An assessment of the awareness level among general public
About breast cancer
Nihar Ranjan Pal1 *, Santanu Kumar Tripathi2,
Subrata Chakraborty1, Jahar Majumdar3
Dr. B.C.Roy College of Pharmacy & AHS, Bidhannagar, Durgapur
-713206
Dept. of Clinical & Experimental Pharmacology, School of Tropical
Medicine, Kolkata-700073
Chittaranjan National Cancer Institute, Kolkata – 700026
*Corresponding Author : pal.nihar1954@gmail.com
ABSTRACT
The aim of the present work is to assess the awareness level of the
general public about breast cancer, which is the leading cause of
cancer deaths among women in India & many parts of the world. The
study was performed amongst women who were admitted at a reputed cancer
institute at Kolkata and have been residing in different parts of West
Bengal. While examining the level of awareness among women, it has been
found that only 4% of them were aware about BSE, 79% were unaware of
safe diet, 22% were unaware of the demerits of addiction, 83%
population were not aware about harmful effects of using contraceptives
& Hormone Replacement Therapy [HRT] which might be responsible for
breast cancer.
Key words:
Breast Self Examination [BSE]. Hormone Replacement Therapy [HRT],
Addiction, malignant tumor, Clinical Breast Examination [CBE],
Mammography, Estrogen, Melatonin.
1.
INTRODUCTION:
Breast cancer is a malignant tumor that starts in the cells of the
breast. A malignant tumor is a group of cancer cells that can grow into
[invade] surrounding tissues or spread [metastasize] to distant areas
of the body. The disease occurs almost entirely in women, but men can
get it, too.
The aim of the present work is to assess the awareness level of the
general public about breast cancer. It is the leading cause of cancer
in women worldwide with 1.05 million new cases every year. It
represents over 20 % of all malignancies among females [1].
Over 50 % of breast cancer incidence occurs in the developed world.
High – risk areas include Europe and North America. The lowest rates
are reported from Africa and Asia. Incidence of breast cancer is
increasing in most of the countries, including the areas, which have
had previously low rates [2-4]. It is estimated that in 2001 there were
approximately 80,000 new breast cancer cases in India [5].
The population based cancer registry data from the various parts of the
country, has revealed that the breast cancer is the commonest cancer
among women in Delhi, Mumbai, Ahmadabad, Kolkata and Trivandrum. In the
rest of the other Indian registries, breast cancer is listed as the
second leading site among women [6-7].
An increasing trend in the incidence rates of the breast cancer has
been reported from the various registries of National Cancer Registry
project [7]. In Chennai, with the crude incidence rate [CIR] being
30.1/100,000 in the Madras Metropolitan Tumor Registry [MMTR], a
significant increasing trend in the incidence of breast cancer was seen
during 1982-2005 with an average annual increase of 0.72 cases per
100,000 [8].
The trend of rising incidence is likely to continue due to further
changes in life style factors such as age of first childbirth and
dietary habits [9].
Moreover, increases over the past several decades in breast cancer
incidence have been observed in Bangalore, Chennai, Mumbai, Nagpur and
Pune registries. These changes may reflect the effects of rapid
transition towards industrialization and urbanization as well as
adoption of semi – Western diets and lifestyle, including childbearing
patterns, among higher socioeconomic urban subgroups [10-12].
Increasing awareness about breast cancer would go a long way in the
cure of this disease, since breast cancer is a progressive disease
having a predilection of early dissemination and consequently detection
of small tumors are more likely to be early stage disease, which would
have a better prognosis and higher probability of getting effectively
treated. BSE is an important tool for early detection of breast cancer.
Unsafe diet, addiction to nicotine and alcohol, irregular work schedule
like night shift duty regular flight attendance, availing
contraceptives or HRT etc are risk factors for causing breast cancer.
Women, in general, and especially those over the age of 35 years are
required to be more educated about the many available screening
modalities for breast cancer and also need to be encouraged to adopt
these measures as efficiently as they can.
Screening for breast cancer includes BSE, mammography, clinical breast
examination (CBE) by a physician. Although mammography has been
established as an effective technique for early detection of breast
pathologies, mammographic screening of an outsized population cannot be
supported as a priority in India owing to its high cost.
