|Year : 2022 | Volume
| Issue : 2 | Page : 196-201
Awareness and practice of breast self-examination (BSE) with its socio-demographic associates: a cross-sectional survey in the capital of Rajasthan, India
Pragya Kumawat1, Ajay Gupta1, Kusum L Gaur1, Sadhana Meena2, Gajendra S Sisodia3, Ishrat Jahan4
1 Department of Community Medicine, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Community Medicine, RUHS College of Medical Science, Jaipur, Rajasthan, India
3 Department of Community Medicine, NIMS Medical College, Jaipur, Rajasthan, India
4 Department of Community Medicine, Government Medical College, Kota, Rajasthan, India
|Date of Submission||08-Feb-2022|
|Date of Acceptance||24-May-2022|
|Date of Web Publication||17-Jun-2022|
Gajendra S Sisodia
Department of Community Medicine, NIMS Medical College, Chitanukalan, Jaipur, Rajasthan 303121
Source of Support: None, Conflict of Interest: None
Introduction: Breast cancer is the most common cancer of women worldwide. Early diagnosis of it has a very important role in its management. Breast self-examination (BSE) is a key to the early diagnosis of breast cancer. Materials and Methods: A community-based cross-sectional study was conducted on 300 females of Jaipur city. This study was conducted by a house-to-house survey through a systematic random sampling technique in the field practice area of the Urban Health Training Centre (UHTC) of SMS medical college, Jaipur (Rajasthan), India. A predesigned semi-structured questionnaire containing predesigned questions regarding knowledge and practice of BSE was used to collect data. A Chi-square test was used to find out associations. Results: Only 18% of females were aware of BSE and 5.7% of the females were practicing BSE. Health professionals (31.03%) were the main source of knowledge. Only 50% of females who have heard the name of BSE, knew that it is performed by self. Awareness and practice of BSE both were found to be associated with religion, education, socioeconomic status, and occupation and there was no association with age and marital status. Females with higher education and socioeconomic status were more aware of BSE. The most common (94.69%) reason for not practicing BSE was the lack of awareness of steps followed by ‘find it unnecessary’. Conclusion: As knowledge and practice of BSE were observed very poor and considering the important role that can be played by BSE in the early diagnosis and management of breast cancer, there is an urgent need to implement and reinforce BSE in the existing cancer awareness and screening programs. IEC activities regarding BSE also motivated proper knowledge of BSE.
Keywords: Awareness, breast self-examination (BSE), practice, screening
|How to cite this article:|
Kumawat P, Gupta A, Gaur KL, Meena S, Sisodia GS, Jahan I. Awareness and practice of breast self-examination (BSE) with its socio-demographic associates: a cross-sectional survey in the capital of Rajasthan, India. MGM J Med Sci 2022;9:196-201
|How to cite this URL:|
Kumawat P, Gupta A, Gaur KL, Meena S, Sisodia GS, Jahan I. Awareness and practice of breast self-examination (BSE) with its socio-demographic associates: a cross-sectional survey in the capital of Rajasthan, India. MGM J Med Sci [serial online] 2022 [cited 2022 Jul 6];9:196-201. Available from: http://www.mgmjms.com/text.asp?2022/9/2/196/347684
| Introduction|| |
Breast cancer is the most common cancer among women both in the developed as well as in the developing world. In 2020, it was estimated that 685,000 women died from breast cancer – that is approximately 15% of all cancer deaths among women globally. It is estimated that breast cancer with 2,38,908 cases is expected to be the most common site of cancer in females in 2025. In urban areas, 1 in 22 women is likely to develop breast cancer during her lifetime as compared to rural areas where 1 in 60 women develops breast cancer in her lifetime.
In India, a higher proportion of breast cancer is in premenopausal women, and the peak age is between 40 and 50 years. This is of concern because early-onset breast cancer is more aggressive and has a poorer prognosis than late-onset breast cancer. Furthermore, 60–70% of all patients with breast cancer in the United States are diagnosed with stage 1 disease, whereas only approximately 1–8% of Indian women present with stage 1 disease. Although only approximately 10% of women in the United States present with stage IV disease, in India this number is approximately 6–24%. The 5-year survival rate for breast cancer is 85% with early detection whereas later detection decreases the survival rate to 56%. So, the prognosis of breast cancer cases lies in early diagnosis and breast cancer screening was found to reduce the risk of mortality by 20%.
There are many reasons for late detection of breast cancer like low awareness, presence of stigma, fear about pain during screening and fear about the disease, gender inequity, lack of screening tests and infrastructure, low literacy, and low-income levels.
