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ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 61-65

A cross-sectional descriptive study to assess the awareness of breast cancer and practice of breast self-examination among rural women in Kancheepuram district


1 Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Final Year MBBS Student, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
3 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission22-Aug-2019
Date of Decision16-Oct-2019
Date of Acceptance02-Apr-2020
Date of Web Publication5-Jun-2020

Correspondence Address:
Prateek Saurabh Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu - 603 108
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_69_19

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  Abstract 


Introduction: Breast cancer has been ranked as leading cancer across the world among women. The current study was done to assess the awareness about breast cancer and the practice of breast self-examination (BSE) among rural women in Kancheepuram district.
Material and Methods: A cross-sectional community-based descriptive study in the rural field practice area of a medical college was conducted for 2 months. The sample size for the study was estimated to be 120 and systematic random sampling was employed. All women aged between 30 and 70 years of age were included in the study, and they were interviewed using a pretested semi-structured schedule. The knowledge responses were arbitrarily categorized as poor, fair, and good knowledge. Utmost care was taken to maintain privacy and confidentiality. Data entry was done in Microsoft Excel, and statistical analysis was performed using SPSS version 23.0.
Results: The mean age of the study participants were 47.2 ± 7.8 years, with the majority of women from 50 to 60 years age-group. Most of the study participants 102 (85%) have heard about breast cancer, and positive family history and inadequate breastfeeding were identified as the most common risk factors. Only 4 (3.3%) women were practicing BSE and even among them none of them were doing it regularly. Factors like women being not aware of what to look for or how to perform it were the main barriers preventing them from doing BSE.
Conclusion: In conclusion, 51 (42.5%) women had good to fair knowledge about breast cancer, whereas only 20% of the study participants were aware about BSE and its role in early detection of breast cancer. These findings clearly indicate that intensive efforts have to be taken for the advocacy, communication, and social mobilization to enable early detection of breast cancer among these underprivileged women.

Keywords: Breast cancer, breast self-examination, rural


How to cite this article:
Shrivastava SR, Sowbha C, Shrivastava PS. A cross-sectional descriptive study to assess the awareness of breast cancer and practice of breast self-examination among rural women in Kancheepuram district. Indian J Community Fam Med 2020;6:61-5

How to cite this URL:
Shrivastava SR, Sowbha C, Shrivastava PS. A cross-sectional descriptive study to assess the awareness of breast cancer and practice of breast self-examination among rural women in Kancheepuram district. Indian J Community Fam Med [serial online] 2020 [cited 2020 Oct 30];6:61-5. Available from: https://www.ijcfm.org/text.asp?2020/6/1/61/286032




  Introduction Top


Breast cancer has been ranked as leading cancer worldwide, accounting for 2.09 million cases and 0.6 million deaths in the year 2018 as per the estimates released by the World Health Organization.[1] Even in Indian settings, breast cancer is reported as the most common cancer among women in 7 out of the 8 hospital-based cancer registries in the period 2012–2014, including at the Cancer Institute of Chennai, wherein 24.3% of breast cancers were reported.[2] Similar alarming trends have been reported even in population-based cancer registries.[3]

In India, the rates of breast cancer are on the rise and this can be attributed to the poor awareness and limited or nonexisting screening activities.[2],[3] In fact, the role of these factors gets multiplied immensely among illiterates and in women living in rural areas.[2],[3] Further, due to the reluctance of the women to approach health system and not being “breast aware,” a major proportion of the breast cancers are being diagnosed in the advanced stages, which significantly limits the outcome of the therapy and cast a major impact on the quality of life of the women, the family and the community.[2],[3],[4],[5]

Acknowledging the scope of the problem in the developing nations, it has been advocated that women need to be “breast aware” to identify the risk factors and symptoms of breast cancer and through the strengthening of the screening activities.[3],[4],[5],[6] For screening, three methods, namely breast self-examination (BSE), clinical breast examination (CBE), and mammography has been advocated.[4],[5],[6],[7] In contrast to CBE and mammography, which require a hospital visit and specific equipment/technical expertise, BSE is a cost-effective, simple, noninvasive intervention carried out by women on their own.[4],[5],[6],[7] BSE not only familiarizes women with the appearance/feel of their breast but also plays a crucial role in the early detection of breast abnormalities.[4],[5],[6],[7]

Further, the findings of epidemiological studies conducted in developing nations have shown that BSE is the most reasonable and feasible approach in early detection of breast cancer, especially in low-resource settings.[4],[6],[8],[9] However, although multiple merits have been associated with BSE, a wide knowledge-application gap has been reported globally.[7],[9],[10],[11],[12] Thus, among the rising incidence of breast cancer in low-resource settings, the current study has been planned to assess the awareness about breast cancer and practice of BSE among rural women in Kancheepuram district.


  Material and Methods Top


Study design and setting

A cross-sectional community-based descriptive study in the rural field practice area of a medical college with a population of 1900.

