Awareness of Breast and
Cervical cancer among
females aged 18 yrs and
above in rural areas of central
Kerala-
A Cross Sectional Study
Contents
• Introduction
• Objectives
• Materials And Methods
• Ethical Considerations
• Results
• Recommendations
• Limitations
Introduction
• The prevalence of breast cancer and cervical cancer are high among
Indian women.
• Cervical cancer is the cancer of cells lining the cervix, which is the
lower part of uterus.
• The commonest form of breast cancer is invasive ductal carcinoma.
• Incidence of breast cancer and cervical cancer are increasing every
year.
• According to WHO success of the treatment is greatly depending on
the time of detection- Early detected cases having good prognosis.
• By this study, we aim to assess the awareness of female population
about breast and cervical cancer.
• It will help in planning health education programs for the awareness.
• It may help in decreasing the incidence and also early detection of
cases.
Objectives
• To assess the awareness regarding prevention and screening of breast
cancer and cervical cancer among females aged 18 years and above in
Avanoor panchayat, Thrissur during March 2023
Materials And Methodology
• Study Design: Community based Cross sectional study
• Study Setting: Study was conducted in the households of Avanoor panchayat
of Thrissur district of Kerala
• Study Period: 18/03/2023 to 29/03/2023
Materials And Methodology..
Study Participants: Females belonging to age group of 18 years or more in
the study area
Inclusion Criteria:
• Female residents of Avanoor
• Participants of 18 years and above
Exclusion Criteria:
Those who were not willing to participate in the study.
Materials And Methodology..
Study Sample size: Sample size (n) was
Calculated using the formula
N = 4pq/d^2
P = 31%(from the study conducted by Kunal Oswal titled assessment of knowledge
and screening of breast cancer)
Q = 100-p =69% d = 20% of p
=6.2
N = 222
In study, N =211
A total of 211 female residents aged 18years and above participated in the study.
Materials And Methodology..
Data Analysis:
• Data entry was performed using Microsoft Excel
• Analyzed using SPSS
Data Collection Tools:
• Collected using pretested structured questionnaire containing
• general information and demographic profile
• questions related to awareness towards breast and cervical cancer
Materials And Methodology..
Data Collection Methods
• After establishing a rapport with the family, an informed consent was
obtained from study participants
• Interview technique was done using a structured questionnaire
Ethical Concern
• Informed consent was obtained from study participants before data
collection
• Only cooperative and willing adults were included in this study
Results
The study was conducted among 211 households of Avanur Panchayat of
Thrissur district of Kerala using pretested structured questionnaire. The
results of the study were discussed as the following headings:
I. Sociodemographic profile of the study participants.
II. Awareness regarding prevention and screening of breast cancer.
III. Awareness regarding prevention and screening of cervical cancer
Sociodemographic profile
• 1.1 Age distribution
• Mean age of the study participants is 44.27 ± 15.89 years.
Bar graph showing age distribution
• 1.2 Occupation
Bar graph showing distribution of occupation
Majority of study participants are unemployed(53.1%) followed by
professionals (14.7%).
1.3.Religion
RELIGION
34; 16%
36; 17%
141; 67%
HINDU MUSLIM CHRISTIAN
Pie chart showing distribution of religion
Majority of the residents were hindu(66.8%)
1.4 Marital status
MARITAL STATUS
9; 4%
78.2; 31%
165; 65%
WIDOWED MARRIED UNMARRIED
Pie chart showing marital status
The major share of the study population is married (78.2%).
1.5 Parity
PARITY
PARITY
100 44.1%
90
80
70
60
50
18.5%
40 15.6% 14.7%
30
20 7.1%
10
0
0 1 2 3 >=4
Bar graph showing parity
Majority of the population has 2 children.
1.6 Family type
FAMILY TYPE
0.066,
14
0.261,
55
0.673,
142
NUCLEAR JOINT EXTENDED
Pie chart showing family type
Majority of the families are nuclear(67.3%).
• 1.7 Socioeconomic status
SOCIOECONOMIC STATUS
24%
51
76%
160
APL BPL
Pie chart showing socioeconomic status
The major share of the study population belongs to the above poverty
line ,APL (75.8%).
Awareness about breast cancer
2.1Awareness about breast cancer
no, 3.80%-----
8
yes, 96.20%--- 203
Pie chart showing awareness about breast cancer
Major share of the study population are aware of breast cancer(96.2%).
