Breast cancer is a global health concern and a significant contributor to morbidity and mortality among women worldwide. In India, it is the most common cancer among women and its incidence is on the rise. Early detection through breast cancer screening can substantially improve survival rates and treatment outcomes. However, awareness and knowledge about breast cancer screening practices among women, particularly in regions like Himachal Pradesh, are crucial factors influencing screening utilization [1-3].

Breast cancer is a complex disease characterized by the uncontrolled growth of breast cells, often forming a lump or tumor that can be felt or seen on a mammogram. The impact of breast cancer extends beyond the physical aspects, affecting emotional and psychological well-being. Effective screening programs and early detection are essential for reducing the burden of breast cancer, as they enable timely interventions, reducing the need for aggressive treatments and improving overall quality of life [4-6].

While breast cancer awareness initiatives have gained momentum globally, the effectiveness of these programs can vary by region, influenced by socio-cultural factors, healthcare infrastructure and accessibility to services. Himachal Pradesh, a northern state of India known for its diverse landscape and unique cultural heritage, presents a distinctive backdrop for examining breast cancer screening awareness among its female population [7-9].

Breast cancer screening comprises various modalities, including breast self-examinations, clinical breast examinations by healthcare professionals and mammography. Understanding the importance of these screening methods, their frequency and age-appropriate guidelines is pivotal for women's health. This study endeavors to unveil the levels of awareness and knowledge regarding breast cancer screening practices among women in Himachal Pradesh [10-12].

Breast cancer awareness and knowledge play a pivotal role in promoting early detection and reducing breast cancer-related morbidity and mortality. Previous studies have highlighted disparities in awareness and screening utilization among women in different regions of India. These disparities are often linked to socio-economic factors, education and access to healthcare services [13-15].

Himachal Pradesh, with its unique socio-cultural milieu and geographical diversity, merits a comprehensive study to assess the current awareness levels and knowledge about breast cancer screening. This research can contribute valuable insights to guide targeted awareness campaigns and healthcare policies tailored to the specific needs of women in this region. By addressing awareness gaps and promoting regular breast cancer screening practices, the study aims to enhance early detection, improve treatment outcomes and ultimately reduce the burden of breast cancer among the women of Himachal Pradesh.                

Objectives of the Study

The primary objective of this study is to evaluate the awareness and knowledge regarding breast cancer screening practices among women in Himachal Pradesh. Specifically, the study aims to:

• Assess the general awareness levels among women in Himachal Pradesh about breast cancer, its risk factors and the importance of early detection through screening

• Determine the knowledge of women in Himachal Pradesh regarding different breast cancer screening modalities, including breast self-examinations, clinical breast examinations and mammography

• Identify potential barriers, misconceptions, or gaps in understanding that hinder the utilization of breast cancer screening services in Himachal Pradesh

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area:  State of Himachal Pradesh

• Study Duration: Between May 2023 to July 2023

• Study Population: All reproductive age group females who were staying in the Himachal Pradesh for 12 months or more

• Sample Size: 400 reproductive age group females, assuming 50% have adequate knowledge regarding Breast Cancer Screening Awareness, 5% absolute error, 95% confidence level and 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Breast Cancer Screening Awareness was created. The questionnaire was initially pre-tested on a small number of females 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 regarding Breast Cancer Screening Awareness. 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 reproductive age group female residents of 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

Present study was developed to evaluate the knowledge towards Breast Cancer Screening Awareness among reproductive age group females of Himachal Pradesh. A total of 400 females were participated.

In the present study 24.5% (98) females had very good knowledge (16-20 marks) towards Breast Cancer Screening, 34.25% (137) having good knowledge (12-15 marks), 23.25% (93) having fair knowledge (8-11 marks) and 18% (72) having poor knowledge (<8 marks).

Breast cancer is a pressing global health issue and its prevalence is steadily increasing, particularly in India [1]. Early detection through breast cancer screening is instrumental in improving treatment outcomes and reducing mortality rates. However, for screening programs to be effective, it is essential that women have adequate awareness and knowledge about breast cancer and the available screening methods. This study delves into the levels of awareness and knowledge regarding breast cancer screening among women in Himachal Pradesh, shedding light on their understanding and identifying areas that require attention.

