A Study to assess the knowledge attitude and practice regarding Breast Cancer screening among Women in reproductive age (15-45 years) in selected rural areas of Chamarajanagar district with a view to develop educational programme

 

Madhu S1, Sathish D K2, Vinay Kumar G3

1Nursing Tutor, JSS School of Nursing, Chamarajanagar. 2Nursing Tutor, JSS School of Nursing, Chamarajanagar.

3Principal, JSS School of Nursing, Chamarajanagar.

*Corresponding Author E-mail: mpmadhumadhu4@gmail.com

 

ABSTRACT:

Objective: To assess the knowledge attitude and practice regarding Breast Cancer screening among Women in reproductive age (15-45 years) in selected rural areas of Chamarajanagar district and to find the association between the knowledge attitude and practice scores with the selected demographic variables. Methodology: Questionnaire on demographic Performa. Knowledge about breast cancer screening was used to collect the data. An explorative descriptive method has been adopted and 150 Women were selected for the study using simple random sampling technique.5-point likert scale and interview schedule was performed with the help of structured and semi structured questionnaire to collect data. Results: Result of the study revealed that of Out of 150 participants only 0.7% of participants having moderate knowledge and 99.3% of participants having inadequate knowledge The large proportion of participant (90.7%) have moderately favourable attitude towards screening of breast cancer and 9.3% participant of have unfavourable attitude towards screening of breast cancer and none of the participant have favourable attitude towards screening of breast cancer High majority of the participants (100%) do not practice breast self-examination and having poor practice. Conclusion: The knowledge regarding Breast cancer screening is lacking in many participants, many women have moderately favourable attitude regarding breast cancer screening and majority of women having poor practice regarding screening of breast cancer so there is need for educational programme which helps in prevention and early detection of Breast cancer. IEC activities should gear up in rural areas.

 

KEYWORDS: Breast cancer, Knowledge, Attitude, Practice reproductive age women.

 


INTRODUCTION:

BACKGROUND OF THE STUDY:

Breast cancer is a malignant cell growth in the breast if left untreated the cancer spreads to other areas of the body excluding skin. Breast cancer is the most common cancer in women in the United States accounting for one in every three cancer diagnosis. Breast cancer can be invasive or non-invasive1

 

Factors that are associated with an increased risk of breast cancer include being female, increasing age, a personal history of breast condition a personal and family history of breast cancer, inherited genes that increase cancer risk. Radiation exposure, obesity, menarche at younger age, beginning menopause at an older age, having never been pregnant, postmenopausal hormone therapy and drinking alcohol but the exact causer of breast cancer may be unknown. Research shows that lifestyle changes can decrease the risk of breast cancer1

 

Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627,000 women died from breast cancer that is approximately 15% of all cancer deaths among women. While breast cancer rates are higher among women in more developed regions, rates are increasing in nearly every region globally.6

 

In 2019, an estimated 268,600 new cases of invasive Breast cancer will be diagnosed among women and approximately 2,670 cases in men. In addition, an estimated 48,100 cases of DCIS will be Diagnosed among women. Approximately 41,760 women and 500 men are expected to die from breast cancer in 20192.

 

More than 3.8 million US women with a history of  breast cancer were alive on January 1, 2019.18 some of these women were cancer-free, while others still had evidence of cancer and may have been undergoing treatment. More than 150,000 breast cancer survivors are living with metastatic disease, three-fourths of whom were originally diagnosed with stage I- III.19Approximately 1 in 8 women (13%) will be diagnosed invasive breast cancer in their lifetime and 1 in 39 women (3%) will die from breast cancer. Lifetime risk is an average of risk for all women and accounts for deaths from other causes that may pre-empt a breast cancer diagnosis4.

