Cancer, a diverse group of diseases characterized by the uncontrolled growth and spread of abnormal cells, represents a formidable global health challenge. It is a leading cause of morbidity and mortality worldwide, with millions of lives affected each year. Early detection of cancer is crucial for improving patient outcomes and one of the key factors in early detection is the recognition of warning signs and symptoms [1-3].

While significant advancements have been made in cancer research, diagnosis and treatment, the importance of public awareness and knowledge about cancer warning signs cannot be overstated. Understanding the subtle and sometimes not-so-subtle indicators of cancer can lead to early diagnosis and timely intervention, ultimately saving lives [4,5].

District Bilaspur, nestled in the serene landscapes of Himachal Pradesh, boasts a unique cultural and geographical diversity. However, like many regions across the globe, it is not immune to the burden of cancer. The extent to which the residents of District Bilaspur are aware of cancer warning signs and symptoms is a critical subject of inquiry. This study endeavors to shed light on the levels of awareness and knowledge about these warning signs among the general population.

Cancer can manifest in various forms and its symptoms can be elusive, mimicking common ailments or remaining asymptomatic until advanced stages. Recognizing warning signs is akin to holding a key to early detection and, consequently, better treatment outcomes. Early-stage cancer is often more amenable to curative therapies, while advanced-stage cancer poses greater challenges to effective treatment [6-8].

The diverse nature of cancer adds complexity to the recognition of warning signs. Different types of cancer may exhibit distinct symptoms, making it essential for individuals to be well-informed about the specific signs relevant to various cancer types. These signs can range from subtle changes in the body to more noticeable symptoms, such as persistent pain, lumps, or changes in bodily functions [9-12].

Awareness about cancer warning signs is influenced by various factors, including cultural beliefs, socio-economic status, access to healthcare and educational background. Regional disparities in cancer awareness have been documented worldwide, with some areas having more comprehensive knowledge than others [13-16].

In the context of District Bilaspur, where cultural practices, dietary habits and healthcare accessibility may differ from other regions, understanding the local awareness levels becomes imperative. Tailoring cancer education and awareness programs to the specific needs of this community can help bridge knowledge gaps and facilitate early detection.

Public health campaigns and initiatives aimed at improving cancer awareness have been instrumental in enhancing early detection rates and reducing cancer-related mortality in various parts of the world. These programs often rely on comprehensive community education, emphasizing the importance of recognizing warning signs, seeking medical attention promptly and participating in cancer screening when appropriate [17-18].

By assessing the levels of awareness and knowledge about cancer warning signs and symptoms in District Bilaspur, this study seeks to contribute valuable insights for public health professionals, policymakers and community leaders. The findings can inform the development of targeted interventions and awareness campaigns tailored to the specific needs and cultural context of this region.

Objectives of the Study

The primary objective of this study is to gauge the levels of awareness and knowledge about warning signs and symptoms of various cancers among the general population of District Bilaspur, Himachal Pradesh. Specifically, the study aims to:

• Assess the overall awareness levels regarding cancer warning signs and symptoms

• Identify any variations in awareness based on demographic factors such as age, gender, education and socio-economic status

• Explore the sources of information through which individuals in District Bilaspur have gained knowledge about cancer warning signs

• Understand the perceived barriers to seeking medical attention when potential cancer warning signs are observed

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: District Bilaspur, Himachal Pradesh

• Study Duration: between April 2023 to June 2023

• Study Population: The study's target population encompassed all adults aged 18 and above who had been residents of District Bilaspur for a minimum of 12 months

• Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Warning Signs ansd symptoms of various cancers, a precise 5% absolute error margin and a conservative 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Warning Signs and symptoms of various cancers was created. The questionnaire was initially pre-tested on a small number of participants 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 related questions regarding Warning Signs and symptoms of various cancers . 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 the residents of District Bilaspur, 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. 

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The primary objective of this study was to gauge the understanding of Warning Signs and symptoms of various cancers among the general population of District Bilaspur. A total of 400 participants took part in the study, with 241 (60.25%) residing in urban areas and 159(39.75%) in rural areas (Table 1).

Table 1: Knowledge Regarding Warning Signs and Symptoms of Various Cancers Among Study Participants

In the present study 22.75% (91) participants had very good knowledge (16-20 marks) towards Warning Signs and symptoms of various cancers, 35.75% (143) had good knowledge (12-15 marks), 21.5% (86) had fair knowledge (8-11 marks) and 20% (80) having poor knowledge (<8 marks) (Table 2).

Table 2: Knowledge Scores Towards Warning Signs and Symptoms of Various Cancers Among Study Participants

The findings of this study offer valuable insights into the levels of awareness and knowledge about warning signs and symptoms of various cancers among the residents of District Bilaspur, Himachal Pradesh. Understanding these findings is crucial for enhancing early cancer detection and improving overall cancer outcomes in the region. In this discussion, we will analyze the results and consider their implications, while also comparing them to other relevant studies.

The study results reveal a mixed level of awareness regarding cancer warning signs among the participants. While some individuals demonstrated good knowledge, others exhibited significant knowledge gaps. Only 22.75% of the participants scored in the "very good" category, indicating a comprehensive understanding of warning signs for various cancers. This suggests that a substantial portion of the population may benefit from enhanced education and awareness programs.

It is noteworthy that knowledge levels varied across different types of cancer. For instance, breast cancer garnered relatively higher awareness, with 59% of participants able to name at least three warning signs or symptoms. Conversely, skin cancer awareness was significantly lower, with only 6.75% of participants familiar with the ABCDE rule for identifying potential symptoms in moles or skin lesions. These variations underscore the need for targeted education efforts that focus on specific cancer types with lower awareness levels [16-18].

Enhancing awareness about cancer warning signs is a critical component of public health efforts to reduce cancer-related morbidity and mortality. The study's findings underscore several key implications for public health interventions in District Bilaspur:

• Targeted Education Campaigns: Tailored awareness campaigns should be designed to address specific cancer types with lower awareness levels, such as skin cancer. These campaigns can include both digital and community-based approaches to reach diverse populations effectively

• Education Equity: Efforts should be made to bridge knowledge gaps among individuals with lower levels of education. This could involve simplified and culturally sensitive educational materials and programs

• Continuous Monitoring: Ongoing assessment of awareness levels is essential to track improvements and identify evolving knowledge gaps. Regular surveys and studies can inform the adaptation of awareness campaigns over time

• Cultural Sensitivity: Given District Bilaspur's unique cultural diversity, awareness campaigns should be culturally sensitive and consider local beliefs and practices. Community involvement and cultural competency are crucial for success

• Access to Healthcare: Future research should explore how socio-economic factors, healthcare access and health disparities impact cancer awareness. This can inform policy and healthcare infrastructure improvements

This study provides valuable insights into the levels of awareness and knowledge about warning signs and symptoms of various cancers among the residents of District Bilaspur, Himachal Pradesh. While there are areas of relatively good awareness, there are also significant knowledge gaps that warrant attention. By implementing targeted education campaigns, addressing education disparities and considering the region's cultural diversity, District Bilaspur can take meaningful steps toward improving cancer awareness and early detection, ultimately leading to better cancer outcomes in the community.

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