Despite the presence of various screening methods, the majority of breast cancer cases are detected by women themselves, stressing the importance of BSE. It is considered to be a simple, inexpensive, non-invasive, and non-hazardous intervention, which is not only an acceptable, cost-effective, and appropriate method of early detection of cancer but also encourages women to take active responsibility in preventive health.
According to the American Cancer Society (ACS) recommendations, women should start BSE in their early 20s, should know the normal feel of their breasts, and promptly report any changes to their healthcare providers.
But there is a paucity of studies related to BSE in Rajasthan, so this study was conducted to assess the knowledge and practice of breast self-examination (BSE) among females residing in the field practice area of the urban health training center (UHTC) attached to the medical college of the capital of Rajasthan.
| Materials and methods|| |
This is a community-based cross-sectional study conducted among females residing field practice area of Urban Health Training Centre (UHTC) attached to SMS Medical College, Jaipur (Rajasthan) India. This study was undertaken by the Department of Community Medicine in the year 2019–2020 after getting approval from Institutional Research Review Board and Institutional Ethical Committee. The sample size for this study was calculated at 296 subjects with a 95% confidence limit and 5% absolute allowable error assuming knowledge of BSE in 26% of urban females. So, 300 eligible females were included in this study after round-off.
For the study, females of 20 years and more aged and residing in the field practice area of UHTC for more than one year who had given written informed consent were included in the study. Females who were terminally ill or not cooperative or were not able to communicate were excluded from the study.
Subjects for the study were selected by a house-to-house survey. The first house was selected through a simple random sampling technique then every 4th house from the 1st house was selected for the survey through a systematic random sampling technique to cover the whole field practice area.
A predesigned semi-structured questionnaire containing 3 sets of questions was used to collect data regarding the study. After gathering information regarding general information about female (Section I), questions regarding knowledge (Section II), and questions regarding practice (Section III) of BSE was asked as per a questionnaire for data collection at the end of the interview, women were educated about the steps of BSE. For socioeconomic status, modified BG Prasad’s classification was used modified as per the All India Consumer Price Index for April 2020.
Data was entered in MS Excel 2010 and analyzed using Primer version 6. Descriptive statistics were obtained and to determine association Chi-square test was used, for which the ‘p-value less than 0.05 was considered significant.
| Results|| |
Characteristics of study subjects
Out of these 300 subjects, the majority i.e. 66.67% belonged were in the 20 to 39 years age group. The mean age with a standard deviation of the study subjects was 35.44 ± 12.21 years. Most (86.67%) of the study subjects were married and most (72.67%) of them were housewives. The majority (82.67%) of study subjects belonged to the Hindu community. Maximum (70.33%) of the study subjects were literates. Most (24.33%) of the study subjects belonged to Socio-economic Class III based on modified BG Prasad’s classification.
Awareness of BSE and source of knowledge
Out of 300 women, only 54 (18%) of the study subjects heard about BSE [Figure 1] and among them, health professionals (31.03%) were the main source of knowledge followed by Television (25.87%) [Table 1].
|Table 1: Distribution of subjects as per various variables of Knowledge of BSE|
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Knowledge of BSE
Out of these 54 females who were aware of BSE, only 27 (50%) knew that it is performed by self, 3 (5.56%) reported that BSE is performed by Doctor whereas 24 (44.44%) had no idea about who should perform BSE [Table 1]. Out of these 54 females, 27 (50%) knew how to perform BSE, out of that only 15 (27.78%) were aware of the correct age for starting BSE. On questioning about the frequency and correct timing of doing BSE, only 28 (51.86%) knew that BSE should be performed monthly and only 4 (7.40%) had knowledge that the correct time for performing BSE is after menstruation [Table 1].
Socio-demographic associates of awareness regarding BSE
In this study, awareness regarding BSE was found to associate with religion, occupation, education, and socio-economic status whereas no association was found with age, marital status and occupation [Table 2]. The awareness of BSE was highest in those who were Sikh by religion (100%), educated up to Post Graduate (53.80%), had Government jobs (47.80%), and belonged to socio-economic class I (33.90%) (p-value <0.05).
|Table 2: Association of knowledge and practice of BSE with socio-demographic factors|
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The practice of BSE
Out of 300 study subjects, 283 (94.33%) never practiced BSE [Figure 1]. Among those who were practicing BSE (5.67%), none of the subjects were performing the steps of BSE correctly.