2.2 Knowledge about any warning signs of breast cancer
no, 17.10%
36
yes, 82.90%
175
Pie chart showing knowledge about warning signs of breast
cancer
Among the study population 82.9% know about atleast one of the warning signs of
breast cancer
2.3 Warning signs of breast cancer
82%
173
36%
75
19% 17%
41 35
p ge on ce
um ar cti an
t_l sc
h
tra
e a r
s di e
ea e_ _r pp
br l le _ a
pp pp el
ni ni _pe
g e
an
or
Bar graph showing warning signs of breast cancer
Major share of the study population (82%) knows about breast lump, followed
by nipple discharge and nipple retraction and only few knows about orange
peel appearance (16.6%) as the warning sign of breast cancer.
Warning signs Frequency Peecentage of those who know
Breast lump 173 82.0%
Nipple discharge 75 35.5%
Nipple retraction 41 19.4%
Orange peel appearance 35 16.6%
Table showing awareness about warning signs of breast cancer
2.4Risk factors of breast cancer
46.4%
98
53.6%
113
yes no
Pie chart showing awareness about risk factors of breast cancer
About 53.6% knows about risk factors of breast cancer and 46.4%
of population are unaware about risk factors.
2.5 Risk factors
100
80
60
40
20
FREQUENCY
0
E RY Y G RS Y
AG O IT IN A S IT
ST AR ED YE BE
HI LLIP FE 30 O
ILY N U S T
VE
A M EA BO
F BR A
OF ON
CK PTI
LA E
NC
CO
T
RS
FI
RISK FACTOR
Majority (79.1%) knows age is a risk factor.
56.9% knows family history is a risk factor.
12.3% knows that nulliparity is a risk factor .
26.1% knows that lack of breast feeding is a risk factor.
8.5% knows that delay in first conception is a risk factor.
12.3% knows that obesity is a risk factor.
Risk factor Frequency Percentage
Age 44 20.9%
Family history 91 43.1%
Nulliparity 26 12.3%
Lack of breast feeding 55 26.1%
First conception above 30 year 18 8.5%
Obesity 26 12.3%
Table showing knowledge about risk factors of breast cancer
2.6 Screening tests of breast cancer
no, 26.50%
64
yes,
69.70%
147
Pie chart showing awareness about screening tests of breast cancer.
Majority of population(69.7%) aware of screening test
2.7 Screening Tests of breast cancer
usg 6.20%
mammogram 32.20%
self_breast_examination 43.60%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00%
Bar graph showing awareness about screening tests of breast cancer
Majority (43.6%) knows about self breast examination , followed by
mammogram (32.2%) and USG (6.2%).
2.8 Age at which breast examination should be started
BREAST EXAMINATION
18%
38
49%
104
33%
69
ABOVE 40 YEARS
BELOW 40 YEARS
DON'T KNOW
Pie chart showing awareness about breast examination
Majority (49.3%) knows that breast examination should be done above
40years and 32.7% assumes that breast examination is done less than 40years
2.9Protective
factors
Pr otecti ve f actor s
35.00%
30.00% 31.80%
25.00% 27.50%
20.00% 20.90% 20.40%
15.00%
10.00%
5.00%
0.00%
ce ity ng m
nan ctiv e di ol
is
e a e h
nt al
_ _f lco
ai st a
m sic ea d_
t_ ph
y br a n
gh g_
ei kin
w o
y_ m
a lth _s
he id
a vo
Bar graph showing awareness about protective factors of breast cancer
About 31.8% people know physical activity and 27.5% know maintaining
healthy weight can prevent breast cancer to an extent
2.10
rognosis
do you feel that early detection can
improve prognosis
no, 7.10%
15
yes, 92.90%
196
Pie chart showing awareness about prognosis
92.9% of the study population believe that early detection can
improve prognosis.
Awareness about cervical
cancer
3.1.Awareness about cervical cancer
29.90%
63
Valid yes
Valid no
70.10%
148
Pie chart showing awareness about cervical cancer
70.10% of population have heard cervical cancer and 29.90% haven’t.
3.2.Warning signs of cervical cancer.
37.90%
80 Valid yes
Valid no
Valid
62.10%
131
Pie chart showing awareness of warning signs of cervical cancer
Among the study subjects,62.10% are aware of atleast one of the
warning signs of cervical cancer while 37.90% are not .
