Screening for breast cancer in a low middle income country: predictors in a rural area of Kerala, India.
BACKGROUND
In India, breast cancer is the leading malignancy among women in a majority of the cancer registries. Therefore it is important to understand screening practices and its predictors, including in rural areas with high female literacy and good health indices.


METHODS
A cross-sectional study with multistage sampling was conducted in Vypin Block, Ernakulam district, Kerala, India. Four Panchayats (self administration units) were randomly chosen and a woman in every second household was invited to participate from the tenth ward of each. Thus a total of 809 women were interviewed.


RESULTS
The majority of the repondents (82.1%) were not aware of risk factors and about a third (37.9%) were not aware of symptoms of breast cancer. About half of the population studied (46.6%) had undergone screening. Age (35-50 years), being married, health professionals as source of information and working were significant predictors of screening. Logistic regression showed that older women (35-50 yrs) were more likely to practice screening. Out of the never screened, about a third (35%) were desirous of doing it, but had not for various reasons and 53.5% were not willing to screen. The reasons identified for not screening among those desirous of doing it were grouped into knowledge 66 (43.4%), resources 23 (15.1%) and psychosocial 32(21.1%) factors. Unmarried women were significantly more likely to express factors related to all the three domains.


CONCLUSIONS
This study showed that in spite of the absence of a population-based screening program, about half of the study population had undergone some type of screening. The older women (35-50 years) in particular were significantly more likely to practice screening. At this critical juncture, a high quality breast cancer awareness and screening initiative can help to consolidate the gains and tackle knowledge, resource and psychosocial barriers.
Community Medicine Amrita Institute of Medical Sciences, Ponnekkara P.O Amrita Vishwa Vidyapeetham Kochi, Kerala E-mail : aswathys@aims.amrita.edu,draswathygopan@gmail.com.
Aswathy
A
Sreedevi
Mariya Amin
MA
Quereshi
Beteena
B
Kurian
Leelamoni
L
Kamalamma
D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D007194:India; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult