Multiple behavioral risk factors causing cancer in rural women of Mysuru

INTRODUCTION

The term ‘cancer’ is derived from the Greek word ‘Karkinos’ (for crab). It is a non-communicable disease caused by the abnormal proliferation of cells in the human body.^1,2 Cancer studies aim to develop preventive methods, diagnose, detect, and treat the disease. Understanding the disease well helps in diminishing the disastrous human and economic impact of cancer.³

Cancer has the highest death rate across the world, around 9.6 million deaths occurred in 2018. Commonly occurring cancers are as follows: lung cancer (2.09 million), breast cancer (2.09 million), colorectal cancer (1.8 million), prostate cancer (1.28 million), non-melanoma skin cancer (1.04 million), gastric cancer (1.3 million).⁴

Cancer occurs when normal cells transform into tumors cells, it is a multistage process where normal cells from the pre-cancerous stage transform into neoplastic cells. This change is due to the interaction of an individual’s genetics and environmental agents. Cancer arises when there is an uncontrolled division of normal cells, it is a multistage process that converts normal cells to pre-cancerous cells and finally to malignant tissues. It mostly occurs due to genetic factors but environment and lifestyle also play a major role. Adopting a healthy lifestyle/avoiding risk factors can reduce cancer incidence to a great extent. Common risk factors include smoke tobacco/smokeless tobacco, obesity, poor diet with fewer fruits and vegetable intake, alcohol, poor physical activity, infections like hepatitis, sexually transmitted infections like HPV, pollutants in the air, indoor/outdoor smoke.⁴ Common causes for cancer deaths: lung (1.76 million deaths), colorectal (8,62,000 deaths), stomach (7,83,000 deaths), liver (7,82,000 deaths) and breast (6,27,000 deaths).⁴ As per National Cancer Registry Program (NCRP), >1300 deaths daily because of cancer in India. From 2012-2014, cancer mortality increased by nearly 6%.⁵

In the year 2012, there were 478,180 deaths out of 2,934,314 cases. In 2013 there were 4,65,169 deaths out of 3,016,628 cancer cases. In 2014, 4,91,598 people died among 2,820,179 cases.⁵ Projected incidence of cancer patients in India was 6,79,421. 94/1,00,000 in males and 712,758 (103/1,00,000) by 2020. It was estimated that 1in 68 males, 1 in 29 females, at least 1 out of 9 Indians will get diagnosed with cancer in their lifetime. These 5 cancers were projected to occur commonly in 36% of cancers in men (carcinoma of lungs, oral cavity, prostate, and stomach) and (carcinoma breast, cervical carcinoma, cancer of ovaries, and lung carcinoma) would constitute 53% of all cancers by 2020 and in females.⁶ Tobacco is a major cause of cancer and accounts for nearly 22% of cancer deaths globally.⁷

Deaths due to cancer can be prevented by early detection through timely screening and treatment including vaccination. Cancer has a huge impact on public health in the USA. The economic burden due to lost productivity, years of life lost due to premature deaths, the long-term effects of cancer, the costs associated with illness, and its treatment on the quality of life, in cancer survivors, have a huge burden on the population level.⁸ With changes in lifestyle, increased longevity, prevention, and control of infections, NCDs have become a major public health problem worldwide, especially in developing and under developed countries. After cardiovascular diseases, cancer is the next cause of mortality and morbidity. The National Centre for Disease Informatics and Research in Bengaluru, India, 1.45 million cancer cases were estimated in 2016. 4 The incidence is expected to double in the coming 20 years.^9,10

Objective

The objective of this study was to assess the association between multiple behavioral risk factors and cancer among rural women.

METHODS

This was a cross-sectional study and it was conducted at Bharat Hospital and Institute of Oncology, Mysore. A total of 380 patients were included in the study. The study was conducted for 5 months (February to June 2021). A structured questionnaire was used to collect the data on socio-demographic characteristics like age, gender, education, occupation, family income, marital status, socio-economic status, type of cancer, staging of cancer, BMI, risk factors like diet, physical activity, smoking/tobacco consumption, alcohol consumption, and sun exposure. Data was collected by interviewing the patient and entered into Google forms.

Assuming the percentage of behavioral risk factors as high as 45% sample size calculated, with an absolute precision of 5% and confidence interval of 95% a sample size of 380 was obtained.

The data obtained was coded and entered into Microsoft excel. Descriptive statistics such as mean, frequencies, and percentages were calculated. Crosstables were constructed, Chi square test was done to determine the association of behavioral risk factors causing cancer. Data were analyzed using SPSS version 25.

Inclusion criteria and exclusion criteria

Patients diagnosed with cancer for at least 1 year and those who are on treatment for at least 6 months, patients who are conscious, mentally stable, and cooperative, female patients from rural areas, and patients who are willing to participate in the study were included. Female cancer patients from urban areas and patients who are terminally ill and uncooperative were excluded.

RESULTS

In this study out of 380 women, the mean age of the participants is 50±7.9 years. 106 (27.9%) were in the age group 41-45 years and 94 (24.7%) were in the age group 51-55 years. In this study, 279 (73.4%) belonged to class I, 94 (24.7%) belonged to class II, 1 (0.3%) belonged to class IV and 6 (1.6%) belonged to class V. Out of 380 women, 119 (31.3%) were diagnosed with breast cancer, 84 (22.1%) were diagnosed with cervical cancer, 44 (11.6%) had ovarian cancer, 41 (10.8%) had uterine cancer and 92 (24.2%) were diagnosed with other types of cancer included AML, peri-ampullary cancer, gastric cancer, lung cancer, thyroid cancer, and colorectal cancer.

