Background: For the past few decades, the world is encountering significant reduction in incidence of different kinds of communicable diseases whereas the prevalence of various non-communicable diseases (NCDs) is reaching its peak and India is not an exemption for this trend. Epidemiological studies have shown that the global burden of Breast cancer is expected to cross almost 2million by the year2030. Breast Self-Examination (BSE) is simple, non-invasive and quick, the practice of BSE is very low among women due to various reasons like not knowing the correct technique how to perform it, lack of time, lack of confidence and fear of being diagnosed with breast cancer. Therefore, the present study is aimed at improving the knowledge and practices o n BSE and impact of health education on breast self-examination among women. Research question: What is the impact of health education on breast self-examination among women residing in urban field practice area of KMC, Kurnool? The setting of the study was at a community urban field practice area, Kurnool Medical College, Kurnool, Andhra Pradesh. A six months observational study was conducted during the period from September 2023 to February 2024 on about 227 women aged 30- 60 years who are residing at UHTC Sriram Nagar, Kurnool by studying their socio-demographic profiles including literacy & occupation and Evaluating their Knowledge and Practice related to BSE by analyzing the data collected through pre & posttest questionnaire comparatively etc; Results: Pre-test knowledge mean scores were 0.55±0.55, practice mean scores were 0.17±0.84. After the educational intervention, a significant improvement was observed in women’s knowledge and practice. The impact of health education was reflected on post-test mean scores of knowledges and practice being 7.53±1.76, 5.32±1.85 respectively. Conclusion: This study showed the importance of regular awareness activities at community level to enhance the BSE practices among women for early detection of breast cancer.
Over the past few decades, there has been a notable global decline in the incidence of major communicable diseases, but the prevalence of numerous non-communicable diseases (NCDs) has peaked, with India being no exception. Cancer is one of the non-communicable diseases that are becoming more prevalent and burdening society. These diseases are becoming more important as public health issues in both developed and developing nations1. According to the Globocan 2022 study, breast cancer is the second most common cancer in the world and the fourth in terms of mortality. Globally, breast cancer (BC) is associated with an incidence of 22,96,840 cases and a mortality of 6,66,103 deaths per year2. In India, breast cancer ranks first both in terms of incidence and mortality, with an incidence of 1,92,020 cases and a mortality of 98, 337 deaths per year2.
As breast cancer treatment is getting expensive, primary prevention is the key to breast cancer management. Breast cancer has a one hundred percent success rate if detected early and a high survival percentage till the middle stages. Approximately half of all breast cancer patients in India are in stages 3 and 4, when the chances of survival are exceedingly low and treatment costs are considerable3. According to the ICMR, fewer than 5% of women undergo breast screening in India. The reasons are lack of awareness about the importance of early detection and the absence of an organised nationwide breast cancer screening programme4. The reasons for late detection of breast cancer includes low awareness, presence of stigma, fear about pain during screening and fear about the disease, gender inequity, lack of screening test and infrastructure, low literacy, and low-income levels5,6.Breast cancer occurs in an observable organ, thus awareness regarding its symptoms can help in its early detection and treatment. Breast self-examination (BSE), clinical breast examination (CBE), and mammography are three techniques that can aid in early detection of breast cancer; the latter two require time to visit a doctor for examination, while BSE can be performed at home at your convenience7.
BSE is a simple, inexpensive, quick, noninvasive, nonhazardous intervention. In nations with limited resources, where access to more effective screening techniques is limited, this could be a helpful approach for early detection of breast cancer. The test's sensitivity was shown to be 78%8. Therefore, the present study is aimed at improving the knowledge, practice on BSE and impact of health education on breast self-examination among women.
The setting of the study was at a community urban field practice area, Kurnool Medical College, Kurnool, AndhraPradesh. A six months observational study was conducted during the period from September ,2023 to February, 2024 on about 227 women aged 30 - 60 years who are residing at UHTC SriramNagar, Kurnool by studying their socio-demographic profiles including literacy & occupation and Evaluating their Knowledge and practice related to BSE by analysing the data collected through pre & post test questionnaire comparitively etc; The sample size was determined using a single population proportion formula. Awareness on Breast Self-examination from the Ranjan Kumar Prusty, Shahina Begum et al study, Mumbai, India (49%)9, with the assumption of 7% of absolute error,95%CI and 10% non- response, the sample size was collected as follows
By using systematic random sampling technique, women above 30 years of age who are the residents of SriramNagar were selected until final sample size is reached. All the women who are residing in that community during the above period up to reach the required sample size was included in the study as study subjects after duly following the inclusion and exclusion criteria as indicated below. Inclusion criteria: Women aged 30-60years of age who were willing to participate were included in the study.Exclusion criteria: Women who were already diagnosed with breast cancer and under treatment, pregnant woman and lactating women were excluded from the study. Objectives:1.To study the sociodemographic profiles & risk factors 2.To study the impact of health education on Breast Self –Examination among the study subjects in terms of Knowledge and Practice. After receiving the Ethical committee clearance from the institution with IEC No: 390/2023 the study was began and the required data was collected by using a predesigned, pretested and a self administered closed ended questionnaire proforma pertaining to their socio-demographic profiles including literacy & ocupation and their Knowledge and Practice related to BSE before & after intervention of health education. Informed consent was obtained from all individual participants included in the study.
Initially all the participants were assessed about knowledge and practices related to breast self-examination through questionnaires with the help of ASHAS and ANMS at their homes itself prior to give the educational intervention (pretest). After that women were informed about the awareness sessions that were planned to be conducted a day before itself. Then sessions were conducted to all selected women on breast cancer, importance of Breast Self-Examination and then demonstrated the technique of breast self- examination by using slide show, video clips with the help of laptop and provided handouts to everyone. All the sessions were conducted in separate room of UHTC SriramNagar, each day for about 20-25 women. This was continued for a period of 10 days until the sample size was reached. After 4 weeks, during the second visit all the selected women who were initially educated about BSE were reassessed regarding their knowledge and practice levels on breast self-examination by using the same validated questionnaire and recorded their responses to study the impact of educational intervention among the selected women of age 30-60 years.
Finally the collected data was entered into Microsoft Excel and analyzed by using appropriate statistical tools like percentages, proportions, measures of central tendency, measures of dispersion, standard error of mean and tests of significance by using SPSS version 21computer software etc. The study results were compared and discussed in the light of published material of various similar studies belongs to different authors and there by conclusions and recommendations was framed.
OBSERVATIONS & RESULTS
GRAPH 1: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO AGE
Mean ± 2 SD = 43.73± 14.4, 29.33 - 58.13
GRAPH2: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO EDUCATIONAL STATUS
GRAPH3: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO OCCUPATION
TABLE 1: COMPARISION OF PRE AND POST TEST KNOWLEDGE QUESTIONS
Knowledge variable |
correct response-number (percentage) |
