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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 61-65

A community-based study on awareness of cancer and anticipated barriers in seeking help


Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India

Date of Web Publication4-Jul-2019

Correspondence Address:
Deepak Sharma
Department of Community Medicine, Government Medical College and Hospital, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_34_19

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  Abstract 

Introduction: Cancer is a leading public health problem worldwide. Contributing factors include lack of awareness regarding cancer and improper help seeking behavior.
Objective: To assess the awareness regarding early warning signs of cancer, its risk factors and anticipated barriers in seeking help.
Methodology: A community-based cross-sectional study was conducted among 470 study participants. Trained workers administered a standardized tool to respondents after obtaining their informed consent. Epi Info software for windows version 7.2 was used for the analysis.
Results: Overall, merely 7.7% (36/470) of the study respondents were aware of all the nine warning signs of cancer. The most commonly known early warning sign of cancer was “unexplained swelling” (58.3%). Further, although majority knew that cigarette smoking is a risk factor for cancer (90.4%), very few were aware about the role of inadequate physical activity (9.3%) and diet devoid of adequate amounts of fruits and vegetables (11.9%). There were few anticipated barriers in seeking help such as embarrassment (13.2%) and difficult to interact with a doctor (7.9%).
Conclusion: There was inadequate awareness about cancer but a favorable help-seeking behavior. It is, therefore, recommended that health-care professionals should scale up efforts for disseminating information regarding cancer among the people.

Keywords: Cancer, early warning sign, risk factors


How to cite this article:
Sharma D, Goel NK, Sharma MK, Walia DK, Puri S. A community-based study on awareness of cancer and anticipated barriers in seeking help. Indian J Community Fam Med 2019;5:61-5

How to cite this URL:
Sharma D, Goel NK, Sharma MK, Walia DK, Puri S. A community-based study on awareness of cancer and anticipated barriers in seeking help. Indian J Community Fam Med [serial online] 2019 [cited 2019 Sep 17];5:61-5. Available from: http://www.ijcfm.org/text.asp?2019/5/1/61/262121


  Introduction Top


Cancer is a global public health issue. Its incidence and mortality are rapidly increasing. According to the World Health Organization, worldwide every year, around 10 million people are newly-diagnosed with cancer. There are approximately 7.5 million deaths, of which two-thirds are from developing countries.[1] In India, cancer is a leading cause of death next to cardiovascular disease.[2] The age-standardized cancer incidence rate of India, according to GLOBOCAN 2018 report, is 89.4/lakh population (females 90.0/lakh; males 89.8/lakh).[3] The cancer incidence is comparatively higher in Chandigarh; according to the Population-Based Cancer Registry report (105/lakh in women; 93.4/lakh men).[4]

Cancer is caused by both inherited mutations and lifestyle factors such as smoking,[5] obesity,[6] lack of exercise,[7] and poor diet.[8] Certain infections such as human papilloma virus (HPV) increase the risk of cervical cancer.[9] Cancers are preventable if people are aware of their early warning signs and associated risk factors.[10] Research has shown that people lack awareness regarding cancer. Feizi et al. in a study conducted in Iran reported that a few respondents had adequate level of knowledge about cancer.[11] Ryan et al. in their study among Irish adults documented poor awareness of risk factors for cancer.[12] Babu and Thomas observed a low level of awareness of cancer warning signs among the rural population of Kerala, India.[13] There is a need to document public awareness about the early warning signs of cancer, its risk factors, and anticipated barriers in seeking help. The objective of the current study was, therefore, to find this in a selected area of Chandigarh.


  Methodology Top


A community-based cross-sectional study was conducted among individuals aged between 20 and 50 years residing in the rural field practice area of the Department of Community Medicine. A sample size of 480 study participants was calculated using the formula 4pq/l2; considering 50% awareness of cancer, 0.05 desired precision, 95% confidence interval, and a non-response rate of 20%. A random selection of houses was done; and in each house one eligible person was interviewed by workers who were trained in administering the questionnaire. Before starting the interview, the study participants were apprised about the objective of the study, and informed consent was obtained. “Cancer Awareness Measure”, a validated tool, was used to measure the awareness of warning signs of cancer, anticipated barriers in seeking help, and risk factors of cancer.[14],[15] The nine early warning signs included: “unexplained swelling,” “persistent unexplained pain,” “unexplained bleeding,” “persistent cough or hoarseness,” “persistent change in bowel habits,” “persistent difficulty swallowing,” “change in appearance of mole,” “sore that does not heal,” and “unexplained weight loss.” The anticipated barriers in seeking help included “embarrassment,” “scared,” “worried about wasting the doctor's time,” “difficult to talk with doctor,” “difficult to make an appointment with doctor,” “busy to make time to go to the doctor,” etc., The risk factors for cancer included “smoking any cigarettes,” “exposure to second-hand cigarette smoke,” “alcohol drinking,” “eating <5 portion fruit and vegetables a day,” etc., moderate physical activity <30 min five times a week, etc.