In this study out of 380 women, the majority (27.9%) were in the age group 41-45 years. The mean age of the participants was 50±7.9 years, 88.2% were married, 67.9% had received a basic education, 72.6% were housewives, 73.4% belonged to class I, and 47.9% were overweight.

In the present study out of the multiple behavioral risk factors causing cancer, a significant association was found between the frequency of dairy products intake/week and cancer (p value=0.00), fruits intake/week and cancer (p value=0.01), the frequency of vegetable intake/week and cancer (p value=0.01), frequency of sweets intake/week and cancer (p value=0.0003877).

In the present study out of the multiple behavioral risk factors causing cancer, no significant association was found between the frequency of fish intake/week and cancer (p value=0.19), frequency of poultry intake/week and cancer (p value=0.17), frequency of red meat intake/week and cancer with (p value=0.14), the frequency of fried food intake/week and cancer with (p value=0.07). In the present out of the multiple behavioral risk factors causing cancer, no significant association was found between the frequency of eating outside/week and cancer (p value=0.63). In this study out of the multiple behavioral risk factors causing cancer, a significant association was found between the frequency of tea, coffee consumption/day, and cancer (p value=0.0).

In this study out of the multiple behavioral risk factors causing cancer, no significant association was found between the frequency of alcohol consumption/day and cancer (p value=0.25). In this study out of the multiple behavioral risk factors causing cancer, no significant association was found between smoking and cancer (p value=0.53). In this study out of the multiple behavioral risk factors causing cancer, a significant association was found between frequency of smoking/week and cancer (p value=0.02). In this study out of the multiple behavioral risk factors causing cancer, a significant association was found between frequency of snuff and cancer (p value=0.04). In this study out of the multiple behavioral risk factors causing cancer, a significant association was found between the frequency of sun protection practices and cancer (p value=4.75 E-06).

DISCUSSION

An individual’s lifestyle choices have a huge impact on his/her health. Risky choices can be treated/modified. Behaviors about diet, physical activity, smoking, tobacco chewing, alcohol abuse are all some of the major behavioral risk factors. In our study out of 380 women, 119 (31.3%) were diagnosed with breast cancer, 84 (22.1%) were diagnosed with cervical cancer, 44 (11.6%) had ovarian cancer, 41 (10.8%) had uterine cancer and 92 (24.2%) were diagnosed with other types of cancers. In the present study out of the multiple behavioral risk factors causing cancer, a significant association was found between the frequency of dairy products intake/week (p value=0.00), frequency of fruits intake/week (p value=0.01), frequency of vegetable intake/week (p value=0.01), frequency of sweets intake/week (p value=0.00), the frequency of tea, coffee consumption/day (p value=0.00), frequency of smoking/week (p value=0.5), frequency of snuff (p value=0.04), sun protection practices various cancers (p value=4.75 E-06). The results were at par with the following studies, A study revealed obesity, a sedentary lifestyle, alcohol abuse are associated with a greater risk of developing breast cancer. Cigar, pipe, and smokeless tobacco use also increase the risk of cancer, as does exposure to environmental tobacco smoke.¹¹

A study revealed, the evidence indicates, almost 25-30% are due to tobacco, 35% are diet-related, 15% are caused by infections, the other causes are stress, etc.¹² A sedentary lifestyle has been linked to 5% of deaths from cancer.¹³ In terms of cancer and chronic disease prevention, a healthy diet is rich in fruits and vegetables, is limited in red meat and animal fat, and includes a daily multivitamin with folate.¹³

In the present study out of the multiple behavioral risk factors causing cancer, no significant association was found between the frequency of fish (p value=0.19), frequency of poultry (p value=0.17), frequency of red meat intake/week (p value=0.14), frequency of fried food intake/week (p value=0.07), eating outside/week (p value=0.63), alcohol consumption/day (p value=0.2).

As the above risk factors are preventable along with dietary awareness the following measures should be considered. Public information on screening for early detection and knowledge of common signs and symptoms is crucial for better health outcomes. Education on self-breast examination should be prioritized. HPV vaccination among girls can be encouraged. Awareness of timely follow-ups is important to detect and prevent a recurrence.

Limitations

The limitations of the study were- (a) results cannot be generalized to the whole population as it is a hospital-based study; (b) study focuses only on rural women; and (c) other behavioral risk factors like sexual activity, screening, etc were not studied.

CONCLUSION

The study was conducted to find the association of behavioral risk factors causing cancer in rural women. Rural women have poor access to health care, poor health-seeking behavior, lack of awareness, and low socio-economic status making them vulnerable to various diseases. Studying the influence of such risk factors on cancer among rural women can help in prevention strategies. As per the results, there is a need for appropriate IEC materials, behavior change strategies, and periodic awareness in rural areas to promote healthy living and reduce the incidence of cancers.

ACKNOWLEDGEMENTS

The authors thank all the participants involved and the study.

Funding: No funding sources

Conflict of interest: None declared

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

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