Awareness and current knowledge of women on breast cancer in Hyderabad, Telangana State
Abstract
The purpose of the present study is to accomplish research objectives that are to assess the effectiveness of an awareness program on knowledge and attitude regarding breast cancer and screening technique among women. 105 women were selected living in the Hyderabad district, Telangana state, selected for the study by Simple random sampling technique between 13-70 years. Appropriate data collection is the most important and central part of any investigation, which provides necessary data for the study. We made a standard Structured knowledge questionnaire and attitudes scale containing 57 questions to assess women knowledge and attitude regarding breast cancer. The most significant and important part of any exploration is gathering significant data, which will give the information expected to respond to the inquiries brought up in the survey. We made a standard Structured information Questionnaire, and a disposition like a scale containing 57 inquiries was utilized to evaluate the information and demeanor of women with respect to malignant breast growth. We designed and developed an Informational booklet on knowledge and attitude regarding breast cancer and screening technique after pre-test knowledge and lacking attitude areas like Objectives, Breast Structure, Types of Cancer and Causes of Breast Cancer, Risk factors, Symptoms, Diagnosis, Prevention and Screening of breast cancer, Clinical Breast Examination, Mammography and Treatment. After data collection, analysis was done to determine the association between selected variables, computing co-efficient of correlation to find the relation between knowledge scores and attitude scores.
Keywords
Breast cancer, Knowledge, Awareness, Screening, Telangana State, India
Introduction
Breast cancer is one of the most medical conditions and the main cause of death in ladies. The primary reason for the occurrence of breast cancer in India is the absence of an “organised national breast cancer screening programme”.
There are over 200 different types of cancer, some of which are far more common worldwide than others are lung and breast cancer (12.3 % of total cancer cases), colorectal, i.e. the large Intestine cancer (10.6 %), Prostate cancer (7.5 %) and stomach cancer (6.1 %), according to the World Cancer Research Fund International Statistics (Francies, Hull, Khanyile, & Dlamini, 2020).
The most recent review report released by the Indian Council for Medical Research (ICMR) and National Centre for Disease Informatics and Research (NCDIR) has revealed that more than half of breast cancer cases in Telangana state are detected at a late stage, which is a cause of significant concern (Rajan et al., 2021).
When it comes to cancer in women’s breast cancer cases, have seen an alarming rise over the past few years in Hyderabad and the remaining districts of Telangana. Most doctors believe that mammography is the best way to detect breast cancer at its nascent stage (Beral et al., 2011). But still, it is not adopted widely In India and other parts of the world, despite its numerous advantages over other screening methods.
When it comes to mammography, doctors take it as the best technique to identify cancer, and it is expensive to give electronic pictures of the breasts, which can be upgraded by computer technology, stored on computers, and even communicated electronically in situations where remote admittance to the mammogram is required (Secginli & Nahcivan, 2006). “This is especially valuable in cases of younger women with dense breasts to detect early subtle cancerous changes in the breast”.
It additionally gives a 3D picture of the breast, which helps in better diagnose. As per Indian Council for Medical Research reports, 1.5 lakh new breast cancer cases in India, of which 70,000 succumb every year. In the absence of a cancer registry, experts in Hyderabad say the caseload could be equally alarming, especially when women avoid the assessment.
Ductal Carcinoma is the Initial alarming signal where malignant growth cells are found inside the milk ducts (the canals that allow milk to move from the milk gland to the nipple) in the breast but have not spread to the encompassing breast tissues or organs.
Stage Zero Breast Cancer is not life-threatening but can spread to the encompassing tissues if left untreated. In view of the presence of the cells under a microscope and on the rate with which they grow, it can be divided into low grade and high grade. It is doubtful for a low-grade DCIS to be an invasive breast cancer when compared to a high-grade DCIS. The treatment depends on the degree of the DCIS within the ducts and its grade (NBCCEDP, 2015).