Study duration

The duration of the study was 2 months.

Sample size

Based on the findings of a study done in Trichy, 89% of the rural women were aware about breast cancer.[5] Considering that estimate as the basis, the sample size for the present study will be calculated as:

[where, P – 89; Q – 11, L (allowable error) – 6].



Assuming a 10% nonresponse rate, the final sample size is approximated to 120.

Sampling technique

Systematic random sampling.

Inclusion criteria

All women aged between 30 and 70 years of age and those who are willing to be a part of the study.

Exclusion criteria

Women who were interviewed initially, but did not come to attend the sensitization session or could not be contacted for posttest.

Study tool

It was a semi-structured schedule, which was developed after a thorough review of the literature and translated into the local language (Tamil) and back-translated to English to check for consistency and clarity. The schedule was piloted among 12 women and based on the findings obtained, it was modified.

Study variables

Sociodemographic parameters, knowledge about breast cancer (viz., risk factors, symptoms, methods to prevent breast cancer, treatment options, source of information) and parameters linked with BSE (viz. appropriate time to perform BSE, frequency, the importance of BSE, reasons to perform/not perform BSE).

Data collection

The village comprises 380 households, with a population of almost 1900. The first household was selected randomly by lottery method, and subsequently, every third (380/120) household was included in the north to south direction, and all lanes were covered. From each of the selected household, all the eligible women (30–70 years) were interviewed face-to-face using the pretested questionnaire after establishing a rapport with them. In case there is more than one eligible woman in the selected households, all of them were included.

Scoring pattern of knowledge

Each question pertaining to the knowledge will be given equal weight-age. Three categorical responses (viz., yes/no/don't know) will be assigned to each question. For every correct and incorrect/don't know response, a scoring of 1 and 0 will be given, respectively. The total knowledge score will be computed by adding scores of all knowledge-related questions, with a minimum score of 0 to a maximum score of 28. Subsequently, women will be categorized as poor knowledge (<10), fair knowledge (10–20), and good knowledge (>20).

Ethical considerations

Ethical clearance was obtained from the Institutional Ethics Committee before the start of the study. Written informed consent was obtained from the study participants before obtaining any information from them. Utmost care was taken to maintain privacy and confidentiality.

Statistical analysis

Data entry was done in Microsoft Excel. Statistical analysis was performed using SPSS version 23.0 (IBM, Bengaluru, Karnataka, India). Frequency distribution, along with mean and standard deviation was calculated for all the variables.


  Results Top


[Table 1] represents the sociodemographic attributes of the study subjects. The mean age of the study participants was 47.2 ± 7.8 years, with the majority of women from 50 to 60 years age-group. It was noteworthy that 82 (68.3%) women were literate and that 99 (82.5%) of the interviewed women were from the middle socioeconomic status. Further, most of the employed women were working under the National Rural Employment Guarantee scheme.
Table 1: Baseline characteristics of the study subjects

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[Table 2] depicts the attributes pertaining to the knowledge about breast cancer. Most of the women 102 (85%) have heard about breast cancer, while the remaining 18 (15%) women were not aware. Positive family history and nil or inadequate breastfeeding by the postnatal women were identified as the most common risk factors. With regard to the prevention, dieting and physical activity were identified as the most common approaches by 15 (14.7%) women each. A total of 29 (24.2%) women responded that the surgical approach was the most common treatment modality. Apart from the health-care professionals, sources such as mass media, relatives, and neighbors were cited as the common sources of information by 34 (33.3%), 28 (27.5%), and 27 (26.5%) study participants, respectively. Only 4 (3.3%) women were practicing BSE, and despite that, they were not aware about the appropriate time or frequency. In this study, 96 (80%) of women were not aware about BSE and its role.
Table 2: Knowledge about breast cancer

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[Table 3] shows the distribution of reasons or hindering factors in promoting BSE. Only 24 (23.5%) of the study participants were aware about BSE and that it can aid in the early detection of breast cancer. A wide range of factors such as lack of awareness, absence of motivation from family members, and no reinforcement from health providers were identified as the common barriers preventing them from doing BSE.
Table 3: Barriers for breast self-examination

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  Discussion Top


The current study was conducted among women living in a rural area, with their mean age being 47.2 ± 7.8 years, and 36 (30%) women were from 50 to 60 years age-group. The findings of a study done among college going girls in Karachi found that the mean age was 20.2 ± 1.7 years.[4] In our study, 117 (97.5%) study participants were married, while studies done among college going or high school students reported the majority of the participants being married.[4],[13]

In the present study, most of the women 102 (85%) have heard about breast cancer, while the remaining 18 (15%) women were not aware. Similar to our findings, the results of a study done among rural women in Trichy reported that 178 (89%) of the women were aware about breast cancer.[5] Further, the results of another study conducted among female undergraduate students in Cameroon revealed that 304 (88%) of the respondents have heard about breast cancer.[6] The encouraging findings obtained across different settings suggest that a significant proportion of women are aware about breast cancer, and the contribution of different stakeholders needs to be acknowledged.[4],[5],[6] On the contrary, from a public health perspective, it is noteworthy that breast cancer has become quite common regardless of the geographical settings, as a result of which gradually many women are aware about it.