A. BREAST SELF EXAMINATION [BSE]
BSE on the other hand is simple, self generated, repeatable at monthly
intervals and cost free. BSE involves regular monthly systematic
examination of the breasts and axillary area, both visually and by
palpation, for any signs of abnormality. It has been observed that how
a woman learns about BSE can determine the frequency with which she
performs it, and therefore it is important for every woman to adopt the
correct method of performing BSE as demonstrated by a nurse or
physician.
B. AWARENESS OF SAFE DIET:
Food has been the centre of focus around every disease and that is true
with breast cancer too. Patients should consume a balanced healthy diet
that includes at least five portions of fresh fruits and vegetables
every day. This will have all nutrients and fibre required daily.
Some research has been done to look at the effect of both diet and
exercise on survival after
breast cancer. Pierce, Director of the Cancer Prevention and control
program at the Moores UCSD
Cancer center, in La Jolla, California, and his team looked at the
combined effects of diet
and exercise on breast cancer survivors [13].
C. AWARENESS OF ADDICTION:
Nicotine and alcohol are mostly used for addiction. Nicotine may spur
the spread of breast cancer, pushing cells from the original tumor to
other parts of the body [14]. Alcohol may change the way the body
metabolizes estrogen. Many breast cancers are fuelled by the hormone
estrogen. Therefore, regular use of alcohol is thought to increase the
risk of breast cancer by increasing blood estrogen levels. Drinking as
little as half a glass of wine a day may raise a women’s risk of
developing breast cancer [15].
D. AWARENESS OF IRREGULAR WORK SCHEDULE:
Night shift worker and flight attendants are prone to breast cancer
risk. Exposure to light at night and power frequency [50-60 Hz]
magnetic fields may increase the risk of breast cancer by suppressing
the normal nocturnal production of melatonin by the pineal gland,
which, could increase the release of estrogen by the ovaries [16]. The
increased risk of breast cancer and malignant melanoma among cabin
attendants seem to be occupationally related. Cosmic radiation,
disturbance of the circadian rhythm, and electromagnetic fields or
combination of these factors may be the etiologic factors [17].
E. AWARENESS OF AVAILING CONTRACEPTIVE/HRT:
Combined hormone replacement therapy in Women’s Health Initiative trial
has shown the risk of breast cancer to increase [18-19].
2.
MATERIALS & METHODS
2.1 MATERIALS:
The report of indoor patients containing name, date of admission, name
of guardian, age, sex, religion, address, phone number, duration of
stay, marital status, education, occupation, mother tongue, no of
dependants, income per month were collected.
The report also contains diagnosis including histology, stage &
Tumor Board Decision in details with sequence. Surgery [s],
chemotherapy [CT], Palliative [PAL], Radiotherapy [RT]
& Immunotherapy [I] columns are there in the report. It also
contains Admission, discharge dates along with clinical history
containing symptoms & duration. In the next part of the report past
history / previous treatment are found. Relevant family history along
with relationship and disease are recorded.
In personal habits column-none, cigarette, bidi, snuff, chewing
tobacco, betel nut, gutka, khaini, hormonal contraception & others
boxes are there.
Menstrual and obstetric history is available in the report. In relevant
medical history area of the report diabetes, hypertension, heart
disease, jaundice, & others columns are given.
General examination portion of the report includes case histories of
patients having edema, pallor, clubbing, obesity, cyanosis, surface
area, height, weight, pulse, B.P. etc. cervical, axillary, inguinal and
other columns maintain information about lymph nodes. Systemic
examination includes cardiovascular, respiratory, abdomen&
neurological reports. Report of local examination is also kept in it.
Investigation part of the report includes biopsy or cytology , slides,
block- submitted or be submitted, routine blood examination, X-ray
chest, E.C.G., blood biochemistry, urine R/E, Urine C/S, Stool R/E
&OPC, complete hemogram , barium swallow, barium meal follow
through, USG- pelvis/whole abdomen/neck USG-FNAC, CT scan, bone marrow,
bone scan/ typhoid scan, MRI.
In addition to the above report contains tumor markers, endoscopy,
final diagnosis, operative note, radiotherapy note, concommitant
chemotherapy note mentioning CT Regime-1, drug used , cycle date.
Palliative treatment note, anaesthasia / ITU note, death note,
comments/referral note/ follow up remarks are given in the report.
