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 cancerregistries. Therefore it is important to understand screening practices and its predictors, including in ruralareas with high female literacy and good health indices. Materials and
Methods: A cross-sectional study withmultistage sampling was conducted in Vypin Block, Ernakulam district, Kerala, India. Four Panchayats (selfadministration units) were randomly chosen and a woman in every second household was invited to participatefrom 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, healthprofessionals as source of information and working were significant predictors of screening. Logistic regressionshowed that older women (35-50 yrs) were more likely to practice screening. Out of the never screened, about athird (35%) were desirous of doing it, but had not for various reasons and 53.5% were not willing to screen. Thereasons 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 toexpress factors related to all the three domains.
Conclusions: This study showed that in spite of the absence of apopulation-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 criticaljuncture, a high quality breast cancer awareness and screening initiative can help to consolidate the gains andtackle knowledge, resource and psychosocial barriers.