title: A population based case control study on breast cancer and the associated risk factors in a rural setting in kerala, southern India.
abstract: BACKGROUND
  The incidence of breast cancer is increasing in developing countries over three decades. Despite good health indicators breast cancer is a public health problem in Kerala with an annual incidence of 14.9/100000 population. Identifying the risk factors helps to reduce the incidence in future.
  
  
  METHODS
  A Population based case control study was conducted among all the breast cancer cases in the Arpookara Panchayat of Kottayam district in Kerala. 20 cases of breast cancer were paired with age matched controls from the same geographic area (ratio 1:4) with a total of 100 study participants. Data were collected by interviewing the participants using a pre tested structured questionnaire. Analysis was done by the authors using SPSS version 16.0 RESULTS: Age group of participants ranged from 32-70 years with mean age of 49.7 + 10.39. Early menarche < 13 years [Odds Ratio =3.2, p= 0.03], being unmarried and single, family history of breast cancer [Odds Ratio = 3.5, p = 0.02], previous history of benign breast tumours [Odds Ratio =8.14, p= 0.04], breast feeding less than 2 years [Odds Ratio = 2.28, p = 0.01 ] were found to be the risk factors for the breast cancer and the birth of first child before 30 years [Odds Ratio =0.302, p = 0.03 ] was found to be a protective factor for breast cancer. 60% of cases belonged to lower socioeconomic status [Odds Ratio = 14.47, p = 0.03]. Despite high literacy status, significantly lower awareness about symptoms of breast cancer and self examination of the breast were noted [Odds Ratio =11.6, p= 0.03].
  
  
  CONCLUSIONS
  Awareness about symptoms of breast cancer and self examination of the breast were lacking in the study population. Health care personnel should be trained to spread the awareness of breast cancer in the community and to identify the vulnerable groups at the primary care settings itself. The policy makers can consider encouraging community participation by involving the non-governmental organizations, women self help groups and Public Private Partnerships in spreading the awareness of breast cancer.
authors.affiliation: Assistant Professor, Department of Community Medicine, Karpaga Vinayaga Institute of Medical Sciences & Research Centre , Maduranthagam, Kanchipuram - 603308, Tamil Nadu, India .
authors.forename: P
authors.initials: P
authors.lastname: Parameshwari
authors.forename: K
authors.initials: K
authors.lastname: Muthukumar
authors.forename: H Gladius
authors.initials: HG
authors.lastname: Jennifer
keywords: Arpookara Panchayat; Case control study; Kottayam; Odds ratio