3.4.Warning signs of cervical cancer.
Series1 Series2 Series3
30.80%
65
18.50%
39
11.80%
10.40% 25
22
Vagi n al b l eed i n g P ai n d u r i n g i n t er c o u r se P el v i c an d l o w er b ac k Ab n o r m al vagi n al
p ai n d i sc h ar ge
Bar graph showing warning signs of cervical cancer
Among the study population 30.80% have identified vaginal
bleeding ,10.40% pain during intercourse,11.80% pelvic and lower back
pain and 18.50% have identified abnormal vaginal discharge as warning
signs of cervical cancer.
Warning signs Frequency percentage
Vaginal bleeding 65 30.80%
Painduring intercourse 22 10.40%
Pelvic and lower back pain 25 11.80%
Abnormalvaginal discharge 39 18.50%
Table showing awareness about warning signs of cervical cancer
3.4.Risk factors of cervical cancer
23.20%
23.20%
Valid
Valid yes
yes
Valid
Valid no
no
76.80%
76.80%
Pie chart showing risk factors of cervical cancer
Among the study subjects,76.80% are aware of atleast one among the
risk factors of cervical cancer while 23.20% are not.
Risk factors of cervical cancer
12.30%
26
10.00%
10.00%
21
21
9.00%
19
4.70%
10
Age Fam i l y h i st o r y M u l ti p l e s e x Smoki ng M u l ti p a r i t y
p ar t n er
Bar graph showing risk factors of cervical cancer
Among the study population 10.00% identified age ,12.30% identified
family history,9.00% identified multiple sex partners,10.00% identified
smoking and 4.70% identified multiparity as risk factor of cervical cancer.
Risk factors Frequency Percentage
Age 21 10.00%
Family history 26 12.30%
Multiple sex partners 19 9.00%
Smoking 21 10.00%
Multiparity 10 4.70%
Table showing risk factors of cervical cancer
3.5 Screening tests of cervical cancer
18.5%
39
81.5%
172
yes no
Pie chart showing the awareness of screening tests for cervical cancer
Among the study subjects 81.5% have awareness of screening test for
cervical cancer and 18.5% haven’t .
3.6.Pap smear test
12%
26
88%
185
yes no
Pie chart showing the percentage of subjects aware of pap smear test
Among the study subjects 12% know about pap smear test and 88%
doesn’t.
3.7.HPV Vaccination
15%
32
85%
179
Yes No
Pie chart showing the awareness about HPV Vaccination
Among the study subjects 15% are aware about HPV vaccination while
remaining 85% are unware.
3.8.Early diagnosis and prognosis
22%
46
78%
165
Yes No
Pie chart showing that awareness of early detection can improve prognosis
Among the study subjects 78% are aware that early detection can improve
prognosis while the remaining 22% are unaware.
DISCUSSION
Breast cancer
• Our study revealed that majority (96.2%) of participants had a basic
awareness regarding breast cancer. This finding is higher when
compared to study conducted by A.Sreedevi 2 et al in rural areas of
Kerala which was 79.9%. Among the symptoms of breast cancer
lump was stated by 82%, discharge by 35.5%, nipple retraction by
19.4%, orange peel appearance by 16.6%. About 13% of women
said that they didn’t know any symptoms of breast cancer while
Kunal Oswal 3 et al observed that the understanding of symptoms
of breast cancer is about 54% among study participants.
• The causes or risk factors of breast cancer were reported by 26.1% as an
absence of breast feeding, 12.3% related to obesity, 43.1% as heredity, 12.3%
as infertility and about 46.4% of women were not aware of risk factors of
breast cancer while A.Sreedevi 2 et al observed that causes or risk factors of
breast cancer were reported by 9.8% as an absence of breast feeding, 4.6%
related to obesity, 2.6% related to heredity and 0.2% as infertility. About two-
third (69.7%) of the respondents knew that there is a test to detect breast
cancer early and the screening test were reported as BSE by 43.6%,
Mammography by 32.2%, and USG by 6.2%, while Subhashis Saha5 et al
observed that 57.9% of respondent’s were aware of availability of screening
for breast cancer.
Cervical cancer
• Our study revealed that 70.1% of participants were aware of cervical
cancer. This finding is similar to the study conducted by S.Aswathy 1 et
al among rural population of Kerala which is about 72.1%. Only
37.9% of respondents were aware of symptoms of breast cancer,
while S.Aswathy et al observed that 48.8% were aware of symptoms.
