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Breast Cancer is globally one of the major killer diseases in women 1. In economically deprived regions of the world, lack of awareness about breast cancer and less availability of specific breast clinics, results in delay in seeking medical care and hence in poorer prognosis 2. In Kashmir valley, dedicated breast cancer screening clinics are not existent and hence breast cancer awareness can be a tool to fight this disease. Spouse is the one person who is physically and emotionally intimate to a woman and can become a great medium in early detection of breast cancer in females but this is possible only if males are aware about the features of female breast cancer. In literature, most of the studies have concentrated in studying the level of breast cancer awareness in females only and virtually no data is available regarding female breast cancer awareness in males. This study was undertaken to study the level of awareness regarding breast cancer among Kashmiri males.
A study was conducted in the Department of General Surgery, Sheri-Kashmir Institute of Medical Sciences, (Medical College), Bemina, Srinagar, Kashmir, India over a period of 18 months from September 2007 to February 2009, to assess the level of awareness regarding breast cancer in Kashmiri men. 624 patients admitted in the department for management of various common surgical diseases and their male visitors were selected randomly and explained the purpose of the study as per the ethical guidelines of Helsinki. The persons who agreed to participate in the study were requested to answer a self designed questionnaire after assuring them of confidentiality. Only married persons were included in the study. The exclusion criteria included family history of breast disorders and occupation (self or spouse) in healthcare, on the presumption that their level of awareness might be higher than the general population. The questionnaire included basic signs and symptoms of breast cancer as shown in Table 1. The questionnaire was designed after taking text books of general surgery3 and Toronto breast self examination inventory4 into consideration. Attempt was made to simplify the questionnaire with the aim of getting insight into level of knowledge with minimum possible consumption of time of the participants. There were 15 features related to breast cancer in the questionnaire and awareness regarding each feature earned 1 point and no point was awarded if the lady was unaware. Accordingly three categories of breast cancer awareness were defined as per the total scores as depicted in Table 2. Table 1: Self designed questionnaire to assess breast cancer awareness (Score 0 if unaware, 1 if aware)
Table 2: Categories as per the attained scores
Data was processed and analyzed after one year of study period with the aid of SPSS software (statistical package for social sciences version- 10).
During the study period 1279 males were approached for participation in the study and out of these 855 subjects refused to participate in the study. As shown in Fig 1, out of 624 participants, only 22 (3.5%) had good awareness about breast cancer. The results derived after analysis of data are given in the following figures (Fig.1-2) and tables (Table 3- 6).
Table 3: Awareness as per the economic status
Table 4: Awareness as per the educational background
Table 5 : Awareness as per the occupation
Table 6 : Awareness as per the
age group
In the 161 patients who were found to have average (score 5-10) and good (11-15) awareness, the sources of information regarding breast cancer are as given in Fig.2.
The reasons for non participation
given by 855 subjects who refused to answer the questionnaire
are as shown in Fig 3. Breast cancer
is the commonest cause of cancer in females in most of the
states of India as per the recent statistics.5
But the facilities of breast clinics for early detection of breast
cancer
are not available to a major percentage of
the population. This has been found to result
late reporting of patents to healthcare facility and ultimately
poorer
prognosis. Similar is the scenario in Kashmir valley.6 In such
circumstances, the only viable method to make early reporting of patients
possible is by spreading awareness regarding this disease.7 On review
of literature, we found that virtually all the studies are directed at detection
of the level or ways and means to improve breast cancer awareness among females
and we could not find any study where awareness of this disease in males has
been studied. It was against this background, this study was undertaken to
assess the female breast cancer awareness among male population. From our study, we found that only 11% of males had average to good
awareness and 89% had poor awareness about this disease. These figures
are worrisome keeping in view the fact that like other parts of Indian
subcontinent, spouse is the closest relation physically and emotionally.
