Breast cancer is a significant global public health concern and a leading cause of cancer-related morbidity and mortality among women. Early detection through breast cancer screening plays a pivotal role in improving survival rates and treatment outcomes. Despite the proven benefits of breast cancer screening, many women, particularly in low- and middle-income regions, continue to face barriers in accessing and utilizing these services. This study seeks to evaluate the awareness and knowledge of breast cancer screening among women in Himachal Pradesh, a northern state of India and to explore the barriers they encounter in the process.

Breast cancer is characterized by the uncontrolled growth of malignant cells in the breast tissue and its incidence continues to rise globally. In India, breast cancer is the most common cancer among women, accounting for approximately 27% of all cancer cases among females. The burden of breast cancer is not only reflected in its high incidence but also in its impact on mortality, making it the leading cause of cancer-related deaths among Indian women [1,2].

Breast cancer screening is a fundamental component of early detection and includes methods such as mammography, Clinical Breast Examination (CBE) and Breast Self-Examination (BSE). Mammography, a specialized X-ray of the breast, is considered the gold standard for breast cancer screening due to its ability to detect tumors at an early stage, often before they are palpable. CBE, performed by trained healthcare providers and BSE, conducted by women themselves, are also essential tools in identifying breast abnormalities. Regular screening facilitates the diagnosis of breast cancer at an early, more treatable stage, reducing the need for aggressive treatments and improving survival rates [3-5].

Despite the established benefits of breast cancer screening, various challenges persist, affecting women's access to and utilization of these services. These challenges can encompass sociodemographic factors, healthcare system-related issues, cultural beliefs and knowledge gaps [6,7]. In Himachal Pradesh, a region marked by its unique geographical and cultural diversity, understanding the specific barriers and knowledge gaps related to breast cancer screening is crucial for designing effective interventions to promote early detection and reduce breast cancer-related morbidity and mortality.

This study aims to comprehensively assess the awareness and knowledge of breast cancer screening among women in Himachal Pradesh, shedding light on the barriers that hinder their participation in screening programs. By identifying these barriers and knowledge gaps, the research endeavors to formulate evidence-based strategies to enhance breast cancer screening awareness and utilization, ultimately contributing to improved breast cancer outcomes in this region.

Objectives of the Study

To evaluate the awareness and knowledge regarding Breast Cancer Screening Awareness among Women of Himachal Pradesh.

Research Methodology:

• Research Approach -Descriptive
• Research Design-Cross-sectional survey design
• Study area: State of Himachal Pradesh
• Study duration- between April 2023 to July 2023
• Study population: All reproductive age group females who were staying in the Himachal Pradesh for 12 months or more

• Sample size-400 reproductive age group females, assuming 50% have adequate knowledge regarding Breast Cancer Screening Awareness, 5% absolute error, 95% confidence level and 5% non-response rate.

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Breast Cancer Screening Awareness was created. The questionnaire was initially pre-tested on a small number of females to identify any difficulty in understanding by the respondents

Description of Tool

Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

Questionnaire

The questionnaire contains 20 structured knowledge regarding Breast Cancer Screening Awareness. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as:

>80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

Validity of tool  =  by the experts in this field

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated among reproductive age group female residents of Himachal Pradesh for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. 

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Present study was developed to evaluate the knowledge towards Breast Cancer Screening Awareness among reproductive age group females of Himachal Pradesh. A total of 400 females were participated (Table 1).

In the present study 26% (104) females had very good knowledge (16-20 marks) towards Breast Cancer Screening, 33.0% (132) having good knowledge (12-15 marks), 24.75% (99) having fair knowledge (8-11 marks) and 16.25% (65) having poor knowledge (<8 marks) (Figure 1).

Breast cancer is a significant public health concern worldwide and early detection through breast cancer screening is critical for improving treatment outcomes and reducing mortality rates. This discussion section analyzes the findings of the study on breast cancer screening awareness among women in Himachal Pradesh, highlighting areas of strength, knowledge gaps and barriers encountered by women in accessing screening services. It also compares these findings with existing literature to provide a comprehensive understanding of the situation.