 

Belgium had the highest rate of cancer followed by Denmark and the Netherland. Slightly more cases of breast cancer were diagnosed in less developed countries. The lowest mortality rate for breast cancer found in china and japan4

 

Breast Cancer is the most common cancer in women in India. 27.7% of all new cancers detected in women in India in the year 2018, were breast cancers. One woman is diagnosed with breast cancer, in India, every 4  minutes one woman dies of Breast cancer, in India,  every 8 minutes3

 

An estimated 1, 62,468 women were newly detected with breast cancer, in India, for the year 2018. 87,090 women died of breast cancer in India, for the year 2018, the second highest in the world for that year.4

 

minant young population and hence the numbers of women being diagnosed with breast cancer, in that age group is only going to increase.4

 

There is no end to such facts and figures. Breast cancer in India is reaching alarming proportions. As the most common cancer type, women in their early thirties till fifties are at considerable risk to develop breast cancer, and the incidence risk increases till its peak reach 50-64


years of age. One in twenty-eight Indian women is likely to develop breast cancer during her lifetime. It is more (1 in 22) for urban women than the rural4

 

Cancer survival becomes more difficult in higher stages of its growth, and more than 50% of Indian women suffer from stage 3 and 4 of breast cancer. Post cancer survival for women with breast cancer was reported 60% for Indian women, as compared to 80% in the U.S.5

 

With the latest study reports, India’s highest cancer rate is listed in the state of Kerala. Other states with high cancer rates in India include Mizoram, Haryana, Delhi and Karnataka. Mizoram accounted for the highest cancer death rates in the country, followed by Kerala and Haryana.5

 

Estimated 45,000 new cancer cases reported every year in Karnataka, over 8,000 are breast cancer cases.

 

The State-run Kidwai Memorial Institute of Oncology sees nearly 22,000 new cancer cases every year and of these over 850 are breast cancer cases. Doctors say this has much to do with lifestyle.9

 

In Bangalore, there are 126 cases of cancer detected amongst every 1 lakh people. According to the Population Based Cancer Registry, there are more cases of cancer detected in women than in men. For every 1 lakh men and women, there are 113.4 and 139.1 cancer cases diagnosed respectively. This put Bangalore ahead of New Delhi and Mumbai.8

 

Concerned over the growing incidence of breast cancer in the State, specialists are focussing more on creating awareness about this second-most common cancer among women.3

 

Women can self-diagnose their condition and know of the presence of lumps or masses that suggest cancerous outgrowths. The very reason for a low breast cancer survival rate of women in India accounts from its lack of awareness and poor early screening and diagnosis rates.3

 

For a country like India with a huge population, diverse cultures, geographical variations, diets and habits, sources of information on cancer risk factors are considerably limited.7

 

Women in rural areas of India have poor knowledge about breast cancer, its symptoms and risk factors. Breast self-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screening provide an opportunity to promote breast self- examination 7


Data from four major Indian cancer centres have shown that most Indian women who suffer from breast cancer first visit health care centres when they have already reached the late stages. The common reasons for delay in seeking medical advice early are illiteracy, ignorance, myths and superstitions, as well as financial constraints. Scientific studies have demonstrated that women who seek treatment in the early stages of breast cancer have a better chance of survival. In order to develop effective strategies for the early detection of breast cancer, it is imperative to have a deeper understanding of women’s awareness of disease symptoms and their attitudes towards the disease. This is important since simple preventive strategies such as breast self-examination can be implemented successfully only with women’s active involvement.6

 

Focused studies from defined geographical regions are needed since there are huge variations in the political, cultural and socio-economic conditions as well as access to Health services across the country. Several studies from India and other low-middle income countries have reported dismal awareness about the symptoms and risk factors associated with breast cancer in large numbers of women.9

 

Hence by considering the above statistical significant data, the current study aim to enhance knowledge and plan education to women in reproductive age group and to create awareness for them about Breast cancer

 

OBJECTIVES:

1.               To assess the knowledge attitude and practice regarding Breast cancer screening among women in reproductive age group (15-45 years) in selected rural area of chamarajanagar district

2.               To find an correlation between knowledge and attitude scores among women in reproductive age group (15-45 years) with their selected demographic variables

3.               To find an association between knowledge scores among women in reproductive age group (15-45 years) with their selected demographic variables

4.               To find an association between attitude scores among women in reproductive age group (15-45 years) with their selected demographic variables

 

Hypothesis:

H1: There will be a significant correlation between knowledge and attitude scores of Women on Breast cancer screening

H2: There will be a significant association between knowledge scores of Women with their selected demographic variables.

