Breast cancer remains one of the most prevalent and life-threatening forms of cancer affecting women globally. Despite significant advancements in medical technology and treatment options, early detection remains a cornerstone in reducing morbidity and mortality associated with the disease. Awareness and knowledge about breast cancer are critical components in empowering individuals to engage in proactive health behaviors, such as regular self-examinations and participation in screening programs.^1-6

The district of Shimla in Himachal Pradesh, known for its unique demographic and cultural characteristics, presents distinct public health challenges and opportunities. While various national and regional initiatives have been launched to combat breast cancer, there is limited data on the specific levels of awareness and knowledge within this population. Understanding these levels is crucial for designing effective, localized health education interventions.

This study aims to fill this knowledge gap by assessing the awareness and knowledge of breast cancer among adults in District Shimla. By employing a descriptive research approach and a cross-sectional survey design, this study seeks to provide a detailed snapshot of the current state of public knowledge on breast cancer. The findings will inform public health strategies and educational campaigns tailored to the unique needs of the Shimla district's residents.

Through this research, we aim to identify areas where knowledge is lacking and to understand the demographic factors that influence awareness levels. The ultimate goal is to contribute to the reduction of breast cancer incidence and improve early detection rates through targeted educational efforts, thus enhancing the overall health outcomes for the population of Shimla

The primary objective is to gauge awareness and knowledge about  Breast cancer among general public of District Shimla ,Himachal Pradesh.

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Shimla , Himachal Pradesh

• Study duration- between January  2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Hypertension, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Hypertension was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Hypertension. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained.

The study's socio-demographic variables provide a comprehensive overview of the diverse participant pool from District Shimla, Himachal Pradesh. The age distribution reveals that the majority of participants were young adults, with 29.5% falling in the 18-30 age group, followed by 25.75% in the 31-40 age bracket. Middle-aged participants (41-50) comprised 20.5%, while older adults (>50) made up 24.25%. Gender distribution was slightly skewed, with females representing 55.25% of the sample compared to 44.75% males. In terms of marital status, 54.0% of participants were married, 40.5% were single, and a small fraction (5.5%) identified with other marital statuses. The predominant religion was Hinduism, accounting for 74.5% of participants, with Muslims and Sikhs each representing approximately 10%, and 4.75% belonging to other religions. Employment status varied, with half of the participants being employed (50.25%), 25.75% unemployed, and 24.0% students. Educational attainment ranged widely; 34.25% had completed high school, 30.5% were graduates, 20.0% had postgraduate or higher qualifications, and 15.25% had education below high school level.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

The knowledge assessment regarding breast cancer, reflected in Table 2, showed varied levels of awareness among participants. A high awareness of the importance of early detection was noted, with 79.75% correctly identifying its significance. Knowledge about breast cancer symptoms was also substantial, with 69.5% correct responses. Breast self-examination practices were well understood by 74.75% of participants. Awareness of risk factors was moderate at 59.75%, while knowledge about screening methods was identified by 55.25%. Treatment options were correctly known by 64.75% of participants, but only 45.25% were aware of survival rates. Genetic predisposition was understood by 49.5%, and 57.25% recognized the impact of lifestyle on breast cancer risk. The role of diet and exercise was correctly identified by 67.75%, and 53.0% were aware of age as a risk factor. The importance of regular check-ups was well known (77.75%), while fewer participants were aware of the effects of alcohol consumption (47.75%) and the link between smoking and cancer (62.75%). Family history as a risk factor was correctly understood by 65.25%, and the impact of hormone replacement therapy was known by 49.75%. Benefits of breastfeeding were identified by 70.5%, and the importance of mammograms was recognized by 75.25%. Awareness of government health programs was relatively low at 37.75%, and knowledge about support groups and resources was 42.75%.

Table 2: Knowledge Regarding Breast Cancer (N=400)

The overall knowledge scores, as detailed in Table 3, categorized participants into four distinct groups. Approximately 29.75% of participants fell into the "Very Good" category, scoring between 16-20, indicating a high level of knowledge about breast cancer. The largest proportion of participants, 37.0%, had "Good" knowledge with scores ranging from 12-15. Those with "Fair" knowledge, scoring between 8-11, comprised 23.0% of the sample. Finally, 10.25% of participants scored below 8, categorized as having "Poor" knowledge, highlighting a significant gap in awareness that needs addressing through targeted educational interventions.

Table 3: Overall Knowledge Score Categories

The results of this study provide a comprehensive overview of the current state of awareness and knowledge about breast cancer among adults in District Shimla, Himachal Pradesh. The socio-demographic profile of the participants highlights a diverse population with varied backgrounds, which is crucial for understanding the differential levels of awareness and tailoring public health interventions accordingly.

The age distribution indicates that young adults (18-30 years) constitute the largest segment of the study population, followed closely by those in the 31-40 age bracket. This is significant as younger populations are often more receptive to educational interventions, particularly those delivered via digital platforms. The gender distribution reveals a higher participation rate among females, which is pertinent given that breast cancer predominantly affects women, making their awareness levels particularly critical.

Marital status and religious affiliation also play a role in shaping health behaviors and access to information. The predominance of Hindu participants, with smaller proportions of Muslims, Sikhs, and others, suggests that culturally tailored educational programs might be more effective. Employment and education levels further contextualize the data, with a substantial number of participants being employed and having at least a high school education. This indicates a potentially higher baseline level of health literacy, which can be leveraged in awareness campaigns.

The knowledge assessment regarding breast cancer reveals mixed levels of awareness among participants. High awareness of the importance of early detection (79.75%) and regular check-ups (77.75%) is encouraging, as these are critical components of effective breast cancer management. However, there are notable gaps in knowledge regarding survival rates (45.25%), genetic predisposition (49.5%), and the impact of hormone replacement therapy (49.75%). These areas require targeted educational efforts to ensure comprehensive understanding.

The awareness of symptoms, breast self-examination practices, and screening methods is relatively high, with correct responses ranging from 55.25% to 74.75%. This suggests that general knowledge about breast cancer is fairly widespread, but there is still room for improvement, particularly in understanding specific risk factors and advanced treatment options. The lower awareness of government health programs (37.75%) and support groups (42.75%) indicates a need for better dissemination of information about available resources and support networks.

The overall knowledge score categories provide a clear picture of the population's understanding of breast cancer. While nearly 30% of participants fall into the "Very Good" category, a significant portion (37%) have "Good" knowledge, and 23% have "Fair" knowledge. The 10.25% of participants in the "Poor" knowledge category highlight a critical area for intervention. These findings underscore the necessity for targeted educational initiatives to bridge the knowledge gap and enhance overall awareness.

The implications of this study are far-reaching. By identifying specific areas where knowledge is lacking, public health officials and educators can design more effective and targeted interventions. For example, campaigns that focus on the importance of understanding genetic predisposition and the impact of lifestyle choices could significantly improve overall awareness and preventive behaviors.^7-12

Moreover, the relatively low awareness of government health programs and support groups suggests that these resources are underutilized. Increasing visibility and accessibility of these programs could provide much-needed support to individuals affected by breast cancer and their families.

In conclusion, this study highlights the importance of localized health education interventions that consider the unique demographic and cultural characteristics of the population. By addressing the identified gaps in knowledge and leveraging existing awareness, public health initiatives can be more effective in reducing the incidence and improving the early detection of breast cancer in District Shimla. The findings serve as a crucial foundation for developing comprehensive strategies aimed at enhancing breast cancer awareness and ultimately improving health outcomes in the region.

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