Mean |
SD |
t value |
p value |
||
Breast Self Examination should be done by whom |
|||||||
post-test |
227(100) |
1 |
0 |
36.45 |
<0.0001 |
||
pre-test |
33(14.53%) |
0.145 |
0.35 |
||||
Is family history of breast cancer being a risk factor for developing breast cancer among women |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
32.50 |
<0.0001 |
||
pre-test |
26(11.45%) |
0.114 |
0.319 |
||||
Breast Self-Examination is useful in early diagnosis of breast cancer |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
35.21 |
<0.0001 |
||
pre-test |
21(9.25%) |
0.092 |
0.29 |
||||
Which age group are more prone to breast cancer |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
35.817 |
<0.0001 |
||
pre-test |
20(8.81%) |
0.09 |
0.28 |
||||
Need to observe any unusual changes in the shape and size of the breast |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
47.084 |
<0.0001 |
||
pre-test |
7(3.08%) |
0.031 |
0.173 |
||||
Retraction of the nipple is a warning sign that should be observed |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
47.084 |
<0.0001 |
||
pre-test |
7(3.08%) |
0.031 |
0.173 |
||||
Oral contraceptive pills may increase the risk of breast cancer |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
47.084 |
<0.0001 |
||
pre-test |
7(3.08%) |
0.031 |
0.173 |
||||
Early menarche and late menopause increase the risk of breast cancer |
|||||||
post-test |
213(93.83%) |
0.94 |
0.24 |
50.9902 |
<0.0001 |
||
pre-test |
5(2.20%) |
0.02 |
0.132 |
||||
TABLE 2: COMPARISION OF PRE AND POST TEST PRACTICE QUESTIONS
Practice Variable |
Correct response Number (percentages) |
Mean |
SD |
t - value |
P-value |
Do you practice Breast Self Examination |
|||||
post-test |
203(89.42%) |
1 |
0 |
70.1694 |
P<0.0001 |
pre-test |
8(3.52%) |
0.04 |
0.20 |
||
What is the time for Breast Self Examination |
|||||
post-test |
204(89.86%) |
0.90 |
0.30 |
35.8667 |
P<0.0001 |
pre-test |
7(3.08%) |
0.03 |
0.17 |
||
I undress until the waist when doing BSE |
|||||
post-test |
202(88.98%) |
0.89 |
0.31 |
35.8299 |
P<0.0001 |
pre-test |
7(3.08%) |
0.03 |
0.17 |
||
Finger pulps are used to examine any lumps or thickening of the skin |
|||||
post-test |
203(89.42%) |
0.89 |
0.31 |
38.5236 |
P<0.0001 |
pre-test |
6(2.64%) |
0.03 |
0.16 |
||
I press on the nipple to check for any discharge |
|||||
post-test |
200(88.10%) |
0.88 |
0.32 |
36.4500 |
P<0.0001 |
pre-test |
6(2.64%) |
0.03 |
0.16 |
||
I frequently search for the information regarding BSE from internet, magazines, newspaper |
|||||
post-test |
201(88.54%) |
0.89 |
0.32 |
37.8008 |
P<0.0001 |
pre-test |
5(2.20%) |
0.02 |
0.15 |
TABLE 3: OVERALL, KNOWLEDGE AND PRACTICE SCORES
Variable |
Mean |
SD |
t value |
p value |
Knowledge |
||||
post-test |
7.53 |
1.76 |
47.2580 |
<0.0001 |
pre-test |
0.55 |
1.54 |
||
Practice |
||||
post-test |
5.32 |
1.85 |
38.3397 |
<0.0001 |
pre-test |
0.17 |
0.84 |
Present study was conducted among 227 women in the urban field practice area of Kurnool medical college, Kurnool to assess knowledge and practices on Breast Self-Examination and impact of health educational intervention. Initially before the intervention the knowledge and practices regarding breast cancer and breast self-examination were assessed.
The current study found that just 14.53% of women were aware of the term BSE, but only 3.52% practicing it. All other Indian community-based, college-based, and health centre-based studies among the general population had comparable findings10,11,12,13,14,15,16,17. On the contrary, studies showed higher knowledge and practices of BSE among nursing students and healthcare workers18,19,20. So, the current study advocated the relevance of BSE knowledge and procedures to all women of reproductive age at the school, college, and community levels, with the active participation of primary health care field workers.
According to the current study, only 8.81% of women knew that getting older was a risk factor of breast cancer, 3.08% knew that using oral contraceptives would raise the risk of breast cancer, and 2.2% knew that menopause late in life and early menarche also increased the risk of breast cancer. In the current study, 11.45% knew that family history was a risk factor.
