|LETTER TO THE EDITOR
|Ahead of print
Instagram or mammogram: What are Indian women more aware of?
Suhani, Ajit S Oberoi
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||19-Jun-2019|
|Date of Decision||04-Sep-2019|
|Date of Acceptance||23-Sep-2019|
|Date of Web Publication||12-Mar-2020|
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Breast cancer is one of the leading causes of mortality and morbidity worldwide. Among Indian women, breast cancer is the most common cancer. India, United States, and China together account for almost one-third of the global burden. India has witnessed an 11.54% increase in incidence and 13.82% increase in mortality due to breast cancer during 2008–2012., In 2018, 1,62,468 new cases and 87,090 deaths were reported for breast cancer in India, making breast cancer as the leading cause of cancer-related mortality in India.
While the exact etiology of rising incidence is still a matter of speculation, the high mortality in our setting is worrisome. This is attributable to many factors such as advanced stage at presentation, larger and biologically more aggressive tumors, and earlier age at diagnosis. The advanced stage of presentation is one of the key determinants for a higher mortality in our setting. This late presentation is a direct effect of delay in detecting the disease and seeking timely medical aid. The reasons for this delay are a combination of lack of breast health awareness, lack of skilled medical health professionals (who can diagnose, treat or do a timely referral to a specialized center and spread awareness about breast health), and poor access to specialized centers that deal with this disease. If we see the first factor among these, it is, in fact, the only thing which is in a woman's own hand! But in this era of digitalization and boom of the social networking sites where information is available in a finger tap and anybody can virtually connect with anyone, the million-dollar question that comes to our mind is: are our women actually aware about their breast health?
Various studies have been conducted in India to assess breast health awareness among women. Gadgil et al. studied the awareness about breast cancer in middle class urban women in Mumbai and found that the awareness about presentation of breast cancer was poor. In another study conducted by Siddharth et al. on 360 women without any history of breast cancer or undergoing mammogram, it was seen that almost 80% of women did not have any knowledge about breast cancer. There was lack of awareness of breast self-examination (BSE). In a study by Somdatta and Baridalyne to assess the level of breast cancer awareness, it was seen that only around 50% of women were aware of breast cancer. While assessing the knowledge about early detection methods, only 53% of the participants were aware that breast cancer could be detected early. Almost half of the women believed that only a doctor could detect it. Though 11% women were aware of BSE, only 2% of them had ever done it. A handful had clinical breast examination (CBE) done when they experienced some pain in the breast. Only six women in their study knew about early detection by mammography. In a literature review conducted by Gupta et al. to evaluate the awareness level of risk factors for breast cancer among Indian women and health professionals, it was seen that Indian women had a low awareness level about risk factors for breast cancer, irrespective of their socio-economic and educational background. When they reviewed the studies in a chronological order of around 8 years according to their date of publication, there was no increase in the cancer literacy over time with low levels of awareness being consistent for important risk factors such as age at menarche, age at menopause, and age at birth of first child in the general population. This is especially worrisome, as breast cancer has become the most common cancer in our country over the years. However, this pattern was somewhat different for nurses/nursing students, in whom improved literacy of risk factors was observed in more recent studies. Dey et al. conducted a study in Delhi to assess women's awareness regarding the various perceptions of breast cancer. They found that almost 70% of the study population considered breast cancer to be a relatively uncommon disease in India. Most of the women believed lump was the only presenting feature. Although almost all women were aware of the importance of early detection of disease, only half of them were aware of CBE and even lesser (41.2%) were aware of BSE methods. Around 7% underwent mammography or CBE in their lifetime.
There is a strong need to increase awareness regarding the disease and need for BSE as well as CBE. Information about the disease, its risk factors, BSE, and CBE needs to be disseminated by using the mass media (television, radio, newspapers, magazines) as well as the social media to spread the message to all far and near. According to the Internet and Mobile Association of India's 2013 report, 52% of working women and 55% of nonworking women use social media in India. These figures are way higher than those of awareness about breast cancer and BSE or CBE. Small changes in the curriculum of schools and colleges can go a long way. A chapter on information about the disease, screening, and prevention of breast cancer should be incorporated. This will make the young generation, their parents, and teachers aware. Also the healthcare providers (doctors, nursing professionals, auxiliary nurse midwife (ANM) workers, etc.) must consider it their responsibility to teach BSE to all women visiting them for any reason and emphasize the need for screening with CBE. They should also help in active dissemination of information by organizing public lectures, talks, and awareness programs. The Government of India has initiated a screening program for breast cancer which aims at training doctors at various district-level hospitals, ANM and Accredited Social Health Activist (ASHA) workers for spreading awareness and screening population using a standard method of breast examination. They are taught a standard method to record the patient demographics, few important risk factors, and note the clinical findings in the prescribed format given to them. Further, they are also instructed to get fine needle aspiration cytology and imaging for breast lump and seek referral to specialist as and when needed. Those without any symptoms are made aware about the symptoms of breast cancer and BSE. Similar screening is also started for oral and cervical cancers. Hopefully, it will help in increasing awareness and early detection of the disease as the destination of complete awareness is far away and both the government and civil society need to come together and make sincere efforts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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