Breast cancer remains the most commonly diagnosed cancer among women globally and is a leading cause of cancer-related mortality. According to the World Health Organization, over 2.3 million women were diagnosed with breast cancer in 2020 alone, with early detection remaining a critical determinant of survival and treatment outcomes. In India, the burden of breast cancer has seen a steady rise over recent decades, particularly affecting women in both urban and increasingly, rural regions. Despite advancements in screening techniques and the availability    of     treatment    options,      the     awareness, perception, and health-seeking behavior related to breast cancer remain inadequate, especially in socio-culturally diverse and geographically challenging states like Himachal Pradesh [1,2,3,4]

Himachal Pradesh, a mountainous state in northern India, presents a unique context where rugged terrain, limited access to healthcare facilities, socio-cultural stigma, and low health literacy significantly impact preventive health practices. Breast cancer awareness, including knowledge of symptoms, screening methods such as mammography and self-examination, and the importance of early detection, is essential to empower women and reduce morbidity and mortality. Misconceptions—such as the belief that tight bras cause cancer, or that breast cancer is always painful—further delay diagnosis and contribute to fear, denial, and fatalism [5,6,7,8].

While national health programs like the Ayushman Bharat and various state-led screening initiatives offer free or subsidized cancer detection services, underutilization remains a problem due to poor awareness and accessibility gaps. Previous studies have shown that awareness levels are strongly influenced by factors such as education, gender, occupation, and rural–urban residence [9,10,11] However, there remains a paucity of region-specific data fro.m Himachal Pradesh that captures the public’s awareness and misconceptions regarding breast cancer.

In this context, the present study aims to assess the level of awareness, knowledge, and prevalent misconceptions related to breast cancer among the general population of Himachal Pradesh. By analyzing socio-demographic determinants and understanding the gaps in awareness, this research seeks to inform targeted public health interventions and community-based education strategies to strengthen early detection and ultimately reduce breast cancer-related burden in the region.

Study Design and Setting

This was a descriptive, cross-sectional study conducted to evaluate the level of awareness, knowledge, and misconceptions related to breast cancer among the general population of Himachal Pradesh, India. Given the geographical diversity and digital accessibility across urban and rural areas of the state, an online survey approach was chosen for broad outreach.

Study Duration

The study was conducted over a period of three months, from Jan to March, 2025.

Study Population and Sampling

The study population comprised individuals aged 18 years and above residing in Himachal Pradesh, including both males and females from rural and urban areas. A total of 400 participants were included using a convenience sampling technique. The link to the survey was circulated through social media platforms (such as WhatsApp, Facebook, and Instagram), community health networks, and local WhatsApp groups to maximize reach and inclusivity across districts.

Survey Tool

Data were collected using a structured, bilingual (English and Hindi) Google Form questionnaire, specifically designed for this study. The questionnaire consisted of two sections:

Socio-demographic details – including age, gender, education level, occupation, and residence (urban/rural).

Knowledge and awareness section – comprising 20 multiple-choice questions covering key areas such as early symptoms, screening methods (e.g., mammography, self-examination), risk factors, common misconceptions, and preventive practices related to breast cancer.

The questionnaire was adapted from previously validated breast cancer awareness tools and further reviewed by public health experts and clinicians for content validity and contextual relevance. A pilot test was conducted on 20 participants to assess clarity and reliability, following which minor modifications were made.

Scoring System

Each correct response was awarded 1 point, while incorrect or “not sure” responses received 0 points. The total knowledge score ranged from 0 to 20. Based on cumulative scores, participants were classified into four categories:

• Very Good (17–20)

• Good (13–16)

• Fair (9–12)

• Poor (0–8)

Ethical Considerations

Participation was voluntary, and informed consent was obtained digitally at the beginning of the Google Form. The form ensured anonymity and confidentiality of all responses. No personally identifiable data were collected. 

Data Analysis

Data from the Google Forms were exported into Microsoft Excel and subsequently analyzed using SPSS version 25. Descriptive statistics such as frequencies and percentages were used to summarize socio-demographic data and response distributions. Chi-square tests were applied to examine associations between knowledge scores and socio-demographic variables, with a p-value of <0.05 considered statistically significant.

The study included a total of 400 participants from Himachal Pradesh, reflecting diverse socio-demographic backgrounds. The majority of respondents were female (70%), while males constituted 30%, underscoring the gender-relevant nature of the topic. Participants were fairly distributed across age groups, with the largest proportion aged 46 years and above (34.5%), followed by 26–35 years (26.5%), 36–45 years (24.5%), and 18–25 years (14.5%). Educational attainment varied, with 33% holding undergraduate degrees, 28.8% completing secondary education, 17.5% possessing postgraduate qualifications, while 11.8% and 9.0% had only primary or no formal education, respectively. Occupationally, homemakers represented the largest group (28%), followed by individuals working in the private sector (20.5%), students (18%), and government employees (15.3%). Most participants resided in rural areas (56.5%), while 43.5% were from urban settings (Table 1).

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

This distribution highlights the importance of tailoring breast cancer awareness efforts across educational, occupational, and geographic spectra.

Participant responses to 20 awareness questions revealed encouraging but variable levels of knowledge regarding breast cancer. Awareness was high regarding early symptoms, with 76.8% correctly identifying a breast lump, and 77.8% acknowledging the importance of breast self-examination. Knowledge about the role of early detection and screening was also substantial, with 78% agreeing that early detection improves outcomes, 74.5% recognizing that men can also develop breast cancer, and 71% aware of the role of screening in early diagnosis. However, misconceptions persisted—only 59.5% correctly denied the myth that tight bras cause breast cancer, and just 58% understood that not all cases require breast removal. Awareness of hereditary risk (71.5%), lifestyle influence (66.8%), and the importance of mammography (67.3%) was moderate. Only 65.3% knew that subsidized screenings are available under government schemes. These findings reflect both promising awareness and ongoing gaps in public understanding, especially regarding myths and nuanced clinical realities (Table 2).