Epi Info software for windows version 7.2 (Centre for Disease Control, Atlanta, USA) was used for the statistical analysis. Sociodemographic variables were dichotomized (i.e., age [20–35 years and 36 years and above]) and education [illiterate/literate]. The Chi-square test was used to test for testing the relationship between sociodemographic variables and participants' responses. A value of P < 0.05 was considered statistically significant. The study was approved by the Ethical Committee of the Medical College.


  Results Top


The study included 470 participants with a response rate of 97.9%. The mean age of the study participants was 30.4 years (SD = 12.6). Of the 470 interviewed study participants, 190 (40.4%) were male. The majority of the study participants were literate (85.3%). Overall, merely 7.7% (36/470) of the study respondents were aware of all the nine warning signs of cancer. Around half of the respondents thought that unexplained lump (58.3%), unexplained bleeding (50.4%), persistent difficulty in swallowing (52.1%), persistent cough or hoarseness of voice (48.5%), and persistent unexplained pain (40.2%) could be early warning signs of cancer. Around one-third felt that sore that does not heal (34.5%) and unexplained weight losses (32.1%) are the early warning signs of cancer. A few respondents opined that persistent change in bowel habits (24.7%) and change in the appearance of mole (22.8%) could also be indicative of cancer.

Among the risk factors, the most frequently recognized risk factors were smoking tobacco (90.4%; [agree 8.7% and strongly agree 81.7%]) followed by exposure to second-hand cigarette smoke (82.7%; [agree 17.0% and strongly agree 65.7%]), and drinking alcohol (70.4%; [agree 33.2% and strongly agree 37.2%]). Around one-fifth knew that being overweight (23.6%) and age >70 can lead to cancer (28.3%). The least recognized risk factors were inadequate physical activity (9.3%; [agree 7.4% and strongly agree 1.9%]) and having an unhealthy diet with <five portions of fruits and vegetables (11.9%; [agree 9.8% and strongly agree 2.1%]). Only 14.7% (agree 10.9% and strongly agree 3.8%) agreed that infection with HPV can lead to cancer. When asked about the anticipated barriers in seeking help; most respondents did not believe that they would be embarrassed (84.7%) or scared (84.3%). Most of them opined that it would not be difficult to talk with a doctor (90.9%), take appointment (84.5%), or arrange transport for going to him/her (87.7%) [Table 1].
Table 1: Awareness of early warning sign, risk factors, and help-seeking behavior of the study population

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The sociodemographic break up shows that female respondents were significantly more likely than males to be aware of warning signs (significant for persistent cough [female 79.1% vs. male 67.7%], persistent change in bowel habits [female 61.0% vs. male 47.4%], change in appearance of mole [female 62.1% vs. male 42.4%], and sore that does not heal [female 72.7% vs. male 59.6%]). Females had significantly higher awareness of all the risk factors of cancer as compared to males such as smoking (99.6% vs 96.8%) and drinking alcohol (96.6% vs 78.3%). Further, respondents <35 years were significantly less likely than those aged >35 years to be embarrassed (11.6% vs. 19.8%) and scared (12.3% vs. 21.7%). Furthermore, younger participants were less likely to find it difficult to arrange transport for doctor's surgery (9.0% vs. 15.9%) as compared to their counterparts. There was gender variation, in which females were less likely than male counterparts to be embarrassed (4.4% vs. 26.6%) or scared (3.3% vs. 30.5%) and worry about wasting doctors time (1.1% vs. 12.2%) [Table 2].
Table 2: Sociodemographic predictors of cancer early warning signs, its risk factors, and anticipated barriers in seeking help

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  Discussion Top


In the current study, merely 7.7% of the study respondents were aware of all the nine warning signs of cancer. Low awareness of cancer warning signs has been reported in studies conducted in India[13],[16] and abroad.[17],[18] Further, in the present study, we found that the most common known warning signs of cancer were “unexplained lump” and the least was “change in the appearance of mole.” A study conducted among the adult population in a Puducherry, India, reported that “unexplained bleeding” was the most common known warning sign and least known was “change in wart/mole.”[16]

In our study, cigarette smoking was the most known risk factor followed by second-hand smoke and alcohol intake. Only few were aware of the role of inadequate physical activity and having a diet devoid of adequate amounts of fruits and vegetables in cancer prevention. Veerakumar et al. in their study reported that most of the respondents attributed smoking to be a risk factor of cancer with very few knowing the fact that unhealth diet can be a predisposing factor.[16] Poudel et al. in their study among Nepalese adults reported that half of the study respondents were aware that inadequate physical exercise can be risk factor for cancer (51%). Further, around one fourth (23%) knew that unhealthy diet is a risk factor for cancer.[19] In our study, only 15% of the study participants were aware that infection with HPV can lead to cancer. Improper awareness about HPV as a risk factor for cancer has been reported in other studies.[20],[21] In our study, around one-fifth were aware that overweight is a risk factor for cancer. Similar to this finding, Ryan et al. studied Irish adults and reported that only 32% of the public were aware that obesity is a risk factor of cancer.[12]