H3: There will be a significant association between attitude scores of Women with their selected demographic variables.


RESEARCH METHODOLOGY:

 

Setting of the study:

Study was conducted at rural areas of Chamarajanagar district

 

Researh variables:

Knowledge Attitude and Practice of women in reproductive age group (15-45 years) regarding breast cancer screening

 

Demographic variables:

Age, Education, Marrital status, Religion, Family income, History of previous exposure and Family history of Breast cancer

 

Population:

The target population for the present study comprised of Women in reproductive age group (15-45 years) residing in rural areas of Chamarajanagar district

 

Sample:

In this study sample consisted of Women in reproductive age group residing in rural areas of Chamarajanagar District. (15-45 years)

 

Sample size:

The total sample size is 150 Women in reproductive age group (15-45 years)

 

Sampling Technique:

In this study, simple random sampling technique was adopted.

 

Inclusion Criteria:

1.          Women in reproductive age (15-45 years) who are willing to participate in thestudy.

2.          Women in reproductive age (15-45 years) who are available at the time of data collection.

3.          Women age group between 15-45 years.

 

Exclusion Criteria:

1. Women who are sick during the time of data collection

 

Data Collection Tool:

A structured questionnaires and Likert attitude scale was selected on basis of the objectives of the study as it was considered to be most appropriate instrument to elicit responses from the subject


 

RESULTS:

Section 1- Description of selected demographic variables of study subjects

Table 1- Frequency and percentage distribution of women according to their demographic variables. n=150

Sl. No

Variables

Frequency

%

1

Age in years

 

 

 

21-25 years

20

13.3

 

26-30 years

37

24.7

 

31-35 years

42

28.0

 

36-40 years

31

20.7

 

41-45 years

20

13.3

2

Education

 

 

 

Illiterate

22

14.7

 

Primary Education

44

29.3

 

Middle School Education

45

30.0

 

High School education

23

15.3

 

PUC and Above

16

10.7

3

Religion

 

 

 

Hindu

150

100.0

4

Family Income

 

 

 

Below Rs. 5000

15

10.0

 

Rs. 5001-10000

58

38.7

 

Rs. 10001-15000

49

32.7

 

Rs. 15001-20000

28

18.7

5

Marital Status

 

 

 

Married

150

100.0

6

Previous Exposure to information

 

 

 

No

150

100.0

7

Family History of Breast cancer

 

 

 

Yes

3

2.0

 

No

147

98.0

 

The data presented in the table 1 shows that majority of Women (42) in the age group between 31 to 35 years. All of the Women were Hindu. Their families (58) had an income of rupees between 5001- 10000 with their education status is middle school (45) education and all women (150) are married. Majority women (147) not having family history of breast cancer and previously not exposed to information

 

Section II: Description of Knowledge, Attitude and Practice scores of women regarding the Breast cancer screening:

The total level of knowledge score ranged from 0-24. The level of knowledge scores further arbitrarily divided as inadequate knowledge (0-8), moderate knowledge (9-

16) and adequate knowledge (17 and above)

 

Level of Knowledge

Frequency

Percentage

a. Inadequate knowledge

149

99.3

b. Moderate knowledge

1

.7

c. Adequate knowledge

0

0.0

 

 
Table 2: Frequency and percentage distribution of women according to their level of knowledge n=150


Out of 150 participants only 0.7% of participants having moderate knowledge and 99.3% of participants having inadequate knowledge.

