|Year : 2019 | Volume
| Issue : 1 | Page : 13-18
Health-Related Knowledge and Attitude Toward Common Cancers Among Slum Dwellers in Delhi
Damini Batra1, Dhruv Ahuja1, Malvika Sharma2, Bratati Banerjee3
1 Physican, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
2 Manager Epidemiologist, Piramal Foundation Delhi, India
3 Department of Preventive and Social Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
|Date of Web Publication||30-Apr-2019|
Dr. Bratati Banerjee
E-1803, Ajnara Homes, Ajnara Homes, Greater Noida West, UP
Source of Support: None, Conflict of Interest: None
Background: The dead weight of growing incidence and mortality of cancer is a cause of concern for increased economic burden in a developing country. Low awareness levels lead to late presentation and high mortality. Lack of awareness vitiates the screening and early detection measures. Hence, assessment of prevalent knowledge and attitude is cardinal to outline and implement health policies appropriately. Objectives: This study aimed to assess the knowledge and attitude regarding risk factors and early warning signs of common cancers, viz. oral, lung, breast, and cervix, among urban slum dwellers in New Delhi. Methods: This cross-sectional study was carried out in field practice area attached to the Department of Community Medicine, Maulana Azad Medical College, New Delhi, using a pretested semistructured questionnaire to evaluate the awareness levels in 100 study participants. Mean scores and proportions were calculated and Chi square was applied to test the difference in awareness levels across various sociodemographic variables. Results: Unsatisfactory mean scores were obtained, both for knowledge regarding warning signs (3.20 out of 6) and risk factors (5.67 out of 10). Knowledge regarding screening was also poor. Females were significantly more aware regarding passive smoking as a risk factor for future development of cancer (P = 0.012) and prevalence of some cancers (P = 0.010). Conclusion: Low mean scores for knowledge regarding warning signs and risk factors depict a general unawareness. Media advertising and education seemed to play a positive role as more participants were aware of signs of oral cancer and younger population was better acquainted with risk factors further emphasizing the need for health education. There is also a need to strengthen the screening activities.
Keywords: Attitude, common cancers, knowledge, risk factors, slum dwellers, warning signs
|How to cite this article:|
Batra D, Ahuja D, Sharma M, Banerjee B. Health-Related Knowledge and Attitude Toward Common Cancers Among Slum Dwellers in Delhi. MAMC J Med Sci 2019;5:13-8
|How to cite this URL:|
Batra D, Ahuja D, Sharma M, Banerjee B. Health-Related Knowledge and Attitude Toward Common Cancers Among Slum Dwellers in Delhi. MAMC J Med Sci [serial online] 2019 [cited 2019 Sep 19];5:13-8. Available from: http://www.mamcjms.in/text.asp?2019/5/1/13/257429
| Introduction|| |
In its projection, the Indian Council of Medical Research mentioned that in 2016, the total number of new cancer cases was expected to be around 14.5 lakhs and the figure is likely to reach nearly 17.3 lakh new cases in 2020. Over 7.36 lakhs of people were expected to succumb to the disease in 2016 while the figure is estimated to shoot up to 8.8 lakh by 2020. Data also revealed that only 12.5% of patients come for treatment in early stages of the disease. Cancer is the second most common disease in India responsible for maximum mortality with about 0.3 million deaths per year. The causes of such high incidence rates of these cancers may be both internal (genetic, mutations, hormonal, and poor immune conditions) and external or environmental (food habits, industrialization, overgrowth of population, pollution, social status, etc.).
Indian population-based cancer registries, based on the 2012–2014 data, had the highest age-adjusted rates (AARs) in cancers of the tongue and hypopharynx. Among males, seven northeast registry areas occupy top seven positions. Among females, four registry areas from northeast remained at the top followed by Delhi population-based cancer registry (144.8). In Delhi, the leading sites of cancer were lung (10.5%), mouth (6.9%), prostate (6.7%), tongue (6.5%), and larynx (5.7%) among males and breast (28.6%) followed by cervix uteri (10.8%), gall bladder (7.9%), ovary (7.2%), and corpus uteri (3.5%) among females.
