Breast health is an essential aspect of women's overall well-being, with breast lumps representing a common clinical presentation that often triggers fear, anxiety and uncertainty. While the majority of breast lumps are benign, their presence warrants timely medical evaluation to rule out malignancy and initiate appropriate treatment when necessary [1,2]. Early detection and management of breast lumps-particularly through clinical breast examinations, imaging and biopsy-play a pivotal role in improving outcomes for both benign and malignant breast conditions. Despite the availability of effective diagnostic and surgical interventions, significant gaps persist in awareness and timely health-seeking behavior among women, especially in rural and resource-limited regions [3,4].

In India, breast cancer has emerged as the most prevalent cancer among women, with rising incidence rates and delayed presentation commonly attributed to poor awareness, stigma and limited access to healthcare [5,6]. Regions like Kangra, located in the hilly state of Himachal Pradesh, face unique challenges due to geographical isolation, cultural conservatism and infrastructural constraints. Women in such areas often lack access to routine screening services and face social taboos that discourage open discussion about breast health. Consequently, breast lumps-whether benign or malignant-often go unnoticed or are addressed late, leading to avoidable complications and poorer prognoses [7,8].

Studies across various regions in India have highlighted a concerning lack of public knowledge regarding the signs, causes and treatment options for breast lumps [9,10]. Misconceptions surrounding breast lump evaluation, fear of cancer diagnosis and hesitation toward surgical treatment often hinder women from seeking timely and appropriate care. Furthermore, societal perceptions and low health literacy contribute significantly to the underutilization of screening services and delayed consultation. Understanding these factors is crucial to formulating effective health promotion strategies and improving early detection rates in high-risk populations.

Given this context, the present study aims to assess the level of awareness, knowledge and attitudes related to breast lump evaluation and surgical treatment among women in Kangra, Himachal Pradesh. By identifying prevailing misconceptions, barriers to care and the influence of socio-demographic variables, the study seeks to inform culturally sensitive educational interventions and public health policies. Enhancing breast health literacy and reducing stigma through targeted community outreach can play a critical role in promoting early diagnosis and improving outcomes in this vulnerable population.

Research Design

This study adopted a descriptive, cross-sectional research design to evaluate awareness, knowledge and healthcare-seeking behavior related to breast lump evaluation and surgical treatment among women in Kangra district, Himachal Pradesh. The objective was to assess community-level understanding of breast health, with particular attention to early detection and available treatment options.

Study Area and Population

The study was conducted in Kangra district, a region in the Indian state of Himachal Pradesh, characterized by its mix of urban and rural settlements. The target population comprised adult women aged 18 years and above who were permanent residents of Kangra. Special focus was placed on including participants from diverse educational and socio-economic backgrounds to ensure broader representation.

Study Duration

Data collection was carried out over a period of three months, from January to March 2025. This timeframe allowed for widespread digital outreach and adequate response collection.

Sample Size and Sampling Technique

A total of 400 women were included in the study. The sample size was calculated using a 95 percent confidence level, an expected awareness rate of 50 percent and a 5 percent margin of error. A 10 percent buffer was initially considered to account for incomplete responses, but only fully completed submissions were included in the final analysis. Convenience and purposive sampling methods were used to recruit participants, primarily through digital outreach.

Inclusion Criteria

Participants were eligible if they were women aged 18 years or older, permanent residents of Kangra district, able to understand and respond in either Hindi or English and willing to provide informed consent.

Exclusion Criteria

Women with a diagnosed history of breast cancer or other major breast diseases were excluded. Additionally, incomplete or unclear questionnaire responses were not considered for analysis.

Study Tool-Structured Questionnaire

Data were collected using a structured and pre-validated questionnaire, developed in consultation with experts in oncology, public health and women’s health. The questionnaire, available in both Hindi and English, was administered exclusively online through Google Forms. It consisted of three main sections: socio-demographic details; knowledge and awareness of breast lumps, symptoms, diagnostic options and treatment methods; and healthcare-seeking behavior, including attitudes toward medical consultation and surgery and perceived barriers such as fear, stigma, or cost.

