Breast cancer awareness and breast self-examination practice among women in the rural field practice area of a medical college, Karnataka

INTRODUCTION

Worldwide, breast cancer is the most commonly diagnosed cancer among females, impacting 2.1 million women each year, or contributing to, one in four of all new cancer; it is also the leading cause of cancer death in women accounting for 627,000 (15%) deaths.¹ Although the incidence rates of Breast cancer are high in the developed countries, the mortality rates in the developing countries are higher because of the delay in the diagnosis and treatment. In India, breast cancers is the commonest cancer in women accountingfor about 27.7% of all cancers, with 1, 62,468 new cases and 87,090 deaths were reported in the year 2018.^1-4

There is evidence that screening reduces mortality from breast cancer. The 5-year survival rate with early detection is 85%, whereas later detection is about 56%.³ Basic techniques for screening for breast cancer includes breast self examination (BSE), clinical breast examination (CBE) and mammography. Several studies show that BSE is a simple, feasible way for early detection of breast cancer in low-middle income countries. The World Health Organization have determined that only BSE can provide early diagnosis of breast cancer in many parts of the world.⁵ There is evidence that women who correctly practice BSE monthly are likely to detect lump in early stages of its development, resulting in early treatment and better survival rate.⁶

Even though BSE is a simple, quick, and cost-free procedure, the practice of BSE is low and varies in different countries; in India, it varied from 0 to 52%.^7,8 Lack of time, lack of self-confidence in their ability to perform the technique correctly, fear of possible discovery of a lump, and embarrassment associated with manipulation of the breast have been cited as reasons for not practicing BSE.⁹

With the importance of BSE in the early detection of breast cancer and the fact that it is cost effective and easy to perform, this study was conducted to assess the level of awareness on breast cancer, BSE and practice of BSE among the rural women of Chunchunguppe, Karnataka.

METHODS

This community based cross-sectional study was conducted at Chunchunguppe and surrounding villages which is situated 28 km from Bangalore, it is a rural field practice area, attached to the Department of Community Medicine, Raja Rajeswari Medical College and Hospital. Chunchunguppe caters to a population of 8225 people living in 25 surrounding villages, among which 9 villages were selected randomly for the study.

Ethical clearance was obtained from the institution ethical committee. The details of all the villages were taken from the rural health training centre. The study was conducted for a period of one month from April to May, 2019.

Inclusion criteria

All women above 18 years of age who were available at home during the time of interview and willing to participate were included for the study. Informed written consent was taken.

The enumerators included interns and MBBS student, data was collected and entered in Google forms. The students were trained thoroughly on how to administer the questionnaire, fill and submit the Google forms. Houses in the village were approached randomly, and after obtaining consent from the select women who met study criteria, close ended question with multiple choices was administered by the enumerators. For quality control the enumerators were supervised by the department postgraduate. This process continued until all the houses were covered in each village. Followed by the interview, knowledge about how to perform breast self examination was imparted using a video.

Data collected was analyzed using Epi info version 3:5:3 of the CDC Atlanta, USA. Descriptive statistics such as mean, standard deviation were employed to summarize the qualitative data such as age. Frequency and percentage were computed for qualitative parameters such as awareness and practice on Breast Self Examination. The association between variables was tested using Chi square statistics. Significance was set at p<0.05.

RESULTS

Total of 527women were contacted for the study of which 516 women participated in the study with the response rate of 98%. The participants were between 18 to 60 years, with mean age of 33.5±8.5 years. Women in the 25 to 34 years of age constituted the highest age group (34.5%). Majority were Hindus (96.3%), married (87.9%), and housewives (66.2%). More than half of the participants’ education status was up to high school (84.8%) and below poverty line card holder (83%). Table 1 shows the socio demographic details of the study participants.

Table 2 shows only 231 (44.7%) had ever heard of breast cancer, 124 (24 %) knew breast cancer can be prevented, 130 (56%) got the information from media,hospital and friends and 30 (6%) of the participants had afamily member diagnosed with breast cancer.