The findings of this study reveal a mixed landscape of awareness and knowledge among the participants concerning breast cancer screening. An impressive 84.75% of the participants could correctly describe what breast cancer is and how it develops. This high level of awareness regarding breast cancer's nature is a positive outcome, as it lays the groundwork for understanding the importance of screening.

Only 33.25% of the respondents could name at least two methods used for breast cancer screening. This suggests a gap in knowledge about the various modalities available for early detection. Promoting awareness of multiple screening approaches, such as mammography, clinical breast examinations (CBE) and breast self-examination (BSE), is vital to encourage women to engage in regular screening. The understanding of how often women should undergo mammography screening was relatively low, with only 25% providing the correct response. Additionally, 24.25% knew the recommended age for starting regular mammograms. These findings underscore the need for disseminating age-appropriate screening guidelines to ensure that women initiate screenings at the right time.

Importance of Clinical Breast Examinations (CBE) and Breast Self-Examinations (BSE):

A substantial number of participants (49%) recognized the significance of CBE in breast cancer detection and had knowledge about its recommended frequency. Furthermore, half of the respondents (50.5%) understood the concept of BSE and how often it should be performed. These findings are encouraging, as CBE and BSE are vital components of breast cancer screening, particularly in regions with limited access to mammography facilities.

Approximately 68.25% of the participants were aware of common signs and symptoms of breast cancer. Recognizing these indicators is crucial for women to seek medical attention promptly if they experience any concerning changes in their breasts. While a significant proportion demonstrated awareness about breast cancer, there were misconceptions. For instance, 47% of the participants believed that a lump in the breast is always a sign of breast cancer, emphasizing the need to dispel myths and promote accurate knowledge.

A substantial number (26.25%) recognized that cultural or social factors might influence a woman's decision to undergo breast cancer screening. Identifying and addressing these cultural and social determinants of health are essential for designing culturally sensitive awareness campaigns. A noteworthy 26.75% were aware of government or community programs in Himachal Pradesh promoting breast cancer awareness and screening. These programs can serve as vital resources for disseminating information and facilitating access to screening services.

Almost 30% of participants understood how women in rural areas of Himachal Pradesh can access breast cancer screening services. Ensuring equitable access to screening facilities, particularly in remote regions, is critical for improving early detection rates. An impressive 66% recognized the role of early detection in improving the chances of successful breast cancer treatment. This awareness can motivate women to proactively engage in screening.

More than half (52.75%) had heard of myths or misconceptions about breast cancer and screening. Addressing these misconceptions through targeted educational initiatives can enhance accurate knowledge. A significant proportion (57.5%) knew where women in Himachal Pradesh could access reliable information about breast cancer screening and prevention. Identifying trusted sources of information is pivotal for women to stay informed.

Comparing these findings with other studies conducted in India, it is evident that awareness and knowledge levels about breast cancer and screening vary across regions and populations.11-15 Himachal Pradesh's unique socio-cultural context and geographical diversity may influence these disparities.

This study unveils a mixed landscape of awareness and knowledge about breast cancer screening among women in Himachal Pradesh. While there is a commendable understanding of breast cancer itself and some aspects of screening, there are clear opportunities for improvement, particularly regarding knowledge of screening methods, frequency and age-appropriate guidelines.

The implications of this study extend to public health authorities, healthcare providers, educators and policymakers. Efforts should be directed towards designing targeted awareness campaigns that address the specific gaps identified in this study. Culturally sensitive interventions should dispel myths and misconceptions while promoting accurate knowledge about breast cancer and screening practices.

Furthermore, ensuring equitable access to screening facilities, particularly in rural areas, is essential. Government and community programs that promote breast cancer awareness and screening should be expanded and made more accessible to reach a broader audience.

By enhancing awareness and knowledge about breast cancer screening, Himachal Pradesh can take significant strides towards early detection, improved treatment outcomes and ultimately reducing the burden of breast cancer among its female population.

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