|Ahead of print publication
Comparing the knowledge and awareness of cervical and breast cancer among medical and nonmedical students of a private institution in South India
Achsah Susan Sajan1, Sara Rose Eldhose1, Krishnaveni Kandasamy1, Sambathkumar Ramanathan2
1 Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Namakkal, Tamil Nadu, India
2 Department of Pharmaceutics, J.K.K. Nattraja College of Pharmacy, Namakkal, Tamil Nadu, India
|Date of Submission||13-Feb-2020|
|Date of Decision||17-Sep-2020|
|Date of Acceptance||31-Aug-2020|
|Date of Web Publication||06-Jul-2021|
Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Kumarapalayam, Namakkal - 638 183, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Context: Cervical and breast cancer is the most leading cause of death among women globally. Cervical and breast cancer can be cured if detected early.
Aims: The aim of the study was to compare the knowledge and awareness of cervical and breast cancer among medical and nonmedical students of a private institution in South India.
Settings and Design: A cross-sectional study was done on 600 female students of a private institution comprising both medical and nonmedical for a period of 6 months.
Subjects and Methods: A study was done to assess the awareness and knowledge on cervical and breast cancer by using a standardized questionnaire.
Statistical Analysis Used: The data were statistically analyzed with Mann–Whitney test by using GraphPad prism.
Results: Out of the 600 female students, there were each of 300 female students in medical and nonmedical. Majority of the student population was seen in 17–19 years: 143 (47.6%) in medical and 206 (68.6%) in nonmedical. A total of 235 (78.3%) medical students have heard of cervical cancer and its screening (164 [54.6%]). Many nonmedical students have never heard of cervical cancer (248 [82.6%]) and its screening (283 [94.3%]). Nearly 61% of the medical students and 1.1% nonmedical have heard of Pap smear. Both medical students (276 [92%]) and nonmedical students (179 [53.2%]) were aware of the breast cancer but have less awareness about the age of occurrence. Awareness on breast self-examination was poor among medical (137 [45.6%]) and nonmedical (19 [5.6%]) students. The P < 0.0001 (<0.05) showed a statistically significant difference between the medical and nonmedical students.
Conclusions: Through the findings of our study, we analyzed that the knowledge and awareness of cervical and breast cancer among medical students was better than that of the nonmedical students.
Keywords: Awareness, breast cancer, breast self-examination, cervical cancer, vaccination
|How to cite this URL:|
Sajan AS, Eldhose SR, Kandasamy K, Ramanathan S. Comparing the knowledge and awareness of cervical and breast cancer among medical and nonmedical students of a private institution in South India. J Can Res Ther [Epub ahead of print] [cited 2021 Dec 5]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=320552
| > Introduction|| |
Cervical and breast cancer is one of the world's most prevalent condition of cancer death in women. According to the World Health Organization (WHO), cancer cervix comprises 12% of all cancers and is the leading gynecological malignancy in the world. Globally, cervical cancer is the second most common cancer among women. Cervical cancers are preventable, but 493,100 new cases and more than 273,000 women die worldwide each year. Cervical cancer is India's third-largest cause of cancer mortality, accounting for almost 10% of all cancer-related deaths in India. Kerala, Tamil Nadu, and Delhi have the highest rate of cervical cancer. According to the WHO, each year, more than 1.4 million women worldwide are diagnosed with breast cancer, accounting for 23% of all newly diagnosed cancers. In 2012, 144,937 women were newly identified with breast cancer and 70,218 (12.7%) died, meaning that one woman died of breast cancer in India in every two newly diagnosed women. According to the National Cancer Registry, breast cancer is the most frequent cancer among women in Delhi, Mumbai, Kolkata, Ahmedabad, and Trivandrum. By 2030, the global incidence of breast cancer is projected to cross 2 million with rising proportions from developing countries. To reduce the mortality rate of breast and cervical cancer, awareness is of major concern of current time. Even today in developing countries, millions of women are never screened for cervical cancer throughout their lives. Routine cytological screening should be offered to all women above the age of 21 years who are active for at least 3 years. Specific protections for cervical cancer is provided through human papillomavirus (HPV) vaccination. Combined with vaccine testing can significantly reduce mortality from cervical cancer worldwide. Lack of breast cancer awareness prevents women from accessing screening services, undertaking breast self-examinations (BSEs), thus delaying diagnosis and treatment that unwittingly lead to high morbidity and mortality rates. It is appalling to note that the proportion of women screened ranges from about 84% in developed countries to 5% in developing nations like India.