Table 2: Awareness and Misconception Questions on Breast Cancer (n = 400)

The overall knowledge score distribution indicated that while awareness was present, there remains scope for significant improvement. Of the 400 participants, 31.5% demonstrated a very good level of knowledge (scoring 17–20 out of 20), while 36% achieved a good level (13–16), and 20.5% had a fair understanding (9–12). Notably, 12% of respondents scored in the poor category (0–8), indicating limited awareness. These results suggest that although a majority had reasonable or strong knowledge about breast cancer, a considerable proportion of the population still lacks essential understanding, underscoring the need for targeted awareness and educational interventions, especially in under-informed segments (Table 3).

Table 3: Knowledge Score Classification Among Participants (n = 400)

Analysis revealed statistically significant associations between knowledge levels and key socio-demographic variables. Age had a notable impact (p = 0.014), with participants aged 26–35 and 36–45 exhibiting the highest proportions of good and very good knowledge, while those aged 46 and above had relatively lower scores. Gender was also a significant factor (p = 0.047), with females generally scoring higher than males. Education level had the strongest correlation with knowledge (p< 0.001); postgraduate and undergraduate respondents had the highest awareness levels, while those with no formal education had the poorest scores. Urban participants showed significantly better knowledge compared to their rural counterparts (p = 0.026). These findings emphasize that younger, better-educated, and urban residents are more informed about breast cancer, pointing to a need for targeted educational outreach in older, rural, and less-educated populations (Table 4).
 

Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)

This study provides a comprehensive overview of the current state of awareness, knowledge, and misconceptions regarding breast cancer among the general population of Himachal Pradesh—a region with distinct geographical, cultural, and healthcare accessibility challenges. The findings highlight both encouraging awareness trends and critical gaps that warrant attention for effective public health planning and intervention.

A high proportion of participants correctly identified fundamental aspects of breast cancer, such as early symptoms (76.8% recognizing a breast lump) and the importance of self-examination (77.8%). The fact that 78% acknowledged the significance of early detection in improving treatment outcomes indicates a relatively strong understanding of the benefits of timely screening. Moreover, over two-thirds of the respondents were aware that breast cancer is not exclusive to women, that men can be affected (69.5%), and that family history (69.8%) and lifestyle choices (66.8%) play vital roles in determining individual risk. These insights reflect the impact of increasing access to digital health content, social media, and public health campaigns, even in remote areas.

However, a closer examination reveals persistent misconceptions and knowledge disparities that could hinder early diagnosis and appropriate care. Nearly 40% of respondents either believed or were unsure whether tight bras cause breast cancer—a myth that continues to circulate despite scientific evidence to the contrary. Furthermore, only 58% understood that not all breast cancer cases require mastectomy, suggesting a lingering fear that may dissuade women from seeking timely consultation. Similarly, less than two-thirds of participants knew about the availability of government-supported free or subsidized screening services, indicating a major gap in health system communication and outreach.

Knowledge scores varied significantly across socio-demographic strata. Higher education levels strongly correlated with greater awareness (p< 0.001), with postgraduate and undergraduate participants achieving the highest knowledge scores. This aligns with previous studies showing that education enhances health literacy and encourages proactive health behaviors. Age was another influential factor; participants aged 26–45 exhibited better knowledge than both younger and older groups. Interestingly, females showed higher awareness than males (p = 0.047), which may be attributed to direct gender relevance, but also highlights the need for inclusive education targeting men as well—since they play crucial roles in supporting women’s health decisions. Importantly, rural participants demonstrated significantly lower awareness than their urban counterparts (p = 0.026), reflecting challenges in healthcare access, education, and digital connectivity.

These findings echo existing literature from various Indian states and LMICs, where rural-urban divides, low literacy levels, and cultural taboos have consistently contributed to delayed diagnoses and poorer outcomes in breast cancer care. The data from Himachal Pradesh, a region with difficult terrain and scattered settlements, reinforce the necessity of hyper-local awareness campaigns—leveraging community health workers, local languages, and culturally sensitive messaging. Moreover, integrating breast cancer education into existing government health programs and school curricula could significantly improve population-level understanding over time.

While this study successfully captures the ground reality of public awareness across a diverse population, it also brings to light the urgency of dispelling myths, correcting partial knowledge, and improving health system visibility. Interventions must be tailored to reach underserved groups—particularly older women, rural communities, and those with minimal formal education—through door-to-door outreach, health camps, and vernacular media. The potential of digital platforms and mobile health solutions should also be explored, particularly among younger and tech-savvy users [7,8,9,10,11].

In summary, while awareness of breast cancer in Himachal Pradesh is moderately promising, significant educational gaps remain, especially regarding myths, preventive behaviors, and access to screening services. Bridging these gaps through focused, contextually relevant strategies could substantially enhance early detection rates and reduce the breast cancer burden in this Himalayan region.

This study underscores a moderately encouraging level of awareness about breast cancer among the population of Himachal Pradesh, with a significant proportion of participants demonstrating good to very good knowledge, particularly regarding early symptoms, the importance of screening, and preventive practices. However, persistent misconceptions—such as myths about causation and misunderstandings about treatment—highlight critical gaps in public understanding. Socio-demographic disparities, particularly related to education, age, residence, and gender, further emphasize the need for targeted, inclusive, and culturally appropriate awareness strategies. Enhancing community outreach, leveraging local healthcare networks, and integrating breast cancer education into existing public health platforms are imperative steps toward empowering individuals, promoting early detection, and ultimately reducing the burden of breast cancer in this geographically and culturally diverse region.

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