BSE, Guidelines for early detection and screening of Breast Cancer, WHO⁶

Among the study participants 72 (14%) had ever heard of BSE of which 67 felt it is a tool for early detection of breast cancer (Table 3). Only 43 (8.3%) study subjects have been taught on how to do a BSE.Among those who knew of BSE, 63 (87.5%) considered it is good to practice to do BSE regularly, but only 37 (51%) of the women who had knowledge on BSE practiced BSE. Out of the total study participants only 37 (7%) of the study participants practiced BSE on regular basis.

Table 4 shows there is significant association between high school education, employed subject and having heard about breast cancer which was statistically significant

Table 5 shows association of education, occupation and income with practice of self breast examination. There is an association with education and practice of breast self examination it is statistically significant and also association was found with income and practice of breast self examination.

DISCUSSION

Lack of awareness on breast cancer leads to late diagnosis and increased mortality. American cancer society, no more recommends BSE as a screening tool for early diagnosis of breast cancer but mammography has be advocated as a screening tool in US. In low resource setting where access to mammography is highly limited, in such scenario breast self examination (BSE) is one of the screening methods suitable in low resource setting. It can be done at ease with proper training and would create awareness on breast anatomy and hence help detect any abnormality in the breast which facilitates early health seeking behavior. Only 231 (44.7%) of the study subjects have heard of breast cancer, in spite of breast cancer being the number one cancer among women. Similar results have been found by Sideeq et al and Somdatta et al where 26% and 44% the study subject had heard about breast cancer respectively, study conducted in a teaching hospital in Maharashtra by Rao et al a higher proportion of women (81%) never heard of breast cancer.^11,14,18 In contrast study by Kumarasamy et al among rural women, 89% of women had heard about breast cancer, study in Delhi by Dahiya et al 82% knew that breast cancer was most commonest cancer in women and study by Kalliguddi et al among IT professional in Bangalore, all participants had knowledge on breast cancer, this shows that that there is regional difference with respect to awareness on breast cancer, the reason could be the urban women are educated and better informed than the rural counterparts.^12,16,17

Awareness of breast self examination (BSE) was low, only 14% of the study subject had heard of BSE as a screening tool for breast cancer and 6% of them practiced BSE. Similar results were found by Sideeq et al where 8% women knew about BSE and 4% practiced BSE, study by Somdatta et al showed that 11% were aware about BSE and only 2 practiced, study by Rao et al showed that none of the subjects had heard nor practiced BSE, study by Yerpude et al showed 30% of the subjects were aware about BSE and 23% practiced it, study by Paunikar showed 25% knew BSE and only few practiced BSE.^11-15,18 It is the same status in most studies, the reason could be low awareness about BSE or women don’t consider their health as priority

The most common source of information about breast cancer was from media (56%) followed by friends and family (31%) similar finding was seen in most of the studies but in a study by Rao et al major source of information was family and friends and study by Dahiya et al major source of information was doctors.^{11,12,14,17,18} Health centers can play a major role in creating awareness and motivating women to do BSE

This study reported family history of breast cancer among 6% of study subject, other studies also reported similar finding by Kalliguddi et al^,, study by Kumarasamy et al had family history of 8.5%, Dahiya et al family history of breast cancer in 4.5%, Rao et al family history of breast cancer in 1.38%.^12,14,16,17

This study showed association between education and awerness about breast cancer and breast self examination similar results are shown in most studies.^11-13,15,16

Though there has been difference in the awareness about breast cancer and BSE the only thing consistent with most of the study is that higher education status is associated with better awareness about breast cancer and breast self examination. In some studies even with good knowledge on breast cancer and BSE the practice of BSE is poor.^12,16

CONCLUSION

The awareness regarding breast cancer as well as knowledge and practice on breast self examination is low among the study subject, hence efforts must be taken by the health sector to disseminate awareness and health education on breast cancer risk factors, prevention and how to perform breast self examination among women in the reproductive age group, during their visit to health centers or anganwadi centers. Opportunity to educate females regarding the same must be taken up in colleges.

ACKNOWLEDGEMENTS

Authors would like to thank all the faculty, postgraduates and interns from the Department of Community Medicine and management of Rajarajeswari Medical College.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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