This study highlights the lack of awareness among young women of various aspects of cervical and breast cancer, and the growing need for continued educational intervention at the institute level to emphasize the importance and increase awareness of cervical and breast cancer. Intervention at this level will not only ensure a healthier population, but the younger population can also educate masses, increase the health seeking behavior in women, and thus reduce the burden of cancer in the society worldwide. Various studies were undertaken in India to find the awareness and prevention of cervical and breast cancer, but limited cancer studies are available in southern part of India, especially in Tamil Nadu. Therefore, the study focuses to assess the awareness of cervical and breast cancer among medical and nonmedical female students.
| > Subjects and Methods|| |
A cross-sectional study was conducted for a time period of 6 months (January 2019–June 2019) in J.K.K Nattraja Educational Institutions, Kumarapalayam, Tamil Nadu, India, for comparing the knowledge and awareness of cervical and breast cancer among medical and nonmedical female college students within the age group of 17–25 years. The study was approved by the Institutional Ethics Committee (JKKNCP/ETHICS_PRACTICE/019PDS06). The sample size of the study participants was found to be 399 by using Yamane's formula. The sample consisted of 300 medical students (dental, nursing, and pharmacy) and 300 nonmedical students (engineering, arts, and education). The data were collected by a structured questionnaire regarding the awareness of cervical and breast cancer pertaining to risk factors, symptoms, screening, vaccination, and prevention. In answering the questions, the participants have to choose from (Yes/No/Don't know). Each correct answer assigned a score of 1, while an incorrect answer No/Don't know scored 0. Informed consent was obtained from the participants, and the study was approved by the Institutional Ethics Committee. Data were collected and entered in the MS excel Spreadsheet 2016, processed and analyzed by using Graph Pad Prism Version 8.0 (GraphPad Software, San Diego, CA). It was an ordinal data; the data contained unmatched group (medical and nonmedical). Hence, nonparametric test which include Mann–Whitney U-test was used. P < 0.05 was considered statistically significant.
| > Results|| |
The age of the students participated in the study was between 17 and 25 years. Majority of the student population was seen in 17–19 years: 143 (47.6%) in medical and 206 (68.6%) in nonmedical [Table 1].
In [Table 2], out of 300 medical students, 235 (78.3%) have heard of cervical cancer and 164 (54.6%) have heard of cervical cancer screening. Among 300 nonmedical students, majority of them (248 [82.6%]) have never heard of cervical cancer and its screening (283 [94.3%]). In the study population of 600, none of the medical and nonmedical students were having the family history of cervical cancer. Both medical students (276 [92%]) and nonmedical students (179 [53.2%]) were aware about the breast cancer but have less awareness about the age of occurrence. Family history of breast cancer in medical students were 4 (1.3%) and nonmedical students 3 (1%). Among medical students, 61% have heard of the Pap smear test and nonmedical students only 4 (1.1%) were aware of the pap smear test.