Scoring and Classification

The knowledge section contained 20 multiple-choice questions. Each correct answer was awarded one point. Based on the total score, participants’ knowledge was categorized into four groups: very good (80 percent or more correct), good (60 to 79 percent), fair (41 to 59 percent) and poor (less than 40 percent). This classification helped identify knowledge trends and potential gaps.

Data Collection Procedure

The questionnaire was disseminated solely through online channels using Google Forms. The link was shared widely via social media platforms, community WhatsApp groups and email lists to encourage broad participation. All respondents were required to provide informed consent digitally before accessing the questionnaire. 

Data Analysis

Collected responses were organized and cleaned using Microsoft Excel. Descriptive statistics such as frequencies and percentages were used to summarize socio-demographic data, awareness levels and healthcare-seeking behaviors.

Ethical Considerations

The study was conducted in adherence to ethical research standards. Participation was voluntary and confidentiality of responses was strictly maintained. Participants were informed of their right to withdraw at any point during the survey without any consequences.

The study included 400 women from Kangra district, with a diverse representation across age groups. The largest proportion of participants (36.0%) fell within the 26–35 years age group, followed by 28.0% aged 36–45 years, 23.0% in the 18–25 years category and 13.0% aged 46 years and above. Regarding education, the majority had completed undergraduate (33.0%) or secondary education (30.0%), while 15.0% each held postgraduate and primary-level education and 7.0% reported having no formal education. In terms of occupation, homemakers represented the largest group (27.0%), followed by office workers (20.0%), teachers (17.0%), students (16.0%), healthcare professionals (12.0%) and others (8.0%). A slightly higher proportion of participants were from rural areas (54.0%) compared to urban areas (46.0%), reflecting the regional population distribution and emphasizing the inclusion of women from less urbanized settings (Table 1).

Participants demonstrated a generally high level of awareness regarding breast lump evaluation and related surgical procedures. Notably, 85.0% correctly identified a breast lump as an abnormal growth in breast tissue and 88.0% recognized lump or thickening in the breast as a typical symptom. Breast self-examination was correctly identified as a detection method by 82.0% of respondents, while 81.0% accurately described a mammogram as a breast imaging test. Awareness of surgical treatments such as lumpectomy (80.0%) and the use of general anesthesia (80.0%) was also strong. A substantial number of participants (86.0%) knew that breast lump surgeries are performed by breast surgeons. However, knowledge was slightly lower on topics such as nipple discharge as a possible symptom (70.0%), recurrence of lumps post-surgery (69.0%) and the asymptomatic nature of some breast lumps (73.0%). Overall, the responses reflected a promising level of general awareness, with areas identified for targeted educational reinforcement (Table 2).

Table 1: Socio-Demographic Characteristics of Participants (Kangra)

Table 2: Public Knowledge and Awareness of Breast Lump Evaluation and Surgical Treatment

Table 3: Knowledge Score Classification on Breast Lump Evaluation and Surgical Treatment

Knowledge levels among participants were categorized based on correct responses to the questionnaire. The analysis showed that 40.0% of respondents demonstrated very good knowledge (scoring 80% or higher), while the largest group, 40.5%, fell into the good knowledge category (60–79% correct responses). A smaller segment (14.0%) showed fair knowledge (41–59%) and 5.5% of respondents were classified as having poor knowledge, with less than 40% correct answers. These results indicate that while a significant proportion of the population possesses strong baseline awareness, there remains a noteworthy percentage with limited understanding, underscoring the need for targeted awareness campaigns and community-level health education initiatives (Table 3).

This cross-sectional study provides valuable insights into the current levels of awareness and knowledge regarding breast lump evaluation and surgical treatment among women in Kangra, Himachal Pradesh. The findings reveal a generally encouraging level of awareness across multiple domains of breast health, yet they also expose significant knowledge gaps that necessitate targeted interventions.

A major strength of the study lies in its diverse participant pool, with a fairly even distribution across rural and urban areas, various educational levels and occupational backgrounds. The majority of participants were within the economically active age groups (26–45 years), which is noteworthy since this demographic is both at a potential risk of developing breast-related conditions and in a position to influence family health-seeking behavior. The representation of women from rural areas (54%) is particularly significant, as rural populations often face greater barriers to healthcare access and health education.