Among the symptoms of cervical cancer, bleeding was stated by
30.8%, pain during intercourse by 10.4%, abnormal vaginal discharge
by 18.5%, while S.Aswathy et al observed that bleeding was stated
by 35.7% and pain during intercourse was stated by 86%
• Majority of the respondents (76.8%) did not know any risk factors of
cervical cancer. The risk factors were reported by 12.3% as family
history and 9% as multiple sex partners. This finding is lower when
compared to a study conducted by S.Aswathy et al regarding the lack
of awareness of risk factors of cervical cancer which is 89.2%.
• Knowledge, attitude and practice regarding cervical cancer screening
among participants are 18.5%. This result is almost comparable to the
study conducted by Neha Taneja 7 et al, which is about 20%.
• 15.2% of study subjects were aware of vaccination against cervical
cancer.
Limitations
• We were able to collect data from only 211 female participants.
• Unavailability of working population as data collection was done at
daytime which resulted in a greater number of elderly participants.
• Research time period was restricted to 10 days .
• Data on practice may not be reliable
RECOMMENDATIONS
• Health education programmes for increasing awareness among women.
• Campaigns can be conducted along with the cooperation of community for
screening of breast and cervical cancer including mammograms and
papsmear test
• HPV vaccination drives can also be conducted in cooperation with the local
government.
CONCLUSION
• Majority of women have heard about breast cancer than cervical
cancer
• But only half of them had knowledge regarding the warning signs,risk
factors and screening tests.
• Hence there is urgent need to create awareness on warning signs and
screening tests of breast and cervical cancer through intensified
health education programs.
References
• 1.Aswathy S, Sumithra S, Valsala LS, Sandheep S, Lohidas V, Shobha P, George S,
Francis P, Rajeev NS, Johnson AJ. Self reported morbidity and awareness regarding
common cancers in elderly women. J Commun Dis. 2006 Mar;38(1):106-11. PMID:
17370697.
• 2.Sreedevi A, Quereshi MA, Kurian B, Kamalamma L. Screening for breast cancer in
a low middle income country: predictors in a rural area of Kerala, India. Asian Pac J
Cancer Prev. 2014;15(5):1919-24. doi: 10.7314/apjcp.2014.15.5.1919. PMID:
24716912.
• 3. Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M, Venkataramanan R,
Sethuraman L, Caduff C, Purushotham A. Assessment of Knowledge and Screening
in Oral, Breast, and Cervical Cancer in the Population of the Northeast Region of
India. JCO Glob Oncol. 2020 Apr;6:601-609. doi: 10.1200/JGO.19.00257. PMID:
32302235; PMCID: PMC7193798.
4. Baburajan C, Pushparani MS, Lawenya M, Lukose L, Johnson AR. Are rural women
aware of breast cancer and do they practice breast self-examination? A cross-
sectional study in a rural hospital in South India. Indian J Cancer. 2022 Jul-
Sep;59(3):354-359. doi: 10.4103/ijc.IJC_799_19. PMID: 33753612.
• 5. Saha S, Priya SM, Surender A, Jacob RC, George MP, Varghese NM, Kumar N,
Eappen N, Kumar PR, Raymond R, Phillips AC, Mathew RT, Vijayan MM, Sukhadhan
C, Thomas BM, Marconi SD, Sindhu KN, Oommen AM, John SM. Screening practices
for breast and cervical cancer and associated factors, among rural women in Vellore,
Tamil Nadu. Indian J Cancer. 2021 Sep 19. doi: 10.4103/ijc.IJC_83_20. Epub ahead of
print. PMID: 35017369.
• 6. Krishnamoorthy Y, Ganesh K, Sakthivel M. Prevalence and determinants of breast
and cervical cancer screening among women aged between 30 and 49 years in
India: Secondary data analysis of National Family Health Survey - 4. Indian J Cancer.
• 7. Taneja N, Chawla B, Awasthi AA, Shrivastav KD, Jaggi VK, Janardhanan R.
Knowledge, Attitude, and Practice on Cervical Cancer and Screening Among
Women in India: A Review. Cancer Control. 2021 Jan-
Dec;28:10732748211010799. doi: 10.1177/10732748211010799. PMID:
33926235; PMCID: PMC8204637.
