Screening for Breast Cancer in a Low Middle Income Country: Predictors in a Rural Area of Kerala, India

Abstract

Background: In India, breast cancer is the leading malignancy among women in a majority of the cancer registries. Therefore it is important to understand screening practices and its predictors, including in rural areas with high female literacy and good health indices. Materials and Methods: A cross-sectional study with multistage sampling was conducted in Vypin Block, Ernakulam district, Kerala, India. Four Panchayats (self administration units) were randomly chosen and a woman in every second household was invited to participate from the tenth ward of each. Thus a total of 809 women were interviewed. Results: The majority of the repondents (82.1%) were not aware of risk factors and about a third (37.9%) were not aware of symptoms of breast cancer. About half of the population studied (46.6%) had undergone screening. Age (35-50 years), being married, health professionals as source of information and working were significant predictors of screening. Logistic regression showed that older women (35-50 yrs) were more likely to practice screening. Out of the never screened, about a third (35%) were desirous of doing it, but had not for various reasons and 53.5% were not willing to screen. The reasons identified for not screening among those desirous of doing it were grouped into knowledge 66 (43.4%), resources 23 (15.1%) and psychosocial 32(21.1%) factors. Unmarried women were significantly more likely to express factors related to all the three domains. Conclusions: This study showed that in spite of the absence of a population-based screening program, about half of the study population had undergone some type of screening. The older women (35-50 years) in particular were significantly more likely to practice screening. At this critical juncture, a high quality breast cancer awareness and screening initiative can help to consolidate the gains and tackle knowledge, resource and psychosocial barriers.

Breast Cancer Awareness at the Community Level among Women in Delhi, India

“…The findings indicated that the level of awareness of BC is sub-optimal among the women participants of Delhi. Our overall results are consistent with studies done in other parts of the India (Somdatta and Baridalyne, 2008;Gupta, 2009;Khokhar, 2009;Yadav and Jaroli, 2010;Shalini et al, 2011;Grosse et al, 2013;Parameshwari et al, 2013;Sathian et al, 2014;Sreedevi et al, 2014) and world (Okobia et al, 2006;Elsie et al, 2010;Forbes et al, 2011;Samganje and Mafuvadze, 2012;Radi, 2013;Karadag et al, 2014;Kratzke et al, 2014;Asif et al, 2014).…”

“…It's evident from different studies done on BC awareness (Gupta, 2009;Al-Naggar et al, 2011;Rasu et al, 2011;Kanaga et al, 2011;Khokher et al, 2011;Kumar et al, 2011;Grosse et al, 2013;Karadag et al, 2014;Sreedevi et al, 2014) that there has been positive association between BC awareness and educational status, including the present study. Grosse et al (2013) has emphasised that education programmes, aiming to increase BC awareness should target less educated women to increase their knowledge about BC.…”

“…Studies have shown that few women in LMICs have the right knowledge or perform regular breast self-examination (BSE) (Yadav et al, 2010;Shallawani et al, 2010;Shalini et al, 2011;Loh and Chew, 2011;Wu et al, 2012;Yoo et al, 2012;Radi, 2013;Karadag et al, 2014). The reasons for the low rate of BSE and sometimes unwillingness to undergo screening among these women include the fear of finding that they have BC, inadequate knowledge regarding how to perform BSE, and lack of awareness about what to do if a lump is found (Wu et al, 2012;Sreedevi et al, 2014). Given the high and increasing burden of disease due to late presentation of BC, early detection and subsequent prompt treatment are the only ways to ensure long-term survival, and awareness of BC and BSE seems to be an essential option for early detection of BC (Serey et al, 2011;Norsa'adah et al, 2012).…”

Five Year Survival of Women with Breast Cancer in Yazd

“…Limitation of this study were did not examine the survival rates and mortality rates according to disease stage Therefore, early diagnosis of the breast cancer by different approaches at early stages of disease and finding cancer before lymph node involvement can lead to a considerable reduction in mortality for women. Imparting a high quality breast cancer awareness and early diagnosis initiative at this juncture can help to consolidate the gains and also tackle knowledge, resource and psychosocial barriers (Sreedevi et al, 2014). Najafi et al showed that the mortality rate will be reduced by using screening mammography and useful adjuvant therapy.…”

Past, present, and future of molecular oncology in India

“…As mentioned earlier, there is dearth of mass screening programs, for example, efforts for breast cancer screening using methods such as mammography is very low with <2% coverage of the female population. [8,9] According to an assessment conducted by ICMR in association with the WHO in 2006, mass screening for human papillomavirus using Papanicolaou (PAP) smear method lacks feasibility due to high cost (www.icmr.nic.in/Publications/ plan/ICMR XII th Plan (2012-2017).pdf). Consequently, due to limited focus and allocation of public resources, less than 2% of female population can be covered with the current facilities available for PAP smear screening.…”