In terms of knowledge and awareness, most respondents demonstrated a solid understanding of the basic concepts related to breast lumps. An impressive 85% correctly identified a breast lump as an abnormal growth in breast tissue and 88% recognized lump or thickening in the breast as a key symptom. Similarly, 82% were aware of Breast Self-Examination (BSE) as a common detection method and 81% understood the role of mammography in diagnosis. These findings are promising and suggest that public health messaging around breast self-awareness and screening may be reaching segments of the population, particularly through digital and media channels.

However, the study also highlights areas where awareness is comparatively weaker. Only 69% of participants were aware that breast lumps can recur after surgical removal and just 70% recognized nipple discharge as a potential symptom. Additionally, while 73% understood that breast lumps can be asymptomatic, this leaves a significant portion unaware of the silent progression that can occur, especially in malignant cases. Such gaps are concerning, as they can lead to delays in diagnosis and management, ultimately affecting treatment outcomes. These findings are consistent with earlier studies conducted in rural and semi-urban settings, which reported that misconceptions and incomplete knowledge frequently delay clinical evaluation and treatment of breast lumps [11, 12].

The classification of knowledge levels further underscores this duality of awareness. While 40% of participants exhibited very good knowledge and 40.5% had good knowledge, a concerning 14% demonstrated only fair knowledge and 5.5% had poor understanding of the subject. These numbers are critical in shaping health promotion strategies, indicating that while mass awareness efforts may be reaching a broader audience, a focused approach is needed to engage and educate those with limited or no formal education, as well as women from marginalized communities.

The study also reflects positive awareness around surgical treatment options, with 80% of participants identifying lumpectomy as a common treatment and 86% correctly recognizing that such procedures are performed by specialized breast surgeons. This suggests a growing acceptance of surgical intervention when necessary, countering some of the stigma or fear historically associated with breast surgeries in conservative communities. Yet, awareness of post-surgical complications such as infection (76%) and risk factors like hormonal changes (77%) was slightly lower, indicating the need for comprehensive counseling both before and after treatment.

It is important to note that these findings emerge in the context of an online-only survey. While this allowed for efficient data collection and broader reach, it also may have skewed responses toward more digitally literate and possibly better-informed participants. Women without access to smartphones or internet connectivity-often the most vulnerable-may be underrepresented. Future studies incorporating community-based and in-person methods could help bridge this gap and offer a more inclusive understanding.

The findings of this study have direct implications for public health planning in the region. Firstly, awareness campaigns must move beyond general messages to include specific symptoms, risk factors and the importance of timely intervention. Health educators should focus on demystifying diagnostic tools such as mammograms and biopsies, emphasizing that not all lumps are cancerous but still warrant evaluation. Secondly, rural outreach programs need to integrate breast health modules into routine community health visits, Anganwadi centers and women's self-help group meetings, leveraging trusted local health workers to increase relatability and trust [11,12].

Additionally, there is a pressing need to normalize conversations around breast health. Social stigma remains a formidable barrier, particularly in conservative rural areas where discussing such issues may be considered taboo. Incorporating breast health education into school curricula, vocational training centers and community radio programs can help shift the narrative from fear to empowerment.

In summary, while the study paints an optimistic picture of growing awareness among women in Kangra regarding breast lump evaluation and surgical treatment, it simultaneously calls attention to critical knowledge deficiencies that could hinder timely care. Targeted, inclusive and sustained educational efforts-especially those tailored to rural, low-literacy populations-are essential for translating awareness into action. Only then can we ensure that early detection and appropriate management of breast lumps become a reality for all women, regardless of their socio-economic or geographical background.

This study highlights a generally encouraging level of awareness among women in Kangra regarding breast lump evaluation and surgical treatment, with a significant proportion demonstrating good to very good knowledge. However, notable gaps remain in understanding specific symptoms, recurrence risks and post-surgical implications, particularly among women with limited education or rural backgrounds. These findings underscore the urgent need for targeted, community-based health education initiatives that go beyond basic awareness to address misconceptions, reduce stigma and promote timely health-seeking behavior. Strengthening breast health literacy through culturally sensitive outreach, digital platforms and integration into existing public health frameworks will be essential for improving early detection, reducing delays in care and ultimately enhancing outcomes for women at risk of breast-related conditions in underserved regions like Kangra.

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