The study found that a majority (85.5%) of the participants could describe what breast cancer is and how it develops. This high level of awareness regarding breast cancer as a disease is encouraging and suggests that women in Himachal Pradesh have a basic understanding of breast cancer. However, there were notable knowledge gaps    regarding    breast    cancer    screening     methods.

Only 33.5% of participants could name at least two screening methods and even fewer were aware of the recommended frequency of mammography (25.25%) and the age to start regular mammograms (24.5%). This lack of knowledge about screening methods and guidelines underscores the need for targeted education and awareness campaigns to ensure that women are well-informed about the available screening options and when to initiate them. 

Table 1: Responses of the participants to various statements

Figure 1: Knowledge towards Breast Cancer Screening among study participants

One positive finding was that a significant proportion of participants recognized the importance of Clinical Breast Examinations (CBE) and Breast Self-Examinations (BSE) in breast cancer detection. Approximately 49.5% were aware of the importa nce of CBE and 51% knew about BSE. This indicates that women in Himachal Pradesh understand the role of regular breast examinations in early detection, which is crucial for identifying breast abnormalities.

A substantial number of participants (69%) could identify common signs and symptoms of breast cancer, indicating a good understanding of what to look for. Additionally, many participants (57.75%) correctly acknowledged that not all breast lumps are cancerous and that benign (non-cancerous) lumps can also occur. These findings suggest that women in Himachal Pradesh have some awareness of breast cancer symptoms and risk factors.

Approximately 53.5% of participants recognized that lifestyle choices play a role in reducing the risk of breast cancer. This includes factors such as maintaining a healthy diet, regular exercise and avoiding known risk factors like smoking and excessive alcohol consumption. However, only 40.25% correctly identified family history as a significant risk factor and awareness of the age at which one should be cautious due to family history was limited. This underscores the need for targeted education on the hereditary aspects of breast cancer and risk reduction strategies.

The study identified potential barriers that women in Himachal Pradesh might face when seeking breast cancer screening services. These barriers, including cultural and social factors, were recognized by 26.5% of participants. Understanding these barriers is essential for designing interventions that address the specific challenges faced by women in the region and promote greater screening participation.

A majority (66.75%) of participants understood the critical role of early detection in improving breast cancer treatment outcomes. This recognition emphasizes the significance of timely screening and early intervention. However, 47.5% believed that breast cancer could be prevented entirely, highlighting the existence of misconceptions regarding prevention. Public health campaigns should focus on clarifying the distinction between prevention and early detection.

Approximately 53.25% of participants were aware of myths or misconceptions about breast cancer and screening. Addressing these misconceptions is essential to ensure that women make informed decisions about their health. Additionally, 58% knew where to find reliable information about breast cancer screening and prevention, indicating the presence of accessible information sources.

The findings of this study align with previous research on breast cancer awareness and knowledge among women in India and other regions. Similar studies have shown that while basic awareness of breast cancer exists, there are knowledge gaps regarding screening methods, guidelines and risk factors [8,9]. Additionally, misconceptions and barriers to screening have been identified as common challenges [10,11].
 

The study provides valuable insights into the awareness and knowledge of breast cancer screening among women in Himachal Pradesh. While there is a reasonable understanding of breast cancer as a disease and the importance of breast examinations, knowledge gaps exist concerning screening methods, guidelines and risk factors. Additionally, addressing misconceptions and barriers to screening participation is essential.

The findings underscore the need for targeted educational campaigns that focus on promoting awareness of screening methods, guidelines and the 
significance of early detection. These campaigns should also address misconceptions and cultural factors that influence screening decisions. By enhancing awareness and knowledge and addressing barriers, interventions can lead to improved breast cancer outcomes in Himachal Pradesh.

Ethical Approval

Ethical Considerations-Participants confidentiality and anonymity was maintained.

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