Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. It accounts for 21% of death worldwide. The cancer cells exhibit abnormalities in cell division and survival by a mutation which results in the DNA defect by ignoring growth-regulating signals in the environment surrounding the cell, invading tissue and metastasizing to distant organs [1-3].

In low-income settings, Cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals [2-4].

Public awareness about cancer warning symptoms and risk factors in the general population is essential and the basis for cancer control programs. Since Patients are rarely aware of the early warning symptoms and cancer risk factors, the burden of disease is increasing everywhere in the world. Evidence has shown that such Cancer is highly prevalent in India, where the diagnosis is made at a later stage of the disease [3-5].

The alarming warning symptoms of Cancer include but are not limited to changes in bowel and bladder habits, abdominal pain, soreness that does not heal, unusual bleeding or discharge from the body orifices, thickening or a lump in the breast or elsewhere, chronic indigestion and swallowing problems, change in a wart, nagging cough, hoarseness, shortness of breath and unexplained weight loss. The importance of public awareness regarding warning symptoms of Cancer is to improve early case detection, diagnosis and survival rates [6-9]. Thus, the present study was carried out to evaluate this knowledge among the general population of New Delhi.

Objectives of the Study

To evaluate the Knowledge about Risk factors and warning Signs of Cancer among the general population of New Delhi.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: New Delhi

• Study Duration: Between May 2022 to June 2022

• Study population: All adults above 18 years’ old who stayed in New Delhi for 12 months or more

• Sample Size: 400 Adults assuming 50% have adequate knowledge regarding Risk factors and warning signs of Cancer, 5% absolute error, 95% confidence level and 5% nonresponse rate

• Sampling Technique: Convenience and snowball Sampling technique

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography, Risk factors and warning signs of Cancer was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants' backgrounds: age, gender, marital status, religion, employment, education and many more

• Questionnaire: The The questionnaire contains 20 structured questions regarding knowledge about Risk factors and warning signs of Cancer (10 each) having three options, i.e., Yes, No & Don't Know. The participants have to choose the right one. One mark was given for each correct answer and zero for the incorrect answer. The maximum score was ten and the minimum score was zero in each category. Scoring was done on the basis of marks as >80% (9-10) = very good, 60-79% (7-8) = Good, 41-59% (4-6) = Fair, <40% (<4) = poor

• Validity of Tool: By the experts in this field

• Inclusive Criteria: Who were willing to participate in the study

• Exclusion Criteria: Who were not willing to participate in the study

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like email and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban areas of New Delhi till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet

• Data analysis was collected and entered in a Microsoft Excel spreadsheet, cleaned for errors and analyzed with Epi Info V7 Software with an appropriate statistical test for frequencies and percentages

• Ethical Considerations: Participants' confidentiality and anonymity were maintained

The present study was a cross-sectional descriptive study carried out to evaluate knowledge of risk and warning signs of Cancer among the general population of New Delhi.

Four hundred respondents, including 163 (40.75%) from urban areas and 237 (59.25%) from rural areas, participated in the study. Among the participants, the majority, 269 (67.25%), were males, 173 (43.25%) were between 18-30 years, 155 (38.75%) were graduates, 266 (66.5%) were employed, 238 (59.5%) were married and 387 (96.75%) were Hindu (Table 1,2).

Table 1: Socio-Demographic Characteristics of Study Participants

Table 2: Knowledge about Risk Factors of Cancer among Participants

Table 3: Knowledge of Participants towards Warning Signs of Cancer

Table 4: Knowledge towards Risk Factor and Warning Signs among Study Participants

In the present study 54 (13.5%) study participants had very good knowledge (9-10 marks) towards risk factors for Cancer, 221 (55.25%) had good knowledge (7-8 marks), 73 (18.25%) had fair knowledge (4-6 marks) and 52 (13.0%) had poor knowledge (<4 marks) towards risk factors for cancer. Similarly, 49 (12.25%) study participants had very good knowledge (9-10 marks) towards warning signs of cancer, 241 (65.25%) had good knowledge (7-8 marks), 72 (18.0%) had fair knowledge (4-6 marks) and 38 (9.5%) had poor knowledge (<4 marks) towards warning signs of cancer (Table 3,4).