Majority of the medical students were more aware of risk factors of cervical cancer such as having multiple sexual partners (164 [54.6%]), sexually transmitted disease (159 [53%]), and HPV infection (158 [52.6%]) and less aware of other risk factors. The level of awareness of risk factors among the nonmedical students was poor. Majority of the medical students were aware of risk factors such as advancing age (50%) and family history of breast cancer (50%). About 90% of the nonmedical students were less aware of the risk factors. About 90% of the nonmedical students were less aware of the risk factors [Table 3]. Most of the medical students, were aware of symptoms of cervical cancer such as foul-smelling vaginal discharge (152 [50.6%]) when compared to other signs. In contrast, more than 90% of the nonmedical students were not aware of the signs of cervical cancer. Lump in breast (61.6%) was the major symptom of breast cancer identified among the medical students. Nonmedical students were unaware of the symptoms of breast cancer such as lump in breast (20 [6.6%]), change in color/shape/size of breast or nipple (15%), lump or thickening in the armpit (18 [6%]), skin changes over the breast (20[6.6%]), as shown in [Table 4].
In this study, none of the medical and nonmedical students were vaccinated against cervical cancer. On awareness of HPV vaccination, most of the medical students have heard of HPV vaccine (193 [64.3%]), know the age of getting vaccinated (146 [48.6%]), attended seminars/training on HPV vaccine (134 [44.6%]), and believed HPV vaccine would protect against cervical cancer (131 [43.6%]). On the other hand, majority of the nonmedical students have not heard of HPV vaccine (286 [95.3%]), don't know the age of getting vaccinated (285 [95%]), not attended any seminars/training on HPV vaccine (286 [95.3%]), and did not believe that HPV vaccine would protect against cervical cancer (289 [96.3%]), as shown in [Table 5].
Most of the medical students believed that cervical cancer is preventable (207 [69%]), possible to detect (198 [66%]), early detection increases survival (199 ([6.3%]), and vaccination against HPV (172 [57.3%]). More than 90% of the nonmedical students were unaware that cervical cancer is preventable (276 [92%]), possible to detect (281 [93.6%]), early detection increases survival (281 [93.6%]). and vaccination against HPV (290 [96.6%]). Majority of the medical and nonmedical students believed that good nutrition would help them to prevent the breast cancer, as shown in [Table 6].
Out of the 300 medical respondents, it has been identified that majority of them do not know where the test is done (60 [20%]) for undergoing cervical cancer screening followed by fear of bad result (56 [18.6%]), no time (50 [16.6%]), I don't believe I am at risk (40 [13.3%]), no reason (35 [11.6%]), discouraged by others (33 [11%]), and fear of procedure (26 [8.6%]). Whereas in nonmedical respondents, out of 52, majority of them answered that fear of procedure (18 [34.6%]), fear of bad result (7 [13.4%]), I don't believe I am at risk (2 [3.8%]), discouraged by others (3 [5.7%]), do not know where the test is done (10 [19.2%]), no time (6 [11.5%]), and no reason (6 [11.5%]).
Medical students were aware of mammography (76.6%) and nonmedical students were unaware of mammography (195 [65%]) as a diagnosis. [Table 7] shows that many of the medical students have not heard of BSE (163 [54.3%]), do not practice BSE (258 [86%]), believe that BSE is a useful tool in the detection of breast cancer (172 [57.3%]), not taught how to do BSE (232 [77.3%]), and believe that BSE is a good practice (215 [71.6%]). Majority of the nonmedical students were not aware of the BSE and practice. [Table 8] shows that the difference was found to be statistically highly significant (P > 0.0001).
|Table 8: Comparing the awareness of cervical and breast cancer among medical and nonmedical students using Mann–Whitney U-test|
Click here to view
| > Discussion|| |
Awareness is the secret to curbing cervical cancer. Yet, today in India, due to lack of awareness, lack of access to services, and “It-cannot-happen-to-me” mentality, cervical cancer is the most common type of cancer. The most important thing to understand is that it is totally preventable, and therefore education needs to be given to the young population as early as possible. The students age included in the study ranged from 17 to 25 years. Clear awareness on cervical cancer and its screening has been identified among medical students compared to nonmedical students. This is in line with the Koshy et al.'s report, in which the medical students had more information.
