Introduction

In the entire globe, cancer is the leading cause of death. If early detection and prompt access to therapy were available to cancer patients, millions of people each year could be spared from suffering and early death.1 Particularly in low- and middle-income nations, cancer is a serious public health issue that causes high rates of morbidity and death.2 With 12.5% of all fatalities caused by it, it is the most prevalent non-communicable illness worldwide.3

The two cancers that kill the most women from cancer globally are breast and cervical cancer, but these illnesses are largely preventable. Breast, ovarian, and cervix cancers—which together made up 59% of all cancers in women—were all found to have high incidence rates in India. According to projections, breast cancer will account for 30% of all new cases of cancer in women in 2022. According to the World Health Organization, breast cancer rose to the top spot among all cancers as of 2021, making up 12% of all new cancer cases reported annually internationally.4

According to projections, more than 2 lakh women in India were expected to receive a breast cancer diagnosis in 2020, and more than 76,000 fatalities were anticipated. It is anticipated that by 2025, there will be more than 2.3 million instances, as stated in the 2020 National Cancer Registry Program report.5 When cancer is first diagnosed, more than two-thirds of patients are already in an advanced, terminal state.6

Similar to this, low- and middle-income nations bear a disproportionately large share of the impact of cervical cancer globally, accounting for 85% of cervical cancer deaths and 83% of all new cases.7 With 60,078 fatalities and 96,922 new instances of cervical cancer in 2018, India is responsible for almost a quarter of cervical cancer deaths globally.8

The second most frequent cause of cancer mortality among Indian women is this disease, which is mainly preventable.9 Higher income nations have successfully decreased their burden of cervical cancer by up to 65% over the course of four decades by implementing Human Papilloma Virus (HPV) vaccination and screening campaigns.10 The bulk of cervical cancer cases can be avoided by immunising adolescents against HPV 16 and HPV 18, which are responsible for about 70% of cervical cancers. Most instances of cervical cancer are preventable. Furthermore, routine screening permits early discovery and removal of precancerous lesions.

Only opportunistic screening, which is typically provided in private medical facilities in urban areas, is accessible in many developing nations.11

A rural woman's health is also harmed by sociocultural, economic, and environmental factors, which limit her access to medical facilities and her ability to receive health care. Rural areas are home to nearly 72% of India's people.9 According to the findings from Sweden and Barshi, India, the presently available evidence indicates that a shift towards early stages (Figure 1) may be achieved at a great deal lower cost by health education and improved awareness.12 Furthermore, the state of health care systems in many regions of India today indicates that merely improving cancer treatment may not be enough to address the rising cancer burden.12 By using current understanding of the main risk factors and the natural history of the disease, much could be accomplished in the prevention of cancer.13 Decreased incidence and prevalence of breast and cervical cancer can be achieved in part by implementing health promotion initiatives on diet, physical exercise, sexual health, quitting smoking, and alcohol consumption.14 However, in order for such initiatives to be effective, it is critical to comprehend health behaviours and the variables affecting attitudes and perceptions towards cancer. That's what the goal of the current study was.

It may be possible to create locally relevant and targeted awareness campaigns with the assistance of an understanding of the factors that promote the use of cancer screening activities. This research was conducted to identify the opportunities and barriers in the use of current screening services for the early detection of cervical and breast cancer among rural women in a tertiary care centre in Sitapur, U.P.

Materials and Methods

This prospective study was performed from 1 February 2021 to 28 July 2022 at the Hind Institute of Medical Sciences Department of Obstetrics and Gynecology, Athariya, Sitapur. This study was approved by the Institutional Human Ethics Committee. Informed consent was obtained before participants freely agreed to participate in the study after the investigators thoroughly explained the purpose and objectives of the study to them in their native tongue. An individual who visited the Hind Institute of Medical Sciences in Mau, Attaria, and Sitapur during the research period served as the initial source of our study's data. At HIMS Sitapur, a systematic sampling process selects every tenth woman between the ages of 20 and 65 who goes. Breast and cervical cancer survivors were excluded, as were women with these prior diagnoses. Patients who didn't give their consent and didn't fit the inclusion requirements were not included in the study. To achieve this, we used academic research and industry professionals to create a semi-structured questionnaire.