Cancer has become a common disease nowadays. It is one of the most commonly occurring non-communicable diseases and is the third cause of mortality in developing countries. There has been a tremendous increase in cancer incidence, mainly attributed to urbanization, industrialization, lifestyle changes, population growth and increased lifespan [4-6].

Our study's findings show that the general population of New Delhi lacks appropriate information and awareness about risk factors and warning signs of Cancer. Similar results were reported in the studies by Elshami M et al. one and Alam NE et al. [2].

Poor awareness of cancer symptoms and risk factors resulting in delayed presentation, low availability of screening programs and limited access to healthcare services, contribute to cancer-related deaths in low- and middle-income countries. These factors could play a significant role in the high mortality rates [5-7].

Fortunately, around 40–50% of cancers could be prevented if current knowledge about risk factors was translated into effective public health strategies. In addition, it is possible to reduce the current burden of Cancer with early detection, which can radically change the outcome of the disease for the better. One must be aware of early warning signs to detect Cancer in its less aggressive stages. The problem is that the lack of awareness of crucial risk factors significantly contributes to the high cancer incidence. Also, overlooking warning signs results in late diagnosis and poor outcomes. In short, to decrease the occurrence of Cancer, every individual in our population must be aware of risk factors and warning signs of cancer Moreover, noticing a warning sign and going through cancer screening methods can improve prognosis immensely [7-9].

Limitations

The sample size and duration of the study are restricted to 400 respondents and two months in time; thus, the scope and extent of the conducted research might be minimized. This survey was conducted only in one state of India; hence, these findings cannot be generalized all over India.

From the survey results, we conclude that there exists a poor awareness among the general population of New Delhi toward risk factors and warning signs of Cancer. As this is a severe concern and proves to be a significant cause of increased mortality and morbidity due to Cancer, there is a need to initiate cancer awareness camps to make the community aware, which can eventually prevent disability and increase the chances of recovery among cancer patients.

1. Elshami, M. et al. “Knowledge level of cancer symptoms and risk factors in the Gaza Strip: A cross-sectional study.” BMC Public Health, vol. 20, no. 1, March 2020, pp. 414. https://doi.org/10.1186/s12889-020-08503-1

2. Alam, N.E. et al. “Evaluation of knowledge, awareness and attitudes towards breast cancer risk factors and early detection among females in Bangladesh: A hospital based cross-sectional study.” PLoS ONE, vol. 16, no. 9, September 2021, e0257271. https://doi.org/10.1371/journal.pone.0257271

3. Abate, A.B. et al. “Cancer warning symptoms awareness and associated factors among individuals living in Assella Town, Ethiopia.” SAGE Open Nursing, vol. 7, November 2021, pp. 23779608211053493. https://doi.org/10.1177/23779608211053493

4. “Understanding cancer risk.” Cancer.Net, American Society of Clinical Oncology, https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/understanding-cancer-risk. Accessed June 2022.

5. “Signs and symptoms of cancer.” American Cancer Society, https://www.cancer.org/treatment/understanding-your-diagnosis/signs-and-symptoms-of-cancer.html. Accessed June 2022.

6. “Cancer risk factors.” Centers for Disease Control and Prevention, https://www.cdc.gov/cancer/risk_factors.htm. Accessed June 2022.

7. Kaur, J. et al. “Assess the awareness of warning signs and risk factors of cancer among general population.” Indian Journal of Applied Research, vol. 5, no. 10, October 2015, pp. 217–220.

8. “Cancer causes and prevention.” National Cancer Institute, https://www.cancer.gov/about-cancer/causes-prevention/risk. Accessed June 2022.

9. Sabi, E.M. et al. “Awareness level of cancer risk factors and warning signs among Saudi adults in a tertiary hospital in Riyadh.” Asian Pacific Journal of Cancer Prevention, vol. 22, no. 8, 2021, pp. 2421–2428. https://doi.org/10.31557/APJCP.2021.22.8.2421