None of the research population's medical and nonmedical students had family history with cervical cancer. From the literature, it is clear that students with a family history will have better knowledge of cervical cancer about risk factors, screening protocols, and methods of treatment.
Most of the nonmedical students responded don't know about cervical cancer risk factors that suggest that medical students have a higher awareness level than nonmedical students. This is in accordance with Koshy et al.'s research because medical students were better educated than nonmedical students. Increasing awareness of risk factors other than HPV, such as sexual intercourse at young age, multiple male sexual partners, high parity, HPV infections, young age at first full-term pregnancy, prolonged use of oral contraceptives, and HIV infections, will help stop the growth of cervical cancer in the population.
The only symptom found by medical students when evaluating awareness of cervical cancer symptoms was foul-smelling vaginal discharge and more than 90% of nonmedical students were unaware of the signs. This is in line with Bawah et al.'s study that most study population was unaware of the symptoms of cervical cancer. The finding is extremely alarming. This is because one's inability to identify symptoms of a particular disease makes the person more likely to delay in obtaining adequate medical assistance, which is a major reason why women in such settings typically present late to medical facilities for assistance by which time the condition prognosis would have deteriorated.
Nearly 61% of the medical students have learned about the Pap smear procedure in the present study. Just four (1.1%) nonmedical students were aware of the pap smear test. It suggests poor knowledge of screening for cervical cancer. This is in consistent with Monisha and Santosh's research, in which only a few nonmedical students have learned of Pap smear. Pap smear-based cytological screening plays an important role in reducing both the occurrence and mortality of invasive cervical cancer. Despite its recognition, Pap smear as a screening test is in tremendous need.
The awareness about the prevention of the cervical cancer was good among the medical students but poor in nonmedical students. This is in accordance with study conducted by Gamaoun, as cervical cancer is a preventable disease. Early detection of the premalignant lesion by cervical screening or by the anti-HPV vaccine before any sexual relationships is one of the key aspects of its prevention.
HPV vaccine protects against the two most common highly oncogenic forms present in invasive cervical cancer, HPV-16 and HPV-18. HPV-16 was more commonly found out of those two. None of the medical and nonmedical students had been vaccinated against cervical cancer in this sample. This is a report that, according to Bawah et al., indicates that only a few respondents were vaccinated against cervical cancer. Regarding HPV vaccination awareness, most medical students learned of HPV vaccine and nonmedical students have not heard of HPV vaccine. This is in line with the research by Arunadevi and Prasad, in which most participants were conscious of the HPV vaccination. Such results could be as a result of an ineffective pilot project and vaccination scheme, probably due to very low coverage, poor health promotion, or education.
Both medical and nonmedical students were aware of breast cancer, but were less conscious of the age at which it occurred. This is in contrast to Sambanje and Mafuvadze, which is because both medical and nonmedical students lacked expertise on breast cancer awareness. The study showed a need for increased awareness among college students on breast cancer as there is a general will to know about breast cancer. From this study, it is clear that health educators need to develop culturally acceptable programs to increase awareness among students about breast cancer.
There was moderate awareness among medical students about breast cancer risk factors, and low among nonmedical students. The overall knowledge of the risk factors was poor in a study conducted by Subramanian et al. It is important to teach students about the risk factors and emphasize the importance of healthy lifestyle.
The primary breast cancer symptom found among medical students was lump in breast. Neither of the signs of breast cancer is known to nonmedical students. This is in line with the finding of Singh et al., as lump in the breast was more conscious. Students at school/college level should implement breast cancer awareness programs to develop their knowledge. This would aid in early breast cancer screening and prevention.
Mammography is the most efficient way among the screening procedures because it helps to diagnose cancer at an asymptomatic stage. The medical students were aware of mammography and the mammography was not known to nonmedical students. This is in line with a study by Subramanian et al., which showed that most of them were unaware of mammography. Therefore, the knowledge and awareness of breast cancer screening procedures needs to be improved. Understanding of preventive measures such as lifestyle change was appropriate.