An assessment of the existing levels of cancer awareness is a prerequisite for planning comprehensive health programs, early detection and treatment campaigns, that effectively engage communities of women and men. Diagnosis at advanced stages of disease contributes to the high mortality rate that can be attributed to low levels of awareness, cumbersome referral pathways to diagnosis, limited access to effective treatment at regional cancer centers, and incomplete treatment regimens. This study was conducted to assess the awareness regarding cancer and its related aspects.
| Methods|| |
This cross-sectional study was carried out in field practice areas attached to the Department of Community Medicine, Maulana Azad Medical College, New Delhi. The study participants included people aged 18 years and above, residing in the selected area who gave written informed consent to be a part of this study. Data was collected from May 2016 to June 2016. A pretested semistructured schedule was planned to collect information regarding various aspects of cancer such as early warning signs, risk factors, early detection measures, and source of information. Approval of the Institutional Ethics Committee of Maulana Azad Medical College was obtained before conducting the study.
To calculate the sample size, we referred to a previous study by Seth et al. conducted in an urban slum area of Delhi, which reported that 51% of the participants, in general, had some knowledge regarding cancer. Therefore, on the basis of this study, we assumed a prevalence of 50% and an absolute error of 10%, and the sample size was calculated to be 100.
Simple random sampling of the households was done with the help of random table using the household list available with the department as the sampling frame. The individuals from each household were selected by simple random sampling by lottery method.
| Results|| |
In total, there were 54 females and 46 males in the study population (n = 100). The median age of the respondents was 34.50 years, the median family income was Rs. 20,000 per month (median per capita income = Rs. 3750), and the median education level was 8th standard; 86% of respondents were married whereas 14% were unmarried.
The study population was interrogated about various aspects of cancer like warning signs, risk factors, screening, most prevalent cancers in different sexes, and so on.
Knowledge regarding warning signs
The individuals were asked about general warning signs of cancer like significant weight loss, tiredness, and signs of oral and laryngeal cancer, and the mean score was calculated to be 3.25 (out of 6) depicting a general unawareness.
Only the female participants were enquired about the awareness regarding the symptoms of breast and cervical cancer and a similar mean score was accounted (3.20 out of 6).
[Table 1] shows that the mean knowledge score (out of 6) for general warning signs of cancer and warning signs of oral and laryngeal cancer did not significantly differ across sociodemographic variables like age, sex, marital status, and education status.
|Table 1: Demographic characteristics of the study population and their association with mean knowledge scores for warning signs and risk factors of cancer|
Click here to view
The overall knowledge score regarding the symptoms of breast and cervical cancer was quite low and did not vary significantly with age (P = 0.901), education (P = 0.406), and marital status (P = 0.675). However, a higher proportion of females could correctly identify the warning signs of breast cancer like lump (81.5%) and ulceration (75.9%) as compared to signs of cervical cancer like vaginal bleeding (27.8%), unusual vaginal discharge (42.8%), and pain during intercourse (18.5%).
On comparing the knowledge level of individual warning signs, it was seen that the awareness level of warning signs of oral cavity was quite appreciable. Lump (82%) and sore (80%) in the mouth were the most common symptoms identified [[Table 2]].
|Table 2: Variation in awareness regarding general warning signs and signs of oral and laryngeal cancer with gender|
Click here to view
Knowledge regarding various risk factors of cancer
The mean knowledge score for risk factors of cancer was calculated to be 5.67 (out of 10). Further, it was seen that the mean score (out of 10) did not significantly differ with any sociodemographic variable [[Table 1]].
On comparing the individual risk factors, a significantly higher percentage of females (92.6%) than males (76.1%) was aware that passive smoking could be a cause of cancer (P = 0.012). Awareness regarding other risk factors did not significantly differ [[Table 3]].
|Table 3: Variation in awareness regarding risk factors of cancer with gender|
Click here to view
Knowledge regarding screening for cancer
A higher percentage of females than males was aware of screening for breast (males 43.5%, females 59.3%) and cervical (males 39.1%, females 50%) cancer. The awareness regarding the age of initiation of screening was still lower and depicted the same pattern of females being more aware than males for both breast (males 21.7%, females 31.5%) and cervical (males 10.9%, females 11.1%) cancer.