 

Table: 3: Frequency and percentage distribution of women according to their attitude level n=150

Level of Knowledge

Frequency

Percentage

a. Unfavorable attitude

14

9.3

b. Moderately favorable attitude

136

90.7

c. Favorable Attitude

0

0.0

 

The large proportion of respondent have moderately favourable attitude towards screening of breast cancer and 9.3% of respondent have unfavourable attitude towards screening of breast cancer and none of the respondent have favourable attitude towards screening of breast cancer

 

Table: 4 Frequency and percentage distribution of women according to their practice their level

n=150

Level of Knowledge

Frequency

Percentage

a. Poor Practice

150

100.0

b. Moderately Good Practice

0

0.0

c. Good Practice

0

0.0

 

High majority of the participants (100%) do not practice breast self-examination and having poor practice

 

Table: 5 Mean, Median and SD of knowledge, attitude and practice scores

Variable

No. of Items

Max Score

Mean

Mean

%

Med ian

SD

Know ledge

20

20

5.44

27.2

5

1.759

Attitude

24

120

70.06

58.38

71

6.515

Practice

15

22

1.41

6.40

0

2.312

 

Section III: Correlation between knowledge, and attitude score

 

Table: 6 Correlation between knowledge and attitude among women n=150

Variable

Mean

SD

r Value

Remarks

a.       Knowledge

5.44

1.759

- 0.046

Very Low negative Correlation

b. Attitude

70.06

6.515

 

Data presented in the table shows that there is no correlation between knowledge and attitude among women


Section IV: Association of knowledge scores with demographic variables

 

Table:7 Association of knowledge scores of women with demographic variables n=150

SI. NO

Variables

Below Median

Median and above

Chi square

Df

P value (0.05)

Inference

1.

Age in years

 

 

 

 

 

 

 

21-25 years

6

14

2.151

4

0.708

NS

 

26-30 years

14

23

 

31-35 years

13

29

 

36-40 years

7

24

 

41-45 years

5

15

2.

Education

 

 

 

 

 

 

 

Illiterate

6

16

2.091

4

0.719

NS

 

Primary Education

11

33

 

Middle School Education

17

28

 

High School education

7

16

 

PUC and Above

4

12

3.

Religion

 

 

 

 

 

 

 

Hindu

45

105

-

-

-

-

4.

Family Income

 

 

 

 

 

 

 

Below Rs. 5000

5

10

3.967

3

0.265

NS

 

Rs. 5001-10000

12

46

 

Rs. 10001-15000

18

31

 

Rs. 15001-20000

10

18

5.

Marital status

 

 

 

 

 

 

 

Married

45

105

-

-

-

-

6.

Previous Exposure

 

 

 

 

 

 

 

No

45

105

-

-

-

-

7.

Family History of breast cancer

 

 

 

 

 

 

 

Yes

0

3

1.312

1

0.252

NS

 

No

45

102

 


The section IV shows association between the level of knowledge scores of women in reproductive age residing in selected rural area of chamarajanagar on breast cancer screening with selected demographic variables. Variables such as age, education, religion, family income


and family history of breast cancer, previous exposure were not significant at 0.05 level

Section V: Association of attitude scores with demographic variables


 

Table:8 Association of attitude scores of women with demographic variables n=150

SI. NO

 

Variables

Below Median

Median and above

Chi square

Df

P value (0.05)

Inference

1.

Age in years

 

 

 

 

 

 

 

21-25 years

6

14

6.697

4

0.153

NS

 

26-30 years

20

17

 

31-35 years

25

17

 

36-40 years

15

16

 

41-45 years

7

13

2.

Education

 

 

 

 

 

 

 

Illiterate

7

15

6.537

4

0.162

NS

 

Primary Education

22

22

 

Middle School Education

26

19

 

High School education

13

10

 

PUC and Above

5

11

3.

Religion

 

 

 

 

 

 

 

Hindu

73

77

-

-

-

-

4.

