Introduction: Breast cancer is the most common cancer among women worldwide and it can be detected at an early stage through breast self-examination (BSE) which increases chances of survival. Aim: To assess knowledge and practice of breast self examination among females in a rural area of South India. Materials and methods: This descriptive cross-sectional study was carried out among a total sample of 314 women in rural area of South India. Females were interviewed using interviewer administered questionnaires to obtain information on their sociodemographic characteristics, knowledge and practice of breast self-examination. Data were entered using SPSS 13.01.
Results: 30.89% women were in the age group 31-40 yrs.71.34 % women were married. 44.27% women had secondary education and 13.69% were illiterate. Only 30.89% of the women were aware of breast self-examinatin.22.61% of the females had ever checked their breast. The level of awareness of breast self examination was highest among those aged 51- 60 years. Awareness of breast self examination was found to be significantly associated with educational attainment.
Conclusion: The level of knowledge and practice of breast self-examination among female is unacceptably low. Efforts should be made to increase level of knowledge and practice of breast self-examination through health education programmes.
Carcinoma breast is one of the world's leading causes of mortality and is the most frequent malignancies amongst Indian women with a steadily increasing incidence. It is estimated that one out of seven women either has or will develop breast cancer in her life time. 1 It accounts for 19-34% of all cancer cases among women in India. 2In early stages, breast cancer is less aggressive, with low incidence of metastasis and is potentially curable. Since the degree of success in treating this disease is influenced primarily by the stage at which intervention is introduced, secondary prevention (early detection) is the mainstay. 3
There is no definite primary prevention as yet. Therefore, early detection and prompt and adequate treatment (i.e. Secondary prevention) of breast cancer would be helpful to decrease mortality from this disease. In developing countries, early detection by Breast Self Examination (BSE) is considered to be a simple, inexpensive, non-invasive, and non-hazardous intervention, which is not only acceptable, cost-effective and appropriate method of early detection of cancer, but also encourages women to take an active responsibility in preventive health. BSE is the most important individual preventive health strategy to be practiced by women on a regular basis. However, correct and thorough BSE has to be ensured and prompt and adequate medical help should be available when needed.
The objective of this study was therefore to assess knowledge and practice of breast self-examination among females and to identify associated factors. This will be useful in making recommendation with regards to health education of women concerning BSE.
Materials and methods
This study was conducted in the RHC(Rural Health Centre),Prathipadu which is field practice area of dept of Community Medicine,Katuri Medical College,Guntur ,on 314 women beneficiaries over 20 years of age, attending Rural Health Centers during three months, from April to June 2010 by systematic sampling method. A pretested structured questionnaire containing both closed and open-ended questions was administered to the women by trained interviewers. The questionnaire sought information on sociodemographic data, knowledge and practice of breast self-examination. Statistical analysis was done using Statistical Package for Social Sciences software programme (SPSS) Version 13.01 to calculate frequencies and chi-square analysis to test for associations between categorical variables.
A total of 314 respondents were interviewed and their social and demographic characteristics are presented in Table 1. 166(52.87%) were aged between 31 and50 years. 43(13.69%) were between the age of 51-60 years.224 (71.34 %) were married and 47(14.96%) were single.139 (44.27%) had secondary education and 43 (13.69%) were illiterate .
Table 2 showed awareness of BSE among women by age and level of education.
217(69.11%) of the women were not aware of breast self-examination while 97(30.89%), were aware. The level of awareness of breast self examination was highest (39.53%) among those aged 51-60 years and was lowest among those less than 30 years (14.10%).The association between age and awareness regarding BSE was found to be statistically significant(P=0.004) The women who had education upto graduate level and above were more knowledgeable(64.52%) about breast self-examination while those who were illiterate were the least knowledgeable(16.28%) (P = 0.000).
Table 3 showed that 71( 22.61%) of the women reported that they practised breast self-examination. The practice was highest amongst those aged 51-60 years(37.21%)
and lowest for those aged less than 30 years(11.54%) which was found to be statistically significant(P=0.021) .The practice of breast self examination was reportedly higher among women who had education upto graduate level and above(48.38%) and lowest amongst those who are illiterate(16.28%) which was also found to be statistically significant (P = 0.003) .
Breast self-examination (BSE) provides an inexpensive method for early detection of breast tumors, thus knowledge and consistent practice could protect women from severe morbidity and mortality due to breast cancer. 4 This study assessed the knowledge and practice of breast self-examination among women in South India. Less than one- third of the respondents (30.89%) were aware of BSE. This is lower than 85.5% of women studied in Port Harcourt and 50% of those studied in South Africa. 5, 6The level of awareness is however higher than 11.9% of women in China who were aware of BSE . 7This could be due to the fact that 98% of women studied in Port Harcourt had formal education while 90.1% of those studied in China were rural women.
In this study association was observed between age of women and their awareness of breast self-examination. Association was also observed between education of women and their awareness of breast self-examination. Respondents with higher education were more knowledgeable about BSE. This finding is consistent with other studies conducted among nursing students in Saudi Arabia and health workers in Iran. 8, 9
In this study, less than one-fourth of the women interviewed reported practicing BSE, this level is however higher than women studied in United Arab Emirates, South Asia and Brazil. 10, 11, 12.There was association between age and level of education of women and practice of BSE in this study.
This study shows that level of awareness and practice of breast self- examination among women is low. So the mass media should be used to disseminate information on BSE.
Health workers should intensify health education on the importance of BSE when they come in contact with women such as Antenatal and Immunization clinic sessions the group approach would also foster regular practice of BSE as some of the women could be trained to act as peer educators for the other women. Efforts should be made to increase Literacy especially among female.
Acknowledgments: The authors would like to thank study subjects for their co-operation.
Table 1: Sociodemographic characteristics of the study subjects (n=314)
Graduate & above 31(09.87)
Table 2: Awareness of Breast Self-Examination by Age and Level of education of study subjects (n=314)
Characteristic Awareness of Breast Examination P value
Yes (%) No(%)
21-30 11(14.10) 67(85.90)
31-40 36(37.11) 61(62.89) 0.004 Significant
41-50 26(37.68) 43(62.32)
51-60 17(39.53) 26(60.47)
> 60 7(25.93) 20(74.07)
Level of education
Illiterate 7(16.28) 36(83.72)
Primary 31(30.69) 70(69.31) 0.000 Significant
Secondary 39(28.06) 100(71.94)
Graduate and above 20(64.52) 11(35.48)
Table 3: Practice of Breast Self Examination by Age and Level of education of study subjects
Characteristic Practice of Breast Self Examination P value
Yes (%) No(%)
20-30 09(11.54) 69(88.46)
31-40 23(23.71) 74(76.29)
41-50 18(26.09) 51(73.91) 0.021 significant
51-60 16(37.21) 27(62.79)
>60 05(18.52) 22(81.48)
Level of education
Illiterate 07(16.28) 36(83.72)
Primary 18(17.82) 83(82.18) 0.003 significant
Secondary 31(22.30) 108(77.70)
Graduate and above 15(48.38) 16(51.62)