Records of the Institute [CNCI] , personal interview with the
caregivers & patients, reports from NGO like Hitoishini, &
Kalpana Dutta Foundation Cancer care, different books, research papers
and journals are the source of data.
2.2 METHODOLOGY OF PATIENT ANALYSIS:
2.2.1 Awareness of Breast Self Examination: In this method, 50 women
breast cancer patients were enquired about their past experience about
BSE before diagnosis as breast cancer patient. They were asked whether
they would practice BSE beginning from age 20 yrs or not. They also
were asked whether they would know that early detection of the disease
with this tool could help to increase the life span.
2.2.2 Awareness of safe diet: To assess awareness of safe food habit 47
women patients from CNCI were asked about their past food habit before
diagnosed as breast cancer patient. They were asked whether they would
know about the role of diet high in fats, red meat, highly processed
food associated with breast cancer. They also were asked whether they
knew that fruits, vegetables, nuts, grains fish. Chicken meat moderate
quantity, sweet potatoes ,pumpkin, mango , spinach, tomatoes,
watermelon guava, papaya carrots, milk, vitamin c containing fruits can
prevent or slow the oxidative damage to the body and thereby prevent
breast cancer.
2.2.3. Awareness of addiction: To assess awareness of addiction, 45
women breast cancer patients were enquired about their consciousness
about consumption of alcohol or nicotine. They also were asked about
awareness of passive smoking.
2.2.4 Awareness of irregular work schedule: To assess awareness of
irregular work schedule like nightshift duty, regular flight
attendants, exposed to radiation, 47 women breast cancer patients were
asked about their consciousness about these.
2.2.5. Awareness of contraindication for availing contraceptives or
HRT: To assess awareness of availing contraceptives or HRT, 48 women
breast cancer patients were enquired for their consciousness about
contraindications of contraceptives/HRT.
3. RESULTS & DISCUSSIONS
3.1 AWARENESS OF BREAST SELF EXAMINATION
Awareness of 50 subjects about Breast Self Examination was studied and
the following results were obtained. The results are depicted in
Table1-2 and Fig 1-2. Table 1 shows out of 50 women breast cancer
patients 48 were unaware of usefulness of BSE which could have helped
them for earlier diagnosis and better prognosis.
Table 1
: Awareness regarding various parameters assessed amongst the patients
|
Sl No:
|
Awareness related to
|
Total number of patient studied
|
Aware Population
|
Unaware population
|
|
1.
|
Breast Self Examination
|
50
|
2
|
48
|
|
2.
|
Safe Diet
|
47
|
10
|
37
|
|
3.
|
Alcohol & Nicotine addiction
|
45
|
35
|
10
|
|
4.
|
Irregular work schedule
|
47
|
1
|
46
|
|
5.
|
Contraindication in having contraceptives/HRT
|
48
|
8
|
40
|
Table: 2
Age wise distribution regarding the various parameters amongst the
patients participating in the study.
|
Sl No:
|
Parameter Assessed
|
Total number of patient studied
|
Distribution of Age (years)
|
|
|
|
16-25
|
26-35
|
36-45
|
46-55
|
56-65
|
66-75
|
≥ 75
|
|
1.
|
Breast Self Examination
|
48
|
1
|
13
|
15
|
6
|
8
|
5
|
0
|
|
2.
|
Safe Diet
|
37
|
1
|
6
|
17
|
11
|
1
|
1
|
0
|
|
3.
|
Alcohol & Nicotine addiction
|
35
|
1
|
7
|
12
|
13
|
2
|
0
|
0
|
|
4.
|
Irregular work schedule
|
46
|
1
|
8
|
15
|
13
|
6
|
3
|
0
|
|
5
|
Contraindication in having contraceptives/HRT
|
40
|
0
|
7
|
15
|
12
|
6
|
0
|
0
|
Fig.1 shows 96 % population was unaware of the proper technique and
utilities of BSE and thereby loosing the opportunities of early detection
and increasing life span.
As depicted in Table 2 the age wise distribution of unaware subjects where
36-45 age groups of subjects are major in number [15] that means affected
mostly.
Table 2 & Fig 2 also show 26-35 age group being 13 nos. out of 48
subjects which is closer to the above. 16- 25 years of age group is least
sufferer.