Knowledge regarding prevalence of common cancers
Females were significantly more aware than males regarding the prevalence of cancers in males (P = 0.010) whereas the knowledge regarding prevalence of cancers in females did not significantly differ. The knowledge of this prevalence did not significantly differ for other sociodemographic variables.
| Discussion|| |
It has already been emphasized that cancer is a leading cause of mortality worldwide. The number of new cases and deaths are projected to continue rising.
Many lacunae were found in knowledge about common cancers among the population of urban slum dwellers. Low mean scores (3.25 out of 6 for knowledge regarding warning signs of oral and laryngeal cancer and 3.20 out of 6 for knowledge regarding warning signs of breast and cervical cancer among women population) depict a general unawareness. Similar results were obtained in a study conducted by Seth et al. in an urban slum in West New Delhi in which 3% individuals were aware of the risk factors and 2% of the signs of common cancers. Both the community members and the healthcare workers have been found to have a grossly inadequate or poor knowledge about common cancers.
On a positive note, a higher percentage of population was aware of warning signs of oral cancer like sore in the mouth (80%), lump in the cheek (82%), and white patch in the oral cavity (58%). The results were comparable to that reported by Sangeetha et al. and Seth et al.
The overall knowledge scores for the awareness of warning signs of breast and cervical cancer were reported to be quite low (mean score 3.20 out of 6). But the level of knowledge regarding warning signs was higher for breast cancer than cervical cancer.
The results for the awareness of risk factors also depicted a general ignorance. Just 3% and 12% could identify tobacco and cigarettes as the causes of cancer, respectively. This was quite contradictory to the fact that a high percentage of the population was aware of oral cancer despite the extensive media campaigns. Other studies in India, Poland, UK, and USA have also reported people being aware of tobacco as the most important risk factor for cancer.
The awareness regarding other risk factors like lack of exercise, adiposity, exposure to passive smoke, and family history was also low. Only 19% of the individuals said that unsafe intercourse could be a risk factor for cancer that corresponds to the lack of discussion on other important risk factors such as alcohol, reproductive history, and adiposity.
Awareness rabout the age of initiation of screening also was too low regarding both breast (males 21.7%, females 31.5%) and cervical (males 10.9%, females 11.1%) cancer. A higher percentage of females than males was aware of screening for breast (males 43.5%, females 59.3%) and cervical (males 39.1%, females 50%) cancer. The unawareness rates of secondary prevention are congruent to those obtained in the studies performed in New Delhi, Chandigarh, and South Africa.
The level of awareness for some parameters like passive smoking as a risk factor for cancer, awareness regarding screening of breast and cervical carcinoma, and incidences of common cancers in males was higher in females as compared to males that could be attributed to higher exposure to media platforms like television and higher interpersonal communication. It was also seen that the younger population was more aware of risk factors of cancer than their older counterparts evident from their higher mean scores. This can be explained by their educational involvement and other active roles in the society that keeps them more informed. For most of the other parameters, there were no significant differences in the awareness levels with respect to sex, education level, income, occupation, and marital status, which depicts a general lack of health education at all levels.
Low informed coverage through different forms of media is also responsible for the lack of awareness. In India, the media publicity and policy efforts on cancer prevention have primarily focused on reduction and perils of tobacco use, which is responsible for higher level of awareness regarding signs of oral cancer. The higher prevalence of oral cancer might also be responsible for this higher awareness resulting from higher interpersonal communication. The virtually nonexistent awareness efforts against breast and cervical cancer are in parallel to the low knowledge scores obtained.
Patient survival is influenced by early diagnosis and treatment, especially in developing countries, owing to the resource crunch for diagnostic and treatment facilities. Lack of awareness regarding the warning signs and risk factors are primary reasons for delayed presentation. So, emphasis must be on primary and secondary prevention through intensive health education as higher levels of awareness translate into better outcomes.
