Assessment of Awareness About Breast Cancer Among Students of an Engineering College in Kanchipuram,

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Journal of MedVerse Research & Practice

nurexus.com

Assessment of Awareness About Breast Cancer Among Students of an

Engineering College in Kanchipuram, Tamil Nadu - A Cross-Sectional

Study

Dr Balaji S

Senior Resident

Srinivasan Medical College and Hospital, Trichy, Tamil Nadu.

Email ID: balajidrs@gmail.com

C

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: It is feasible to reduce breast cancer mortality in women under 70 by 25% by 2030 and 40% by 2040

through an annual global reduction of 2.5 percent. Key strategies for achieving these targets include early detection,

timely diagnosis, and comprehensive management of breast cancer, prompting an investigation into the awareness

levels among female engineering students in Trichy.

Methodology: An observational cross-sectional study involving 421 female students from an engineering college in

Trichy, Tamil Nadu, was conducted using probability proportionate to size sampling. Data were collected via a

self-administered questionnaire, adapted from the Breast Cancer Awareness Measure (Breast CAM) version 2,

utilizing Google Forms.

Results: The sample predominantly comprised third-year students (N=144) and unmarried individuals (N=388).

Despite a significant number of participants recognizing breast cancer warning signs (58.6%) and risk factors

(99.2%), only a small fraction (4.7%) demonstrated an adequate level of confidence and skill in early detection.

Conclusion: Out of 413 responses, a majority of women identified breast cancer risk factors and symptoms;

however, the overall awareness level among this educated demographic remains inadequate. Current trends suggest

that Indian women are increasingly affected by the disease at a younger age.

Keywords: Breast self-examination, warning signs, risk factors

Introduction

Breast, colorectal, lung, cervical, and thyroid malignancies represent the most prevalent forms of cancer

among women [1]. Breast cancer can impact females globally post-puberty, with incidence rates

escalating with age [2]. About 50% of breast cancer cases are diagnosed in women over 40, who have no

additional identified risk factors apart from gender [3]. In countries with advanced healthcare

infrastructures, survival rates for various cancer types are improving due to early diagnostic methods,

effective therapies, and supportive care [4]. In 2020, breast cancer caused 685,000 women's deaths, while

2.3 million women received a cancer diagnosis worldwide [5]. By the end of 2020, breast cancer was the

most frequently diagnosed cancer globally, with 7.8 million women diagnosed in the prior five years [6].

Submission Date: 23.05.2024

Accepted Date: 20.06.2024

Published Date: 30.06.2024

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Breast cancer causes the greatest loss of disability-adjusted life years of any cancer type internationally

[7].

A lack of knowledge regarding breast cancer discourages women from utilizing screening services and

performing self-examinations [8]. Despite longstanding national programs aimed at enhancing awareness

and promoting early detection, such as the National Cancer Control Program under NPCDCS initiated

during the 12th five-year Plan (2012–2017) [9], breast cancer remains the leading cause of cancer

mortality in the country [10]. Barriers including insufficient awareness, stigma, fear, and gender

disparities contribute to elevated mortality rates and decreased participation in screening behaviours [11].

Although breast cancer is a primary contributor to cancer-related fatalities among Indian women, many

remain oblivious to their condition [12]. Mitigating morbidity and mortality requires enhanced knowledge

of signs and symptoms, as well as early detection through mammography, clinical breast examinations, or

self-examinations [13]. Regrettably, few women engage in these practices to monitor their breast health

[14].

This research evaluated the level of breast cancer awareness among engineering students in an urban

context [15]. The study aimed to ascertain the extent of knowledge engineering students possess

regarding breast cancer [16]. The objectives included examining their awareness, attitudes, and

confidence in recognizing breast cancer symptoms, and the correlation between knowledge of breast

cancer and its warning signs with their confidence, attitudes, and behaviors [17,18].

Materials and methods

A cohort of 421 female engineering students was recruited for this study. Informed consent was acquired

from all participants. Participant privacy and confidentiality were strictly upheld. Data gathered was

solely for research objectives. Methodologies utilized in this research have ethical approval from the

Srinivasan Medical College Hospital and adhere to the Indian Council of Medical Research's ethical

guidelines, consistent with the 1975 Helsinki Declaration as updated in 2000.

Female engineering students from Kanchipuram district were involved in this three-month cross-sectional

study, encompassing one month for data collection, followed by analysis and discussion. A prior study in

Iraq by Alwan et al. indicated that 57.4% of women conducted self-examinations, with a 95% confidence

interval and a 5% margin of error. The minimum sample size was calculated to be N=376 using the Open

Epi platform. With a 10% non-response rate accounted for, the sample size was adjusted to N=421.

Systematic sampling was employed to select every alternate female participant based on probability

proportionate to size. Participants were briefed on the study procedures and consent was obtained.