The awareness on the BSE was poor among medical and nonmedical students. This study is dissimilar to the study by Singh et al. BSE practice, particularly among students, is very troubling; medical students practice less than nonmedical students, which may be an obstacle to screening and increasing awareness campaigns as long as there is an early diagnosis of breast cancer in the community.
The limitations of the study were the access of the whole students at the same time was difficult due to their busy schedule. Some students refused to fill the questionnaire and some did not complete the questionnaire.
| > Conclusionss|| |
Through the findings of the study, we concluded that the awareness and knowledge of medical students was better than the nonmedical students. Even though they were aware of HPV vaccination, none of the students were vaccinated. Regarding BSE, few medical students performed BSE regularly. The main reason for not performing BSE was they did not know how to perform it. Ultimately, to educate community about the disease and its prevention, it is advised to use verbal, written, or visual communication tools intensively in the curriculum irrespective of the medical and nonmedical. Therefore, more effective health promotion campaigns and programs on cervical and breast cancer are required in young female college students. Implementation of such activities might in later years have a very positive and profound effect on their well-being. Effective HPV vaccination arrangements make young girls vaccinated and become more aware of the condition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al
. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
Farley J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: Lyon, France. IARC; 2010.
World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2009b.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al
. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.
Chopra R. The Indian scene. J Clin Oncol 2001;19:106S-111S.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
Arunadevi V, Prasad G. Knowledge and awareness of cervical cancer among women in rural India. Int J Cur Res Rev 2015;7:29-32.
Godfrey K, Agatha T, Nankumbi J. Breast cancer knowledge and breast selfexamination practices among female university students in Kampala, Uganda: A descriptive study. Oman Med J 2016;31:129-134.
Koshy G, Gangadharan V, Naidu A. A study to assess the knowledge and attitude of female graduate students on cervical cancer. Int J Res Med Sci 2017;5:4545-9.
Saha A, Chaudhury AN, Bhowmik P, Chatterjee R. Awareness of cervical cancer among female students of premier colleges in Kolkata, India. Asian Pac J Cancer Prev 2010;11:1085-90.
Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: Current knowledge and practice among women in a rural population of Kerala, India. Indian J Med Res 2012;136:205-10.
] [Full text]
Bawah AM, Suhuyini DM, Mohammed MA. Knowledge of cervical cancer among female students of Salaga Senior High School. Int J Res Stud Medl Health Sci 2018;3:28-36.
Monisha TS, Santosh A. Awareness of cervical cancer and its risk factors among female students of a pre university college in Bangalore, Karnataka, India. Int J Community Med Public Health 2016;3:3533-7.
Dhendup T, Tshering P. Cervical cancer knowledge and screening behaviors among female university graduates of year 2012 attending national graduate orientation program, Bhutan. BMC Womens Health 2014;14:44.
Gamaoun R. Awareness and knowledge about cervical cancer prevention methods among Tunisian women. J Prev Med Hyg 2018;59:E30-5.
Sambanje MN, Mafuvadze B. Breast cancer knowledge and awareness among university students in Angola. Pan Afr Med J 2012;11:70.
Subramanian L, Salini VU, Anandan H, Insuvai U. Breast cancer awareness in South India. Int J Sci Study 2018;6:39-42.
Singh R, Shetty N, Rai P, Yadav G, Gandhi M, Naveed M, et al
. Breast cancer awareness among women in an urban setup in Western India. Indian J Med Paediatr Oncol 2019;39:215-8.
Drukteinis JS, Mooney BP, Flowers CI, Gatenby RA. Beyond mammography: New frontiers in breast cancer screening. Am J Med 2013;126:472-9.
Mohamed EY, Sami W, Alenezi AA, Almutairi AM, Alsalboud AK, Alhusainy KM, et al
. Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and nonmedical students. Int J Res Med Sci 2016;4:685-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]