After that, it was edited and translated into Hindi. The translation has been checked once more. The questionnaire asked closed-ended questions about various topics, including what cancer is, its risk factors, how often it can be cured, its causes, how to screen for it, and various justifications for not getting tested. It is investigated how sociodemographic factors relate to perceptions, attitudes, barriers, and practises. 36 inquiries were created. The analysis also took into account per capita income, family type, age, education, and occupation. Data were gathered using a pre-designed structured questionnaire after receiving written informed consent from each participant.

Help was given even to illiterate women. A Microsoft Excel spreadsheet was filled out with all the data entered into the predefined performa. For different categorical variables, data were computed as frequencies and percentages. Answers with clear categories—yes, no, and don't know—were used for the knowledge factor. After the last set of data was collected, descriptive cross-tabulation statistics were run and percentages of correct and incorrect answers for all questionnaires were calculated.

Results

Discussion

Breast cancer is more common than cervical cancer in India, where the incidence is 25.8 per 100,000 women, compared to 23.07 per 100,000 for cervical cancer. Both cancers account for roughly 2.5 lakh cases and nearly 1 lakh death per year in India.15 The morbidities and mortality that are linked to breast and cervical cancers can be greatly reduced by early detection. However, Breast self-examination (BSE) and uptake of screening for cervical cancer in India is not promising. The purpose of this study, then, was to evaluate the knowledge, awareness, and barriers of early detection of cervical and breast cancer in a tertiary care rural hospital.

In this research, adult women undergoing treatment at a tertiary care rural hospital in north India were asked about their knowledge, attitudes, and screening practises regarding breast and cervical cancer. Although several research studies were conducted with similar objectives in India but concerning to our area no such extensive study is reported. For two reasons, this study is distinctive. To identify risk factor associations, research on women of all ages with diverse demographic characteristics and knowledge-based concepts was conducted. Similar to this, the majority of prior studies carried out in the study population have only identified, without examining, the relationship between participants' demographic and sociocultural backgrounds and their awareness of and knowledge of breast and cervical cancer. Therefore, the goal of this study was to close and fill in these knowledge gaps.

Contrary to our research, other studies have indicated that a greater percentage of women are aware of cervical cancer.16, 17 Women who attend these health centres may have better conditions. Younger, better educated women knew more about cervical cancer than older, less well-educated women, according to a study from north-central India.

This research revealed that there was a shockingly low level of knowledge about cervical cancer among women who visited our tertiary care hospitals. According to studies by Chandrika et al.[Reichheld et al.,8 Ahlawat et al.,18 and Narayana et al.19 only 148 participants (24.7%) had heard of cervical cancer. For cervical cancer, the range is 34-74%.

As in other studies published in India, our study participants had little awareness of risk factors and signs and symptoms. In our study, 93.5% of knowledge, don't know answers related to cervical cancer symptoms showed an extremely low rate cervical cancer.9, 16, 17, 20, 21 Between symptoms (0.5%), awareness, and other factors, there was an extremely low response.

High-risk groups (2.7%), young marriages (3.7%), long-term COC use (3.2%), poor hygiene (6.5%), and big families (0.7%). Patra et al.17 found that women's knowledge of cervical cancer screening procedures was lower than that of the majority of women in our study. (2011), Bansal et al.16 (35%) and Nigar and colleagues (8%).21 Only 20.3% of participants were aware of the Pap smear test, while 21% were aware of the HPV vaccine, 9.3% were aware of cervical cancer screening, and 74.5% said they would get the vaccine if the government provided it. As we studied, I was prepared. Previous reports of improved outcomes exist.96,98,100,103 Our study's findings imply that participants had little knowledge of various parts of cervical cancer and its detection procedures.