Figure- 1:
Percentage of awareness amongst studied population regarding breast self
examination
Figure 2
. Bar-chart of age wise distribution subjects unaware of breast self
examination
3.2 AWARENESS OF SAFE DIET:
High fat diet, Red meat, fiber & antioxidant lacking diet, diet without
fruits, too much fried food has been considered as unsafe diet. Soya,
moderate amount of chicken meat, fish, fruits, vegetables, vitamin C
containing fruits are considered safe diet. Table 1 shows out of 47
subjects, 37 took unsafe diet. Fig. 3 shows 79 % of population took unsafe
food. Table 2 shows age wise distribution of unsafe diet consuming
subjects, where 36-45 age group of population are major in number. No. of
people vs. age [years] bar chart shows result of un-safe diet consumers
vide Fig.4.
Figure- 3:
Awareness amongst studied population regarding food habit.
Figure 4
Age wise distribution of the entire population unaware about safe diet
3.3 AWARENESS OF ADDICTION
Awareness of Addiction:
Table -1 shows out of 45 women breast cancer patients 35 are non addicted.
Fig.5 shows 78% of population are aware of bad effects of alcohol and
nicotine but 22% of population are not. Fig. 6 shows age wise distribution
of non addicted subjects. Where 46-55 age group of patients is predominant
and 36-45 age groups are closer to the above.
Figure 5
: Percentage chart of addiction vs. non addiction aware population
Figure: 6
Agewise distribution of non addicted subjects [35 subjects].
3.4 AWARENESS OF IRREGULAR WORK SCHEDULE:
Nightshift duty staff, regular flight attendants, person exposed to
radiation may suffer from breast cancer. Results show only 2% populations
remains in such category. Nobody was aware about the bad effect of these
(Table 2 & Fig.7). Table 1 shows age wise distribution of subjects
having regular work schedule. This indicates 36-45 age group of women are
worst sufferer because although they maintain regular work schedule
knowingly or unknowingly they are victim of breast cancer may be due to
some other factors. This indicates age is a most important factor
responsible for breast cancer in women. Fig 8 shows ranges of age versus
no. of patients having regular work Schedule.
Figure 7
: Chart of % of regular work schedule & irregular work schedule
population
Figure 8
: Age wise distribution of the entire population of regular work schedule
3.5 AWARENESS OF CONTRAINDICATION FOR AVAILING CONTRACEPTIVES/HRT
Table 2 shows out of 48 women breast cancer patients 40 availed
contraceptives/HRT. Fig.9 through pie chart shows 83 % population availed
contraceptives/HRT. Awareness of contraindication (factor responsible for
causing breast cancer) of using contraceptives/HRT is lacking in majority
of the patients. Table 2 shows age wise distribution of subjects availing
contraceptives.Fig.10 shows 36-45 age group of patients are most sufferer
and 46-55 age group is closer to it. 16 – 25 of age group are least
sufferer patients who availed contraceptives/HRT.
From various population control programs people are now aware of use of
contraceptives as an effective tool for birth control. But they are not
aware of the difficulties or side effects of such drugs. Awareness of side
effects of Hormone Replacement Therapy [HRT] is also lacking. 17% of the
population of the study did not use contraceptives /HRT. For them factor
for causing disease might be other.
Figure 9
Chart showing % of population availing & not availing contraceptives or
HRT
Figure 10
. Agewise distribution of the entire populations availing contraceptive or
HRT.
CONCLUSIONS
This study indicates that awareness level about prevention of breast cancer
of the public from the point of view of BSE, food habit, addiction,
irregular work schedule, availing contraceptives or HRT is very much
lacking.
From the above it may be concluded that, that only 4% of the public are
aware about proper methods of breast self examination, 79% are unaware of
safe diet and 22% are unaware of the demerits of addiction. Also, all of
the 2% of population of irregular work schedule are unaware of its harmful
effects and 83% of the population are not aware of the contraindications of
using contraceptives or HRT which may cause breast cancer. Various
government hospitals, NGOs and other organizations are campaigning to
spread the awareness level of general public about the different risk
factors of breast cancer. More and more these programs are carried out,
people will be more aware & lesser will be the risks of this fatal
disease.
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