DCIS is hard to identify as it does not have any side effects. “women must look out for a change in size, rash nearby the areola, a painless lump, blood-stained discharge from the nipple, swelling under the armpit or a retraction of the nipple (Bevers et al., 2009). Women over 40 years old should have a mammogram at least once in two years for early detection.
As per the World Health Organization statistics, less than 5% of women undergo breast screening in India. The reasons are an absence of awareness about the importance of early detection and an organized nationwide breast cancer screening programme. It’s probably to be nothing, but if there’s something there, you’ll have caught it in time to avoid further consequences (Dhillon et al., 2018).
The present study attempts to address some of these research gaps among women to reduce the prevalence of breast cancer and make them aware of it.
Methodology
Setting and Participants
This study was conducted in Hyderabad, the largest city and capital of the southern Indian state Telangana State. Hyderabad is located on the banks of the Musi River around artificial lakes. In 2014, the estimated population of Hyderabad was 8.7 million and ranked 4th most populous city in India. In 2018 the growth percentages pushed this number to over 9 million residents in the town. Primary health centers at the village level and government and private hospitals at the urban level are the primary health service providers.
This community-based cross-sectional study was conducted among women ages 13–60 who live in Hyderabad, Telangana State. The study aims to identify factors affecting breast cancer screening in urban women of Hyderabad and develop a comprehensive assessment to determine the awareness about breast cancer in women. This community-based study was divided into Six sections (Mittra et al., 2010),
Section- I contained demographic information, Section-II knowledge & awareness levels before the educational intervention, Section-III Attitudes toward breast and breast cancer screening before educational Intervention, Section- IV Influences & motivation for screening, Section- V Knowledge & awareness levels after educational intervention, Section- VI Attitudes toward breast cancer screening after the educational intervention.
To assess the knowledge of women about breast cancer, a sample size of 105 participants selected randomly for the survey contained 57 questions regarding women’s knowledge of breast cancer, screening, and the treatment of breast cancer. Written informed consent from each participant was taken before the study's initiation (Sankaranarayanan et al., 2011).
|
Positive Screening Post-intervention |
Negative Screening Post-intervention |
Neutral Screening Post-intervention |
|||||
|---|---|---|---|---|---|---|---|
|
Characteristic |
n (%) |
|
df |
p |
|||
|
Total |
105(100) |
||||||
|
Age Group (Year) (n=105) |
3.2 |
4 |
0.5 |
||||
|
13 - 30 Years |
29(27.61) |
18(17.1) |
9(5.5) |
2(1.9) |
|||
|
31 - 60 Years |
58(55.23) |
29(27.6) |
27(25.7) |
2(1.9) |
|||
|
Above 60 Years |
18(17.14) |
9(8.5) |
7(6.7) |
2(1.9) |
|||
|
Education (n=105) |
16.1 |
2 |
0.05 |
||||
|
Primary |
19(18.09) |
17(16.1) |
0(0.0) |
2(1.9) |
|||
|
Secondary |
86(81.90) |
39(37.1) |
43(40.9) |
4(3.8) |
|||
|
Family income (INR/Month) (n=105) |
16.5 |
2 |
0.05 |
||||
|
10,000 |
16(15.23) |
16(15.2) |
0(0.0) |
0(0.0) |
|||
|
10,000 |
89(84.76) |
40(38.1) |
43(40.9) |
6(5.7) |
|||
|
Literacy (Hindi or Telugu) (n=105) |
2.5 |
2 |
0.2 |
||||
|
Literate |
90(85.71) |
50(47.6) |
36(34.2) |
4(3.8) |
|||
|
Illiterate |