The study utilized the Modified Breast Cancer Awareness Measure [BCAM Version 2], covering areas

such as warning signs, confidence, skills, behaviors, delays in medical assistance, healthcare barriers, and

risk factors. The BCAM is acknowledged for its effectiveness in measuring women's awareness of breast

cancer. Data was collected through a Google Forms survey, employing a pre-validated proforma to

uphold study integrity. SPSS version 25 facilitated data analysis, assessing demographic variables

through proportions and frequencies, and exploring the relationship between questionnaire domains and

baseline data via the chi-square test. Statistical significance was established at a p-value of <0.05.

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Results

Participants ranged in age from 17 to 25 years old. Each domain's results are listed below.

Table 1: Distribution of participants

S.No

Year of Study

No.of females

Sample taken

1

st

300

129 (30%)

2

nd

200

85 (20.1%)

3

rd

250

146 (34.9%)

4

th

150

63 (15%)

Total

1000

421 (100%)

The table presents the distribution of female participants according to their year of study and the number

of samples collected. Out of a total of 1000 female students, samples were obtained from 421 participants,

representing 100% of the study sample. Among them, the highest proportion of samples was collected

from third-year students, accounting for 146 participants (34.9%), indicating the most active participation

in that group. This was followed by first-year students, from whom 129 samples (30%) were collected.

Second-year students contributed 85 samples (20.1%), while fourth-year students had the lowest

participation, with 63 samples (15%). Overall, the table highlights that students in the middle years of

study (particularly the third year) showed greater involvement in the study compared to those in the early

and final years.

Table 2: Baseline Characteristics

S.No

Variables

Categories

N (%)

1

Age

≤18

131 (31.1)

19 – 25

290(68.9)

2

Year of Study

1

st

126 (29.9)

2

nd

85(20.2)

3

rd

146 (34.6)

4

th

64 (15.3)

3

Marital status

Married

29 (6.8)

Unmarried

392 (93.2)

Table 2: delineates the fundamental characteristics of the student population, indicating that a

predominant portion, 146 (34.9%), were in their third academic year, while 392 (93.2%) female

respondents reported being unmarried, and 290 (68.9%) students were categorized within the age

spectrum of 19 to 25 years.

Table 3: Frequency table on awareness of warning signs of Breast Cancer

S.No

Variables (Warning

Signs)

N (%)

Yes

No

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1

Lump in breast or thickening

353 (83.8)

68(16.2)

2

Thickening or Lump in your armpit

82 (19.5)

339 (80.5)

3

Nipple discharge or bleeding

212 (50.1)

216(49.9)

4

Change in Nipple Position

133 (31.6)

288 (68.4)

5

Rash around your breast

190(45.1)

231 (54.9)

6

Redness around the nipple

103 (24.4)

318 (75.6)

7

Dimpling of skin

171 (40.6)

250 (59.5)

The results are presented in Table 3; 353 individuals (83.8%) and 212 individuals (50.1%) of the

participants acknowledged that the presence of a breast lump or thickening and nipple bleeding or

discharge constitute potential indicators of breast cancer, respectively. Furthermore, 339 respondents

(80.5%), 318 individuals (75.6%), 288 respondents (68.4%), 250 individuals (59.5%), and 231 individuals

(54.9%) were unable to recognize the warning signs associated with breast cancer. A significant

proportion, 325 (77.2%) and 407 (96.7%), strongly concurred that a previous history of breast cancer and

obesity, respectively, are contributory risk factors for the disease. Conversely, 244 individuals (60.4%)

expressed disagreement with the assertion that hormone replacement therapy elevates the risk of breast

cancer.

Table 4: Frequency Table on Attitude, Confidence, and Behaviour of Breast Cancer

S.No

Variables (Attitude, Confidence, Behaviour)

N (%)

1

How often do you check your breast

At least once a week

23(5.5)

At least once a month

44 (10.4)

At least once every 6 months

78(18.5)

Rarely or never

276 (65.6)

2

Do you think you would be able to

tell if your breasts changed?

Very confident

41 (9.7)

Fairly confident

87(20.6)

Not very confident

224 (53.2)

Not at all confident

69(17.2)

3

Have you ever visited a physician

regarding a change you observed

in one of your breasts?

Yes

52(12.3)

No

307 (72.9)

Never noticed a breast change

62(14.8)

4

How quickly would you call your

Within a week

103 (24.5)

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doctor if you noticed a change in

your breast?

Within a month

193 (45.8)

Within 6 months

71(16.8)

Don’t know

54(12.9)

Table 4 shows that 276 participants (65.6%) do not perform weekly breast self-examinations.