Since spouse has the privilege to feel the body of his partner,
awareness
about the abnormalities could result in early pickup of pathological
lesions. Besides since in our society, husband plays a major role in
bringing the patient to the healthcare facility and since breast cancer
of a lady, affects the male partner emotionally and financially, it
becomes all the more important to include males in awareness programmes
regarding this disease. From our data we could not detect any statistically significant
difference among the subjects when classified on the basis of economic
status depicting thereby that improvement in economic status does not
reflect in improved health related awareness.
When studied on the basis of level of formal education, graduates and
above were better aware than less or uneducated group. Similarly
teachers,
office goers and students were better aware though the difference was
not significant. Besides most of these relatively better aware
groups also belonged to graduate and above educational group. But the
fact that about 68.39% of teachers had poor awareness about breast
cancer needs a serious attention and improvement as it has been proved
in many studies that by improving the health-related awareness among
the teachers, the level of awareness in children improves significantly8,9 who in turn have been found to
disseminate health awareness in homes and general population.
But it needs to be mentioned that the literature shows that even in
economically developed regions of the world,
health education has not been made
a constant part of certification programmes of teachers.10 As far as the sources of information are concerned, health
related programmes on local radio, television and articles in local newspapers
were sources of information of 78.7%
of subjects having average and good awareness regarding breast cancer.
Since these sources are widely available, impetus needs to be laid on
focused utilization of these means of education to improve breast cancer
awareness among masses. Special teachers training sessions need to be
organized particularly during vacations when schools remain closed
as these in-service training sessions have been found effective in other
health related issues.10 By establishing a
definite role for schools and teachers in promotion of health, positive
results have been achieved as is evident from literature.11 From
our results we found that 66.85% of the subjects who had been approached
for participation in this study refused to do so and the reasons given
as shown in Fig 3, show lack of interest among our population regarding
matters related to health. This aspect needs to be addressed seriously
as until people take interest healthcare programmes cannot meet success.
The social and religious leaders can
be approached, educated and made part of a programme aimed at health
education as they have direct access to the population and command
respect
and can influence their practices.12
Breast cancer
awareness
is very low among Kashmiri men .In the absence
of breast cancer screening clinics, there is a dire need to take
measures
to improve breast cancer awareness in men so that they can play a role
in early detection of this disease and thereby improve the outcome in
this disease. Rao RS, Nair S, Nair NS, Kamath VG. Acceptability and effectiveness of a breast health awareness programme for rural women in India. Indian J Med Sci 2005;59:398-402 Tjandra JJ, Collins JP. Breast Surgery in the Text book of Surgery Blackwell Publishing Ltd ,USA Ed 3rd 2006, p.273-93 Ferris L, Shamian J, Tudiver F. The Toronto Breast Self examination instrument Its Development, Reliability and Validity. Journal of Clin Epid. 1991;44:1309-17 Murthy NS, Chaudhry K, Nadayil D, Agarwal UK, Saxena S. Changing trends in incidence of breast cancer: Indian scenario. Indian J Cancer January–March 2009;46( 1):73-74 Sadler G, Dhanjal S Bhatia N et al. Asian Indian Women :Knowledge attitude and behavior towards early breast cancer detection Journal Pub Health Nursing 2001;15:214-6 Richards M, Westcombe A, Love S, et al. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 1999;353:1119-1126. Susan K, Everret A, James PH. Effects of an in-service workshop on the health teaching self efficacy of elementary school teachers. J Sch Health 1996:66;261-265. Alnasir Fasal A. Health attitudes of school teachers. Saudi Med J 2004;25(3):326-30 Young EM, Auty D, Lee SY : Development of students attitudes towards school safety measures (SATSSM) J Sch Health 2002;72:107-114 Iverson DC, Kolbe LJ. Evaluation of a national disease prevention & health promotion strategy – establishing a role for the schools. J Sch Health 1983;53:294-302 Leane W, Shute R. Youth suicide: The knowledge and attitudes of Australian teachers and clergy. Suicide Life Threat Behav 1998;28:165-173 |
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