15(14.28) |
6(5.7) |
7(6.7) |
2(1.9) |
|||
|
Screening history (n=105) |
3.1 |
2 |
0.2 |
||||
|
Ever Screened |
23(21.90) |
16(15.2) |
6(5.7) |
1(0.9) |
|||
|
Never Screened |
82(78.09) |
40(38.1) |
37(35.2) |
5(4.7) |
|||
|
Employment (n=105) |
3.3 |
2 |
0.2 |
||||
|
Employed |
78(74.28) |
38(36.1) |
36(34.2) |
4(3.8) |
|||
|
Not Employed |
27(25.71) |
18(17.1) |
7(6.7) |
2(1.9) |
|||
|
Individual Income (INR/Month) (n=60) |
3.3 |
2 |
0.1 |
||||
|
10,000 |
27(25.71) |
18(17.1) |
7(6.7) |
2(1.9) |
|||
|
10,000 |
78(74.28) |
38(36.1) |
36(34.2) |
4(3.8) |
|||
|
Marital Status |
1.9 |
2 |
0.3 |
||||
|
Married |
59(56.19) |
35(33.3) |
21(20) |
3(2.8) |
|||
|
Widow/Divorced |
46(43.80) |
21(20) |
22(20.9) |
3(2.8) |
|||
|
Response |
Pre intervention |
Post intervention |
|---|---|---|
|
n(%) |
n(%) |
|
|
Aware of breast cancer |
43(40.96) |
88(83.8) |
|
Not aware of breast cancer |
62(59.04) |
17(16.1) |
|
Aware of someone diagnosed with breast cancer |
65(61.9) |
65(61.9) |
|
Not aware of someone diagnosed with breast cancer |
40(38.0) |
40(38.0) |
|
Knowledge |
||
|
Any knowledge about breast cancer |
43(40.96) |
98(93.33) |
|
No knowledge of breast cancer |
62(59.04) |
07(0.06) |
|
Awareness of symptoms |
||
|
Lump in breast |
15(14.2) |
33(31.42) |
|
Pain in breast |
63(60) |
52(49.52) |
|
leeding/discharge through the nipple |
14(13.3) |
02(0.19) |
|
Skin changes over the breast |
5(4.7) |
04(0.38) |
|
Cyclical breast tenderness |
0(0.0) |
02(0.19) |
|
Lump in axilla |
8(7.6) |
12(11.42) |
|
Awareness of general risk factors |
||
|
Advancing age |
19(18.09) |
12(11.42) |
|
Early menopause |
8(7.6) |
2(0.19) |
|
Late menopause |
27(25.7) |
30(28.57) |
|
Oral contraceptive pills |
12(11.4) |
8(0.76) |
|
Obesity |
39(37.1) |
53(50.47) |
|
HRT |
0(0.0) |
0(0.0) |
|
Awareness about tests for diagnosis |
|
|
|
Mammography |
5(4.7) |
22(20.95) |
|
Biopsy |
21(20) |
12(11.42) |
|
CT/MRI |
59(56.1) |
62(59.04) |
|
FNAC |
17(16.2) |
9(0.85) |
|
Awareness about treatment of breast cancer |
||
|
Surgery |
12(11.4) |
43(40.95) |
|
Medicine |
64(60.9) |
52(49.52) |
|
Ayurveda/other allied traditional |
29(27.6) |
10(0.95) |
|
Awareness about whom to consult |
|
|
|
Gynecologist |
79(75.23) |
90(85.71) |
|
Family physician/primary care physician |
23(21.9) |
10(0.95) |
|
Surgeon |
3(2.86) |
5(0.47) |
|
Awareness about preventive factors |
|
|
|
Lifestyle medication |
53(50.49) |
70(66.66) |
|
Good nutrition |
16(15.23) |
22(20.95) |
|
Avoiding tobacco and alcohol |
36(34.28) |
13(12.38) |
|
Attitude towards breast cancer |
Pre-intervention n (%) |
Post-intervention n (%) |
|---|---|---|
|
Response |
||
|
Willing to be screened |
39(37.15) |
68(64.76) |
|
Not willing to be screened |
58(55.23) |
20(19.04) |
|
Don’t know |
8 (7.62) |
17(16.2) |
|
Screened for any type of cancer |
35(33.33) |
41(39.04) |
|
Not screened for any type of cancer |
70(66.67) |
64(60.96) |
|
Outlook towards screening |
||
|
Positive |
39(37.14) |
74(70.47) |
|
Negative |
54(51.42) |
23(21.9) |
|
Neutral attitude |
12(11.44) |
8(7.63) |
|
Place of screening |
||
|
Government hospital |
22(20.95) |
27(25.71) |
|
Village health camp |
9(8.58) |
9(8.58) |
|
Private hospital |
4(3.80) |
5(4.76) |
|
Not screened |
70(66.67) |
64(60.95) |
|
Positive attitude: 37(35.24%) Negative attitude: 63(60%) Neutral/ uncertain attitude: 5(4.76%) |
Positive attitude: 56(53.33%) Negative attitude: 43(40.71%) Neutral/ uncertain attitude: 6(5.96%) |
|
|
Attitude |
Mean |
Std. Deviation |
Mean Difference |
't' value |
|---|---|---|---|---|
|
Pre-test |
1.70 |
0.55 |
0.18 |
1.92 |
|
Post-test |
1.52 |