Encouraging individuals to seek help for the suspected sign is the hallmark for early diagnosis and treatment of cancer. In the present study, only a few respondents anticipated barriers in seeking help. Contrary to this finding, a study conducted by Al-Azri et al. reported a comparatively higher proportion of respondents (one half) having barriers in seeking help for the cancer symptoms.[22] This difference can be attributed to the difference in the study area and its population. In the present study, it was found that females were significantly more likely than males to be aware of the warning signs of cancer. This can probably be explained by another finding of this study; wherein females had comparatively better help-seeking behavior than the male counterparts. Thus, they are more likely to report symptoms to a healthcare provider and get information on diseases. Feizi et al. in their study reported that females had a better knowledge of warning signs as compared to that of males.[11]


  Conclusion Top


In conclusion, the results of the present study revealed that respondents had inadequate awareness of early warning signs and risk factors of cancer. There were however few anticipated barriers in seeking help. It is, therefore, recommended that healthcare professionals should regularly hold community-based activities to make people aware about cancer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Cancer. Available form: https://www.who.int/news-room/fact-sheets/detail/cancer. [Last accessed on 2019 Feb 10].  Back to cited text no. 1
    
2.
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4.
Population Based Cancer Registries at Chandigarh and SAS Nagar, Sangrur, Mansa districts Punjab state, India. Available from: http://pbhealth.gov.in/Punjab%20PBCR%20summary%2023%20Feb%202016.pdf. [Last accessed on 2019 Feb 10].  Back to cited text no. 4
    
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De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes 2013;2013:291546.  Back to cited text no. 6
    
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9.
Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006;118:3030-44.  Back to cited text no. 9
    
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11.
Feizi A, Kazemnejad A, Hosseini M, Parsa-Yekta Z, Jamali J. Assessing awareness level about warning signs of cancer and its determinants in an Iranian general population. J Health Popul Nutr 2011;29:656-9.  Back to cited text no. 11
    
12.
Ryan AM, Cushen S, Schellekens H, Bhuachalla EN, Burns L, Kenny U, et al. Poor awareness of risk factors for cancer in Irish adults: Results of a large survey and review of the literature. Oncologist 2015;20:372-8.  Back to cited text no. 12
    
13.
Babu RM, Thomas P. Assessment of public awareness of cancer warning signs among rural population, Kochi. Kerala Int J Adv Nurs Manage 2015;3:253-8.  Back to cited text no. 13
    
14.
Cancer Awareness Measures. Available from: https://www.cancerresearchuk.org/health-professional/awareness-and-prevention/the-cancer-awareness-measures-cam. [Last accessed on 2019 April 10].  Back to cited text no. 14
    
15.
Stubbings S, Robb K, Waller J, Ramirez A, Austoker J, Macleod U, et al. Development of a measurement tool to assess public awareness of cancer. Br J Cancer 2009;101 Suppl 2:S13-7.  Back to cited text no. 15
    
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Veerakumar AM, Kar SS. Awareness and perceptions regarding common cancers among adult population in a rural area of Puducherry, India. J Educ Health Promot 2017;6:38.  Back to cited text no. 16
    
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Brunswick N, Wardle J, Jarvis MJ. Public awareness of warning signs for cancer in Britain. Cancer Causes Control 2001;12:33-7.  Back to cited text no. 17
    
18.
Ravichandran K, Mohamed G, Al-Hamdan NA. Public knowledge on cancer and its determinants among Saudis in the Riyadh region of Saudi Arabia. Asian Pac J Cancer Prev 2010;11:1175-80.  Back to cited text no. 18
    
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Poudel K, Sumi N. Knowledge about risk factors for cancer among adults in Nepal. KnE Life Sci 2018;4:126-36.  Back to cited text no. 19
    
20.
Siddharthar J, Rajkumar B, Deivasigamani K. Knowledge, awareness and prevention of cervical cancer among women attending a tertiary care hospital in Puducherry, India. J Clin Diagn Res 2014;8:OC01-3.  Back to cited text no. 20
    
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Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending obstetrics and gynecology department: A cross-sectional, hospital-based survey in South India. Indian J Cancer 2017;54:481-7.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Al-Azri M, Al-Maskari A, Al-Matroushi S, Al-Awisi H, Davidson R, Panchatcharam SM, et al. Awareness of cancer symptoms and barriers to seeking medical help among adult people attending primary care settings in Oman. Health Serv Res Manag Epidemiol 2016;3:2333392816673290.  Back to cited text no. 22
    



 
 
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