Socio-demographic associates of Practice of BSE
In this study, the practice of BSE was found to associate with religion, education, socio-economic status, and occupation whereas no association was found with age and marital status. The practice of BSE was highest in those who were in Government jobs (17.39%), Sikh by religion (50%), educated up to Bachelor’s Degree (21.95%), and belonged to socio-economic class I (12.90%) (p-value <0.001).[Table 2].
Reasons for not practicing BSE
Most common (in 94.69%) reason for not practicing BSE was that they were ‘not aware of steps’ followed by ‘find it unnecessary’ (2.83%), ‘find it embarrassing’ (1.77%) while least common (0.71%) reason was that they were ‘afraid of detecting cancer’ [Figure 2].
| Discussion|| |
In the present study, the maximum proportion of the study subjects was in the age group of 20–29 years (38.33%) similar to the study conducted by Nitin Gangane et al which showed the majority of the respondents, (43.6%), was aged 20–29 years. This is the appropriate age group to create awareness for the early detection of breast cancer.
In the present study, only 18% of the study subjects were aware of BSE. Almost similar observations were made by AL Kommula et al in their study reported that 16.5% of the study subjects were aware of BSE. Also, Smrithi Maniraj et al in their study in rural Puducherry reported that the awareness of BSE was about (20.08%). In the present study, Health professionals (31.03%) were the main source of knowledge about BSE which was well in resonance with the observations made by H Kumarasamy et al who also reported that Health care workers were the source of information for BSE in 31% of the participants.
Out of 54 (18%) females who were aware of BSE, only 15 (25.86%) were aware of the correct age for starting BSE. On questioning about the frequency and correct timing of doing BSE, only 28 (48.27%) knew that BSE should be performed monthly and only 4 (6.89%) had knowledge that the correct time for performing BSE is after menstruation. According to the study done by Singh R et al majorities of the study, subjects did not know the age and appropriate time for its commencement.
In the present study, only 5.67% practiced BSE which was comparable to the observations made by Punia et al who reported that only 8.7% of women were practicing BSE.
In the majority of the study subjects, the reason for not practicing BSE was that they were not aware of the steps (94.69%) followed by finding it unnecessary (2.83%), finding it embarrassing (1.77%) while the least common reason was that they were afraid of detecting cancer (0.71%). Almost similar results were observed by Neha Tripathi et al, who stated that in their study most common reason was don’t know how to perform an examination (84.93%) followed by don’t have time (15.07%), fear of getting mass (1.83%), forget (1.37%), and lack of privacy (0.46%). S Madhukumar et al reported that the reasons mentioned by the women for the poor practice of BSE were that the act of doing it was embarrassing, lack of privacy, and some felt that it was not required. The majority said that they were not sure about how to do it.
In the present study, education, occupation, religion and socio-economic status of the study subjects were found to be associated with awareness and practice of BSE (p-value<0.05). Those who were educated with Bachelor’s degree and Post Graduation, had Government Jobs, Sikh by religion and belonged to socio-economic class I were more aware and practicing BSE. Similar results were observed in studies done by other authors.,,
Yerpude PN et al in their study reported that the women who had education up to graduate level and above were more knowledgeable (64.52%) about BSE while those who were illiterate were the least knowledgeable (16.28%) and the practice of breast self-examination was reportedly higher among women who had education up to graduate level and above (48.38%) and lowest amongst those who are illiterate (16.28%) which was also found to be statistically significant. Neha Tripathi et al in their study stated that the practice of BSE was more among Teachers (33.3%) followed by a housewife (7.73%) and farmers (1.03%) and there was a significant association between the practice of BSE and occupation. Aswathy Sreedevi et al reported that the practice of screening was more among those with middle socioeconomic status (69.8%) and there was a significant association between the practice of BSE and socioeconomic status.
| Conclusion|| |
The findings of this study conclude that the majority of women had poor knowledge of BSE and only 5.6% were practicing BSE. Among those who were practicing BSE none of them were correctly following all the steps of BSE. The reason for not practicing BSE was that majority of the women were not aware of the steps, they find it unnecessary and embarrassing, and they were afraid of detecting cancer. So, there is a need to strengthen awareness regarding BSE.
BSE has been identified as the feasible and reasonable approach to the early detection of breast cancer, especially in developing nations. Considering the substantial role of BSE in the early diagnosis of breast cancer for better management, there is an urgent need for strengthening IEC activities and interventions to reinforce BSE in the existing cancer awareness and screening programs.
Clearance/approval from the Institutional Ethics Committee of SMS Medical College, Jaipur, India was taken for the research proposal Letter no. 373/MC/EC/2020 dated 9th June 2020.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest
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[Figure 1], [Figure 2]
[Table 1], [Table 2]