0.60 |
Data analysis
After the data collection procedure, data analysis was done using descriptive and inferential statistics—demographic data analysis using frequency and percentage. Mean, median, and Standard deviation of the pre-test and post-test knowledge and attitude scores ‘t’ value to the significance of the difference between the group's mean pre-test and post-test knowledge and attitude scores—Chi-square test to determine the association between selected variables.
Computing co-efficient of correlation to find the relation between knowledge scores and attitude scores (Begum & Ahmed, 2015).
Measures of central tendency and standard deviation were calculated for the aggregate scores on knowledge. We examined the relationship between knowledge of breast cancer screening and demographic data using chi-squared tests. A p-value of <0.05 was considered significant.
Results
Screening Prevalence
During my research work tenure, there were 297 women aged 13–70 years who visited Om Sai Hospital Hyderabad. Among them, 105 women participated in our study. The selection of participants was done after their consent. Table 1, Table 2, Table 3 and Table 4 represents the data regarding the Sociodemographic profile of recruited subjects.
Discussion
The study is discussed in line with the objective, hypothesis, literature review concerning similar studies conducted by the researchers and conceptual framework. This helped the investigator prove that the findings were accurate, and the awareness program effectively improved the knowledge and attitude of women regarding breast and cervical cancer (Sinha & Sharma, 2021).
The present study assessed Ladies' knowledge and attitude related to breast cancer and conducted an awareness programme on it (Gangane, Ng, & Sebastian, 2015). The results revealed that the majority of 58 {55.23%} respondents belong to the age group of 31-60 years and only 18 respondents in the age group of above 60 years. 86 {81.90%} respondent were completed secondary or more than secondary education (69.3%) (Prusty et al., 2020).
Martial status of the majority of respondents, 59 (56.19%), was married, while a large number of participants, 46 (43.80%), have Widow/ Divorced status (Singh, Shrivastava, & Dwivedi, 2015). It was alarming that 82 participants out of the 105 never went for breast cancer screening. Maximum number, 74 of respondents had monthly income Rs. <10,000/-.
65 Respondents out of 105 had no personal history of breast cancer (Divya et al., 2021). Only 65 respondents knew about breast cancer, while others did not know about breast cancer.
The study revealed that the mean knowledge score of pre and post-test in women represents a significant difference. Thus, it can be inferred that the awareness program effectively enhanced Ladies' knowledge regarding breast and cervical cancer and screening techniques (Pydipalli & Roy, 2021; Sodhani et al., 2006).
Conclusion
It concluded that breast self-examination could be used to create breast health awareness among women and female health workers. The awareness program effectively developed Ladies' positive attitudes regarding breast and cervical cancer and screening techniques.
Ethics and Consent
The study was conducted with approval from Om Sai Hospital's institutional review board (IRB Min. No- OMSAI/2019/006 dated 26.03.2019).
Declaration
All authors had full access to the data in the study. Ms Ch Shilpa has responsibility for the integrity of the data and the accuracy of the data analysis. All authors were responsible for the design, collection and management of the data.