Efforts to raise the awareness under National Cancer Control Programme (NCCP) have not reached the masses. Hence, there is a need for more strategic efforts. WHO Global School Health Initiative that is designed to instil school-wide health promotion and education activities in policy and practice by changing school health policies, physical environment, community relationships, personal health skills and health services is one such strategy.,,,
Sources of health information include intrapersonal, interpersonal, and mass media. Intrapersonal sources consist of all previous knowledge, beliefs, and attitudes about health developed from lifetime experiences. Interpersonal sources include healthcare professionals, relatives, and friends. The studies have established the lack of penetration of Information, Education, communication (IEC) activities and lack of involvement of healthcare personnel in IEC activities. So, there is also a need for continuing medical education program with enhanced emphasis on cancer in curriculum of nursing and other hospital staff to serve as mediators of information to the community.
Offering respondents a middle alternative in a survey question makes a difference in the conclusions that would be drawn from the data. The middle option of an attitudinal scale attracts a substantial number of respondents who might be unsure of their opinion. Shyness in answering the questions related to intercourse, breast, and cervical cancer could be a factor in eliciting a low response. There is a possibility of recall bias, observer bias while integrating the data. Knowledge regarding awareness of tertiary prevention and treatment modalities was not assessed. Health-seeking behavior and possible modes of acquisition of health-related knowledge should also be assessed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kernel A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer Statistics, 2007. CA Cancer J Club 2007;57:43-66.
Julka PK, Manoharan N, Rath GK, National Cancer Registry Programme. New Delhi: Indian Council of Medical Research, 2012-2014 [Cited February 13, 2017]. Available at www.nrcpindia.Org
Seth T, Kotwal A, Thakur R, Singh P, Kochupillai V. Common cancers in India: knowledge, attitudes and behaviours of urban slum dwellers in New Delhi. Pubic Health 2005;119:87-96.
Veena KS, Kollipaka R, Rekha R. The Knowledge and attitude of breast self examination and mammography among rural women. Int J Reprod Contracept Obstet Gynecol 2015;4:1511-6.
Sangeetha J, Balaji P, Govindraju P, Srivastava A, Krishna TS. Awareness of oral cancer, oral potentially malignant disorders and their risk factors among dental patients: a cross sectional study. Int J Oral Care Res 2016;4:174-8.
Raczkowska A, Zakrzewska J, Pogorzelska B. Pilot study on Polish public’s knowledge and attitudes towards oral cancer. Oral Dis 1997;3(Suppl 2):S35.
Wardle J, Waller J, Brunswick N, Jarvis MJ. Awareness of risk factors for cancer among British adults. Public Health 2001;115:173-4.
Horowitz AM, Nourjah P, Gift HC. U.S. adult knowledge of risk factors and signs of oral cancers. JADA 1995;126:39-45.
Puri S, Mangat C, Bhatia V, Kaur A, Kohli D. Knowledge of cancer and its risk factors in Chandigarh, India. Internet J Epidemiol 2009;8:1-7.
Pillay AL. Rural and urban South African women’s awareness of cancers of breast and cervix. Ethn Health 2002;7:103-14.
Ministry of Health and Family Welfare, Government of India Annual Report 2009-2010, in The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, (2003) and Related Rules & Regulations; 2003.
Anbazhagan S, Shanbhag D, Antony A, Bhanuprakash K, Anbazhagan S, Chandran N et al.
Comparison of effectiveness of two methods of health education on cancer awareness among adolescent school children in a rural area of Southern India. J Family Med Prim Care 2016;5:430-4.
] [Full text]
Gupta S, Jain M, Roy P, Maiti D. Effect of a health education program on cancer awareness among college students: responding to the challenges of cancer control in India. Int J Med Sci Public Health 2014;3:146-9.
Gupta A, Shridhar K, Dhillon P. A review of breast cancer awareness among women in India: cancer literate or awareness deficit? Eur J Cancer 2015;51:2058–66.
El Saghir N, Adebamowo CA, Anderson BO. Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. Breast 2011;20(Suppl 2):S3-11.
[Table 1], [Table 2], [Table 3]