regarding BSE i.e., how often it should be done, when is the best time, etc. The written informed consent was taken from the participants before interviewing them and utmost care was taken to maintain privacy and confidentiality.

Ethical consideration

Due approval was taken from Institutional Ethics Committee, Dayanand Medical College and Hospital, Ludhiana-wide IEC No. 2019-448.

The data were analysed using Microsoft Excel and Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 20.0 Armonk, NY, USA: IBM Corp). Statistical methods used were simple frequencies and percentages. A Chi-square test was applied to analyse the association between the studied variable and the awareness of breast cancer. A 5% level is chosen as a level of significance in all statistical significance tests.

Results

A total of 370 women were interviewed, who attended urban health centres for general care or for maternity or child care. The mean age of the study participants was 40.3 ± 12.1 years and most of them were in the age group of 20–40 years (54.9%). Majority of the study participants (87%) were married and engaged in household work (87.0%). The mean years of schooling of the study participants were 7.4 ± 4.5 years.

[Table 1] shows the association of participants who knew about breast cancer and their socio-demographics characteristics. It was seen that the proportion of women who had heard increased as the literacy status increased, and this was statistically significant (P = 0.001). It was seen that married women knew more as compared to unmarried, however, this difference was not found statistically significant (P = 0.73). No significant association was found with age.

Table 1: Sociodemographics characteristics of study participants and relation with awareness about breast cancer (n=370)

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A total of 18 questions (10 questions on risk factors and 8 questions on signs and symptoms) were used to assess knowledge amongst 209 participants who knew about breast cancer. Knowledge was computed by giving '1' to the correct answer and '0' for the wrong and 'do not know' answers. The mean knowledge of participants was 4.77 ± 3.9. The overall correct score rate came out to be 26.5% (4.77 out of 18) and 98 (46.8%) of them scored 5 or higher marks. More than half of the participants (59.8%) mentioned at least any one of the risk factors of breast cancer. Family history (43.1%), ageing (35.4%), consumption of high-fat diet (31.1%) and long-term use of contraceptives (22.5%) were the most reported known risk factors by the participants. While an equal percentage of women (92.3%) did not know that the early menarche and early sexual initiation are the risk factors for breast cancer. Painless nodule was the most common sign (86.1%) known to the study participants followed by chest pain (64.1%). Abnormal enlargement of breast (34%), discoloration of breast (25.4%), bloody discharge from nipple (23.9%) and nipple retraction (10.5%) were the others' signs they were aware of. However, 11% of the women did not have any idea about even one single sign of breast cancer [Table 2]. The most common source of information about breast cancer was acquainted from relatives (50.7%). Other sources of knowledge were television (41.6%), friends (34.4%), newspaper (11%) and health workers (10%) [Table 2].

Table 2: Knowledge on risk factors and signs and symptoms of breast cancer amongst study participants (n=209)

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[Table 3] shows the association of socio-demographic characteristics with knowledge score. It was observed that knowledge score increased significantly with increase in literacy status of participants (P = 0.032) and decreased with increase of age, however, it was not statistically significant (P = 0.052) [Table 3].

Table 3: Demographic variables and their association to knowledge of breast cancer (n=209)

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Around two-third of women (67.5%) believed that breast cancer can be cured and about 31.6% of them responded negatively to it. Surgery was the most commonly reported modality of treatment by 49.3% of study participants followed by chemotherapy (20.6%) and radiotherapy (6.7%). Around 43.1% of the women did not know about the treatment of breast cancer [Table 3].

[Table 4] shows the knowledge of study participants towards BSE. It was observed out of 370 women, only 18.4% of the participants had awareness about it. Concerning their knowledge on its frequency, 26.5% of the participants correctly reported that BSE should be done monthly. The remaining gave the wrong response (occasionally, every 3 years and I do not know). Out of those who were aware about BSE, 72.1% of participants were practicing BSE. The main reason behind doing BSE was the fear of having breast cancer in the future (44.9%) and 34.7% of participants were aware it is a method for the early detection of breast cancer. Most mentioned reason for not practicing BSE amongst those who were aware was that they considered themselves as healthy (63.2%), one-fourth (26.3%) did not know how to do the procedure and few (21.1%) participants did not believe that BSE is beneficial [Table 5].

Table 4: Knowledge towards treatment of breast cancer amongst study participants (n=209)

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Table 5: Knowledge towards breast self examination amongst study participants

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Discussion

In the present study, the mean age of the study participants was 40.3 ± 12.1 years and observed that only 46.8% of participants were aware regarding breast cancer. This rate was higher than that reported in a study conducted amongst women seeking outpatient care in a teaching hospital in Maharashtra.^[8] However, this rate is much lower than in many other countries (73% amongst Tanzanian women, 88.35 amongst women from Ghana, 99.5% in young Malaysian women and 98% in young Uganda female students).^{[9],[10],[11],[12]}

In the present study, it was seen that proportion of women who were aware was more educated. Reports from other studies also showed that educated women are more aware of breast cancer.^{[13],[14],[15],[16]}

The present study reported the family history (43.1%) and aging (35.4%) as the most known risk factor while early menarche and early sexual initiation as the least known risk factor of breast cancer. These observations were in consensus with Al Junaibi and Khan who conducted a study amongst Oman females and reported family history of the disease (86.6%) as the most widely known risk factor for breast cancer and early menstruation (49%) as least known risk factor.^[17] Another study conducted by Sehrawat et al. amongst rural and urban women reported the use of pesticides and family history of disease as main contributory factors for breast cancer.^[18]

The presence of painless nodule (86.1%%) and pain (64.1%) in the breasts were identified as the most commonly known symptoms of breast cancer in the present study and these observations were similar to a study conducted by Puri et al. amongst women more than 30 years of age, who found that awareness about breast mass/lump and pain in breast were cited as cardinal symptoms of breast cancer.^[19] Another cross-sectional study conducted by Sehrawat et al. on urban and rural women of Gurdaspur reported the presence of lump mass (painless) as the most commonly known symptom of breast cancer.^[18]

The proportion of women who had correct knowledge on signs of breast cancer was less when compared to other studies done by Bener et al. and Parsa and Kandiah.^[20],[21] This could be due to the differences in culture, health beliefs, education status and health services and policies.

In the present study, around two-third of women believed that breast cancer can be cured, and most commonly reported modality of treatment was surgery by study participants. Similar findings were observed in a study conducted by Dey et al. amongst women of Delhi where majority of them, believed that surgical removal of lump in the breast is the best treatment for breast cancer.^[22]

In contrast, another study conducted by Sehrawat et al. observed that majority (80.8%) of participants held the belief that oral medicines are the best option to treat breast cancer.^[18]

In the present study, 18.4% of the participants were aware of BSE as a screening method of breast cancer and these findings were in agreement with the studies conducted by Kommula et al.^[23] and Kumarasamy et al.^[24] who reported that 16.5% of urban Andhra women and 26% of rural Trichy women, respectively, had knowledge about BSE as a method of self-examination. However, this proportion was contrary to the results reported by other studies done by Ahuja and Chakrabarti and Sehrawat et al.^[18],[25] Another study conducted by Dinegdi in Ethiopia amongst young females studying in tertiary education institutes reported that half of them were aware about breast cancer self-examination and only 13.1% of participants did appropriate BSE.^[26]

In the present study, out of those who were aware about BSE, only 26.5% knew correctly that it has to be done monthly. While in a study conducted by Kumarasamy et al. amongst rural women, 14% said that BSE has to be performed once in a month.^[24] A study conducted by Khapre et al. in the hilly district of Uttarakhand amongst women above 30 years of age reported negligible proportion of participants (0.57%) knew that BSE has to be done monthly.^[27] Another study from south India has also reported lower practice of BSE than the present study.^[23] This could be due to fact that being a cultural taboo, it is not been freely discussed and less women are cured of breast cancer and survive the disease.

Conclusions

In the current study, near to half of the women were aware of breast cancer and few were aware of BSE and very few were practicing BSE. It was seen that women with higher level of education had better knowledge regarding breast cancer than women with low educational status. For the prevention of breast cancer, women are the most important stakeholder. Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and stroke, population-based screening for breast cancer is already documented. There is a need to sensitise women regarding risk factors of breast cancer and preventive practices such as BSE Active and necessary interventions should be taken to emphasise the importance of BSE through various levels of health workers amongst young girls in higher secondary schools and colleges. Women attending antenatal and immunisation clinics can be targeted for health education regarding the prevention of breast cancer. For this purpose, help can be taken from local women's NGOs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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