Furthermore, 224 individuals (53.2%) lack confidence in detecting breast tissue changes. The majority of

307 individuals (72.9%) have not consulted a doctor about noticing breast changes.p value = *<0.05 is

statistically significant

Table 5: Association of Baseline Characteristics & Awareness of Warning Signs

S.No

Variables

Categories

Awareness of

Warning signs

Chi-

square test

P

value

Yes

N=246

No N=175

1

Year of

Study

1

st

Year

70 (55.5)

56(44.5)

17.192

0.001*

2

nd

Year

66(77.6)

19 (22.4)

3

rd

Year

78(53.4)

68 (46.6)

4

th

Year

32(50)

2

Marital

Status

Married

18 (62)

11(38)

0.320

0.571

Unmarried

228 (58.1)

164 (41.9)

p-value = *<0.05 taken as statistically significant

Notably, seventy-eight (53.4%) third-year students displayed awareness of breast cancer warning signs, in

contrast to their peers within the same academic cohort, with this disparity also regarded as statistically

significant (p=0.001).

Table 6: Association of Baseline Characteristics & Awareness of Risk Factors Measure

S.No

Variables

Categories

Awareness of Risk factors

Chi-square

test

p-

value

Yes

N=415

No

N=6

1

Year of

Study

1

st

124 (98.4)

2 (1.6)

4.779

0.189

2

nd

83 (97.6)

2 (2.4)

3

rd

145 (99.3)

1(0.7)

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4

th

63(98.4)

1(1.6)

2

Marital

Status

Married

28 (96.5)

1(3.5)

0.195

0.659

Unmarried

387 (98.7)

5 (1.3)

p-value = *<0.05 taken as statistically significant

Table 7: Association of Knowledge on Warning Signs and Confidence, Attitude,

and Behavior towards Breast Cancer

S.No

Variable

Categories

Knowledge of warning signs

Chi-

square test

P value

Present

N=246

Absent

N=175

1

Confidence

Confident

91 (71.6)

26 (28.4)

12.685

0.0001*

Not confident

155 (52.7)

149 (47.3)

2

Attitude

Positive attitude

169 (57.1)

127 (42.9)

0.810

0.368

Negative attitude125

77 (61.6)

48(38.4)

3

Behavior

Good

16 (72.7)

6 (27.3)

1.869

0.172

Bad

230(57.6)

159(42.4)

p-value = *<0.05 taken as statistically significant

Table 7 shows that 71.6% of confident participants knew warning signs, a statistically significant

difference (p=0.0001) compared to other participants. Meanwhile, 57.1% of those with a positive attitude

and 72.7% of those displaying commendable behavior were aware of warning signs, though these findings

were not statistically significant.

Discussion

This study assessed breast cancer awareness among female college students and revealed a general

understanding of common risk factors and warning signs, similar to observations reported by Sarker et

al., Gupta et al., and Alwan et al. However, notable gaps persisted regarding early detection methods.

Although a majority of participants recognized key symptoms such as breast lumps and nipple

discharge, awareness of other warning signs remained limited, which is consistent with findings

reported by Boulos et al. and Hadi et al. Despite a generally positive attitude toward early detection,

only about half of the participants demonstrated adequate confidence and skills in identifying breast

cancer symptoms, as also noted by Ahmed et al. and Iheanacho et al.

The findings of this study are in agreement with earlier research indicating that delayed diagnosis in

developing countries is largely attributable to inadequate awareness and insufficient screening practices,

as highlighted by WHO et al., Gupta et al., and McCormack et al. Family history and tobacco use were

commonly identified risk factors among participants, aligning with reports by Biswas et al. and

Gebresillassie et al. However, awareness regarding other established risk factors such as obesity, alcohol

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consumption, and reproductive factors was relatively poor, which mirrors the observations of Akhtari-

Zavare et al. and Alwan et al. Furthermore, only a small proportion of participants were aware of the

correct timing and frequency of breast self-examination, a finding consistent with studies conducted by

Gürsoy et al. and Balaiah Mehanathan et al.

The limited awareness of breast self-examination practices among young women underscores the need

for structured educational interventions within academic institutions. Peer education and targeted

awareness programs have been shown to significantly improve knowledge and health beliefs related to

breast cancer, as demonstrated by Gürsoy et al. and Sangwan et al. The present study focused

exclusively on engineering students, which may restrict the generalizability of the findings to broader

female populations, a limitation also acknowledged by Nyström et al. and Arnold et al.

Strengthening public health education initiatives remains critical to addressing existing knowledge gaps

and promoting early detection behaviors. This is particularly important in low- and middle-income

settings where access to mammography and advanced screening facilities is limited. Enhancing breast

cancer awareness through community-based and institution-based programs may contribute to earlier

diagnosis, timely medical consultation, and improved survival outcomes, as emphasized by WHO et al.,

Sangwan et al., and Arnold et al.

Conclusion

The research findings revealed a significantly low level of breast cancer awareness among women in the

general population, which was affected by several factors previously mentioned. In a country like India,

where cultural norms heavily influence society, it is essential to broadly enhance awareness, as these

cultural factors may discourage women from seeking early detection methods such as mammograms.

Continuous educational campaigns are necessary to disseminate information and improve knowledge

about breast cancer.

Conflict of Interest: Nil

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