In an urban resettlement colony in New Delhi, a study by Somdattta and Baridalyne found that 4.9% of women knew that growing older and 8% knew that using OCP increased the chance of breast cancer11. According to the Khokar study, 7.7% of women were aware that early menstruation is a risk factor21. Except for family history, nearly all previous Indian research findings on general women revealed comparable results in terms of risk factor awareness. However, the current study revealed that women were unaware about the family history could be a risk factor22,23,24,25. In the current study, fewer participants (11.45%) knew that a family history of breast cancer in first-degree relatives is a major risk factor prior to the intervention, but their knowledge improved by 93.83% after the intervention. Similarly, in a study by D.V. Bala et al. 27.6% of participants knew that a family history of breast cancer is a major risk factor prior to the intervention and their knowledge improved by 62% after the intervention14. According to comparable research by Apeksha P. Paunikar et al. 45 out of 150 participants knew that having a positive family history is a significant risk factor for breast cancer24. In present study only 3.08% of the participants had knowledge about oral contraceptive pills as a risk factor before the intervention whereas in a study conducted by D.V.Bala et al had pretest percentage of 27.6%14.In present study there was increase in the levels of knowledge about risk factors after the intervention by 90.75% , but in the study by D.V.Bala et al had an increased by 58.8%14. A study conducted by Apeksha P. Paunikar et al. showed that 38.57% women had knowledge that oral contraceptives are major risk factors for breast cancer24.
Current study showed only 3.08% participants had knowledge regarding symptoms of breast cancer like changes in the shape and size of the breast and nipple changes. On contrary, a study conducted in Aurangabad by Paunikar et al among women residing in field practice area showed that 78.57% of women had aware of symptoms and signs of breast cancer24. Singh etal study showed 40.20% of women had aware of breast changes as sign and symptom of breast cancer26. This showed that present study participants were very poor knowledge of symptoms and signs of breast cancer.In the present study 3.52% participants practiced BSE before the intervention but in a study done by Apeksha P. Paunikar et al. showed that 14% of the participants practiced self-breast examination24. A study by Shalini, Divya Varghese, et al showed that 8.5% of participants practiced BSE15.
In the present study, showed that the mean knowledge of pretest is 0.55±1.54 and practice is 0.17±0.84, which showed that awareness about knowledge and practices of breast self-examination was very poor. In this study after the health education intervention there was significant increase in the knowledge and practices of breast self-examination, with mean post-test values of knowledge 7.53±1.76 and practice being 5.32±1.85. Average of all the scores had enhanced after the intervention. The results of the study showed that, there is a need of demonstration for increasing the awareness and improve the correct techniques practicing regarding breast self-examination.
In the present study, after educational intervention, for all knowledge variables post test scores were increased above 90% and for all practice variables post test scores were increased up to 90%.
In a study done by Shankar etal at Jaipur and Mumbai College teachers found that knowledge scores were increased from 69.8% to 100%23. But in our study pre test knowledge scores were low because our study was conducted at field practice area of Kurnool. In a study conducted by Bala and Gameti etal at urban health centre, Ahmedabad found that knowledge scores were increased from 26.8% to 90.8%14. Similar findings were noted in current study. An Educational intervention study done by Gupta etal at Jabalpur among women self help group found that knowledge scores were increased from 16% to 59%12. On contrary, the present study post test knowledge scores were above 90%. In a study conducted by Madhukumar etal among Bengaluru college students found that knowledge scores were increased from 18% to 93% and practice scores were increased from 10% to 90%27. Similar findings were noted in the present study.
The present study highlights the low levels of awareness of BC risk factors and also reveals the low levels of awareness on BSE in the community. We therefore stress once more how urgently awareness campaigns are needed at all levels of healthcare in order to increase understanding of BC. In a nation with low resources, such as India, BSE can be a helpful supplement to identify any changes in the size and shape of the breasts. In order to enable them to teach women in the community how to diligently do BSE, health care providers desperately need to be adequately trained.
This will enable early diagnosis of BC, particularly in settings with limited resources.
The bottomline: Be breast aware, checking from an early age, and going to the doctor if you see any change at all. It’s likely to be nothing, but if there’s something there, you’ll have caught it in time. Regular Health Education about risk factors and preventive measures like breast-feeding practices, reduction in prolonged usage of OCPs, reducing obesity development etc.
Source of Funding: This research project is selected and approved by the Dr. NTRUHS, Vijayawada, AP under the Under Graduate Student Research Schloarship programme 2023(UGSRS 2023). (Selected Candidate Application number: 23M385, University Roll Number: 20M102003018) .
Conflict of Interest: Nil