Additionally, we used a scoring method to determine its relationship to demographic data, with an overall good knowledge score (3.5%) and poor knowledge observed in 96.5% of the population. For the 20–30 year old, 40–50 year old, Hindu, over 25 BMI, nursing staff, private job of husband occupation, and married of marital status subgroups, all associated factors have more than 9 mean knowledge score (Good). The large disparity between the means of the two groups is also demonstrated by additional statistically significant differences. In contrast to our research (max. 13.6), lower levels of score were reported in earlier studies by Saini et al. (6.33)22 and Lee-Lin et al. (5.46%)23 and higher by Kumar et al. (18.8).24

95.5% of the participants in the current study reported having heard of breast cancer, which is higher than the percentages reported by Shreshta et al. (30%)25 and Tripathi et al. (34.88%).9 .More than 20% of women have held nursing positions in the healthcare industry, and many more have heard or read about it, so there may be a high level of awareness.

In another study done in a hospital setting, 95% of people who went to an outpatient surgery department had heard of breast cancer. However, only 45.5% of the women in this study had average knowledge, and only 4.5% had good knowledge, despite the fact that the percentage of women who had heard of breast cancer was high. In community-based research 8.

1% reported having excellent understanding and 45.3% average knowledge.26 In a survey of Delhin teachers, 92.7% reported knowing at least one sign and symptom.27

A higher percentage was found in this study (59.7%), compared to another study where 15% of women reported a family member, friend, or relative with a history of cancer as their source of information. Breast tumours (51.2%) were significantly more common in urban women (33.45%) than rural women (33.45%) as a sign of breast cancer, according to Padmavathi et al. (66.1%).28  According to a research conducted in a Mumbai surgery outpatient department, 40% of the patients recognised at least five breast cancer symptoms, and all patients could list at least one symptom.25 Studies have found that knowledge levels were associated with age, marital status, education and social class/income.9, 29 This presumably explains why in the current study the knowledge levels are higher than general population but less than the teachers.

Such higher knowledge level may be ascribed due to more than 20% of nursing staff and students also these difference observed could be due to the fact that women were all workers of a tertiary care hospital and interact with physicians much more than other groups of population. As opposed to the 24.8% of women in our research, not breastfeeding was reported as a risk factor for breast cancer by 7.69% of university professors, 12.81% of rural women, and 88.8% of patients.9, 25, 30

The knowledge of additional risk factors was minimal or nonexistent in this study, in contrast to other studies that noted age, oral contraceptive use, and infertility.25, 30, 31 By Padmavathi et al. (38.6%) and other28, 32 it was stated that 41.3% of women were aware of breast self-examination.33 According to the research by Khokhar et al., the ideal age, timing, and frequency for mammography were known until ages 31.9%, 10.5%, and 21.6% for women.27 In this study, SBE was tested at a rate of 6.2% whereas other studies reported a range of 11–19%.30, 34

44.5% of the patients in this study had a good level of breast cancer knowledge according to the knowledge rating system. The research revealed significant variations in age, risk factor levels, education, and awareness. This study and a study by Gupta et al.35 show that Indian women, regardless of socioeconomic status and educational level, have low awareness of the risk factors for breast cancer.

Meanwhile, Grosomanidis et al.36 demonstrated that lower breast cancer awareness was associated with lower levels of education. These findings of the above study (Dinegde et al.)37 are consistent with our study.

Conclusion

In conclusion, the study revealed poor awareness of cervical and fear of breast cancer to be significantly associated with the poor education level. The study found out that higher percentage of the respondents answered the questions about breast cancer and lower to cervical cancer. Developing of public screening and educational program through health care system more emphasis on rural areas and less educated women. Promoting cervical/breast cancer awareness would lead to early detection and reduce the stage at diagnosis, potentially improving the odds of survival and cure with simpler and more cost-effective treatment. Overall this inadequate level of knowledge/awareness could be due to poor mass media campaign on specific aspects of prevention and control for cervical/breast cancer, cultural barriers preventing open discussion with peers.Therefore, governments, non-governmental organizations and other societies are encouraged to regularly provide educational campaigns and screening programs to women as well as their families to raise awareness and reduce the problem. Further development of public screening through the health care system, with a greater focus on rural areas and uneducated women. Studies with larger sample sizes are needed to evaluate cognitive programs to get a better idea of ​​the results.

Source of Funding

None.

Conflict of Interest

None.