Family Income

 

 

 

 

 

 

 

Below Rs. 5000

2

13

8.619

3

0.035

S

 

Rs. 5001-10000

29

29

 

Rs. 10001-15000

27

22

 

Rs. 15001-20000

15

13

5.

Marital status

 

 

 

 

 

 

 

Married

73

77

-

-

-

-

6.

Previous Exposure

 

 

 

 

 

 

 

No

73

77

-

-

-

-

7.

Family History of breast cancer

 

 

 

 

 

 

 

Yes

2

1

0.397

1

0.529

NS

 

No

71

76


 

The section V shows association between the level of attitude scores of women in reproductive age residing in selected rural area of chamarajanagar on breast cancer screening r with selected demographic variables. Variable such as Family income is significant at 0.05


level. Variables such as age, education, religion, family income and family history of breast cancer, previous exposure were not significant at 0.05 level


SectionVI: Association of Practice scores with demographic variables

 

Table-9 Association of Practice scores of women with their demographic variables n=150

SI. NO

Variables

Frequency

Percentage

Df

P value (0.05)

P value (0.05)

Inference

1.

Age in years

 

 

 

 

 

 

 

21-25 years

13

7

0.899

4

0.925

NS

 

26-30 years

28

9

 

31-35 years

29

13

 

36-40 years

21

10

 

41-45 years

14

6

2.

Education

 

 

 

 

 

 

 

Illiterate

15

7

0.489

4

0.975

NS

 

Primary Education

30

14

 

Middle School Education

31

14

 

High School education

17

6

 

PUC and Above

12

4

3.

Religion

 

 

 

 

 

 

 

Hindu

105

45

-

-

-

-

4.

Family Income

 

 

 

 

 

 

 

Below Rs. 5000

10

5

0.432

3

0.934

NS

 

Rs. 5001-10000

42

16

 

Rs. 10001-15000

33

16

 

Rs. 15001-20000

20

8

5.

Marital status

 

 

 

 

 

 

 

Married

105

45

-

-

-

-

6.

Previous Exposure

 

 

 

 

 

 

 

No

105

45

-

-

-

-

7.

Family History of breast cancer

 

 

 

 

 

 

 

Yes

2

1

0.016

1

0.899

NS

 

No

103

44

 


The section VI shows association between the level of practice scores of women in reproductive age residing in selected rural area of chamarajanagar on breast cancer screening with selected demographic variables. Variables such as age, education, religion, family income and family history of breast cancer, previous exposure were not significant at 0.05 level

 

CONCLUSION:

It is known fact that breast cancer is the life threatening disease of women early detection and treatment may decrease the mortality rate and complication. The present study shows that majority of people having poor knowledge regarding screening of breast cancer and moderately favourable attitude towards screening of breast cancer and poor practice of breast self- examination so the study strongly suggest for educational programme regarding screening and prevention of breast cancer. It is the point to concern that knowledge regarding breast cancer screening and prevention should reach every corner of the world.


REFERENCES:

1.          https://www.who.int/cancer/prevention/diagnosis-screening/breast- cancer/en/

2.          https://www.wcrf.org/dietandcancer/cancer-trends/breast-cancer- statistics

3.          Ms. Anooja yohannan’s a study to compare the knowledge, attitude and practices regarding breast cancer screening among health professionals and non-health professionals at selected institutions of Mysore.

4.          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496285/

5.          https://www.researchgate.net/publication/286384037_Women's_K nowledge_Attitudes_and_Practices_about_Breast_Cancer_in_a_R ural_District_of_Central_India

6.          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714949/

7.          https://cytecare.com/blog/statistics-of-breast

8.          cancer/https://www.karnataka.com/misc/cancer-patients-in- karnataka-statistics/ http://cancerindia.org.in/karnataka/

 

 

Received on 27.05.2021                Modified on 28.06.2021

Accepted on 22.07.2021              ©A&V Publications All right reserved

Int. J. of Advances in Nur. Management. 2021; 9(4):367-372.

DOI: 10.52711/2454-2652.2021.00084