In the present study, on categorizing the knowledge domain, it was found that only 14 (11.7%) women had good knowledge about breast cancer, while 37 (30.8%) women and 69 (57.5%) women had fair and poor knowledge, respectively. On a similar note, the knowledge about different aspects of breast cancer has been found quite poor, and it is important to acknowledge that there is a significant gap between having heard of breast cancer and having knowledge about breast cancer.[4],[5],[13],[14],[15],[16] In our study, 31 (30.4%) women correctly identified positive family history as one of the predominant predisposing factors. On the other hand, close to 32% of the participants identified that early menarche is a potential risk factor for developing breast cancer.[5] The findings of another study done in Bengaluru reported that age at parity and at menopause are significant determinants of breast cancer.[11] Considering the findings from all these studies, it is worth noting that a wide range of factors predisposes a woman to develop breast cancer, and thus, there is an immense need to strengthen information, education, and counseling activities to make them aware about all of them.

It was observed in our study that lump in the breast [32 (31.4%)] and discharge from nipple [16 (15.7%)] are the most common symptoms. Similar findings have been observed in various other studies done to assess the knowledge about breast cancer.[4],[5],[9],[16] On questioning about the source of information, in our study, doctors/health-care professionals [62 (60.8%)] were identified as the most common source. In another study, television was found to be the most common source being reported by 52% of the study participants.[5] Furthermore, a study done in the central part of India revealed that friends and relatives were the most common source for information on breast cancer.[12] From the public health perspective, it is quite clear that the health team and various modes of mass media have a crucial role to play in ensuring that a greater proportion of people are aware about the predisposing factors, symptoms and how to detect and treat the disease at the earliest.

In the current study, the alarming fact was that only 4 (3.3%) women were practicing BSE and even among them, none of them were correctly aware about the appropriate time or frequency. These 4 women practicing BSE were because of the positive history of breast cancer in the family. Similar kinds of estimates were obtained in a study done among women attending public health institutions in Ethiopia, wherein only 26 (6.5%) women had practiced BSE.[10] In contrast, quite encouraging estimates were obtained in a study done in Pakistan, wherein 60.1% of study participants were practicing BSE.[4] This could be due to the study sample as the study was done among school-going girl students. However, in any case, it is worth noting that the majority of the women, despite being aware about BSE are not practicing and measures have to be taken to sensitize them and ensure that it becomes a regular habit.

In our study, 20 (83.3%) women were not practicing BSE despite being aware about the utility of it. Factors like women being not aware what to look for [17 (85%)] or how to perform it [15 (75%)] were the main barriers preventing them from doing BSE. Similar kind of results was obtained in a study done in Karnataka, with major barriers being not sure about how to do it, the act being embarrassing and lack of privacy. On the other hand, in a study done in Turkey, it was found that almost 35% of the study subjects were aware about BSE.[13] The findings of the study done among women in Iran revealed that lack of awareness about breast examination or about BSE techniques, no training is given by the health care personnel were the main barriers preventing BSE.[17] Some of the epidemiological studies have also find a positive association between the educational status of women and the practice of BSE.[17],[18] These findings clearly indicate that still, a lot needs to be done by the policymakers (to ensure that breast cancer becomes a public health priority) and health professionals (to increase awareness about breast cancer and BSE).[16],[19],[20]

The strength of the study was that it covers an important public health problem, and it predominantly targets rural women who are often vulnerable due to various reasons, including lack of awareness and ignorance. The limitation of the study was that it was a single-centered study, and thus, the findings of the study cannot be generalized.


  Conclusion Top


51 (42.5%) women had good to fair knowledge about breast cancer, while only 20% of the study participants were aware about BSE and its role in early detection of breast cancer. These findings clearly indicate that intensive efforts have to be taken for the advocacy, communication, and social mobilization to enable early detection of breast cancer among these underprivileged women.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ahmed A, Zahid I, Ladiwala ZFR, Sheikh R, Memon AS. Breast self-examination awareness and practices in young women in developing Countries: A survey of female students in Karachi, Pakistan. J Educ Health Promot 2018;7:90.  Back to cited text no. 4
    
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Kumarasamy H, Veerakumar AM, Subhathra S, Suga Y, Murugaraj R. Determinants of awareness and practice of breast self examination among rural women in Trichy, Tamil Nadu. J Midlife Health 2017;8:84-8.  Back to cited text no. 5
    
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Sama CB, Dzekem B, Kehbila J, Ekabe CJ, Vofo B, Abua NL, et al. Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. Pan Afr Med J 2017;28:91.  Back to cited text no. 6
    
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  [Table 1], [Table 2], [Table 3]



 

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