Breast cancer is a major killer disease in females globally and in developing regions, where the early cancer detection facilities are unavailable, prognosis is even worse. Awareness about this disease can lead to early detection and thereby decrease the morbidity and mortality. A self designed questionnaire was used to study the level of awareness regarding breast cancer among males.  The questionnaire had 15 questions and on the basis on score attained, the  subjects were classified as having poor, average or good breast cancer awareness. Out of 624 participants, 555(89%) had poor breast cancer awareness and 47(7.5%) had average awareness. Only 22 (3.5%) had good awareness about breast cancer. The level of awareness regarding female breast cancer in Kashmiri males is very low. Measures need to be taken to spread awareness about this disease in males so that they can play a vital role in early detection of this disease

Rather, A

Salati , SA

English

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Awareness regarding female breast cancer in Kashmiri males - A study

Sajad Ahmad Salati

Ajaz Rather

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Original Article:
Awareness regarding female breast cancer in Kashmiri males - A study
Sajad Ahmad Salati, Ex-Senior Resident, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
Ajaz Rather, Consultant, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
Address For Correspondence:
Dr. Sajad Ahmad Salati, 
Assistant Consultant,
Department of Surgical Specialties,
King Fahad Medical City, Riyadh,
Saudi Arabia.
E-mail: docsajad@yahoo.co.in
Citation: Salati SA, Rather A. Awareness regarding female breast cancer in Kashmiri males - A study.  Online J Health Allied Scs.  
2009;8(4):11
URL: http://www.ojhas.org/issue32/2009-4-11.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Dec 1, 2009; Accepted: Apr 1, 2010; Published: Apr 30, 2010
Abstract:
Breast cancer is a major killer disease in females globally and 
in developing regions, where the early cancer detection facilit-
ies are unavailable, prognosis is even worse. Awareness about 
this disease can lead to early detection and thereby decrease 
the morbidity and mortality. A self designed questionnaire was 
used to study the level of awareness regarding breast cancer 
among males.  The questionnaire had 15 questions and on the 
basis on score attained, the  subjects were classified as having 
poor,  average  or  good  breast  cancer awareness.  Out  of  624 
participants, 555(89%) had poor breast cancer awareness and 
47(7.5%) had average awareness.  Only 22 (3.5%) had good 
awareness about breast cancer. The level of awareness regard-
ing female breast cancer in Kashmiri males is very low. Meas-
ures need to be taken to spread awareness about this disease in 
males so that they can play a vital role in early detection of 
this disease.
Key Words: Breast cancer, males, cancer awareness, teacher
Introduction:
Breast Cancer is globally one of the major killer diseases in 
women 1. In economically deprived regions of the world, lack 
of awareness about breast cancer and less availability of spe-
cific breast clinics, results in delay in seeking medical care and 
hence  in  poorer  prognosis  2.  In  Kashmir  valley,  dedicated 
breast  cancer  screening  clinics  are  not  existent  and  hence 
breast  cancer  awareness  can be  a  tool  to  fight  this  disease. 
Spouse  is the one person who is physically and emotionally 
intimate to a woman and can become a great medium in early 
detection of breast cancer in females but this is possible only if 
males are aware about the features of female breast cancer. In 
literature,  most  of the studies have concentrated in studying 
the level of breast cancer awareness in females only and virtu-
ally no data is available regarding female breast cancer aware-
ness in males. This study was undertaken to study the level of 
awareness regarding breast cancer among Kashmiri males.
Materials and Methods:
A study was conducted in the Department of General Surgery, 
Sheri-Kashmir  Institute  of  Medical  Sciences,  (Medical  Col-
lege), Bemina, Srinagar, Kashmir,  India over a period of 18 
months from September 2007 to February 2009, to assess the 
level of awareness regarding breast cancer in Kashmiri men. 
624 patients  admitted in the department  for management  of 
various common surgical diseases and their male visitors were 
selected randomly and explained the purpose of the study as 
per the ethical guidelines of Helsinki. The persons who agreed 
to participate in the study were requested to answer a self de-
signed  questionnaire  after  assuring  them  of  confidentiality. 
Only married persons were included in the study. The exclu-
sion criteria included family history of breast disorders and oc-
cupation  (self  or  spouse)  in  healthcare,  on  the  presumption 
that their level of awareness might be higher than the general 
population. The questionnaire included basic signs and symp-
toms of breast cancer as shown in Table 1. The questionnaire 
was designed after taking text books of general surgery3 and 
Toronto breast self examination inventory4 into consideration. 
Attempt was made to simplify the questionnaire with the aim 
of getting insight into level of knowledge with minimum pos-
sible consumption of time of the participants. There were 15 
features  related  to  breast  cancer  in  the  questionnaire  and 
awareness regarding each feature earned 1 point and no point 
was awarded if the lady was unaware. Accordingly three cat-
egories  of  breast  cancer  awareness  were  defined as  per  the 
total scores as depicted in Table 2.
Table 1: Self designed questionnaire to assess breast can-
cer awareness (Score 0 if unaware, 1 if aware)
Features/ Risk factors of Breast  Cancer
A Breast lump or thickening that feels different from the sur-
rounding tissue
Bloody discharge from the nipple
Change in the size or shape of a breast
Changes to the skin over the breast, such as dimpling
Inversion of nipple
Peeling or flaking of the nipple skin
Redness or pitting of the skin over your breast, like the skin of 
an orange
A lump or thickening in the underarm area
Being female
Increasing age
Family history of  breast cancer
Beginning menstrual period at a younger age(less than 12 yrs)
Having the first child at an older age(above 35 yrs)
Beginning menopause at an older age (above 50 yrs)
Pain 
1
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Online Journal of Health and Allied Sciences
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Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 8, Issue 4; Oct - Dec 2009
Table 2: Categories as per the attained scores  
Score Categories of awareness level
0-5 Poor awareness
6-10 Average awareness
11-15 Good awareness
Data was processed and analyzed after one year of study peri-
od with the aid of SPSS software (statistical package for social 
sciences version- 10).
Results:
During the study period 1279 males were approached for par-
ticipation in the study and out of these 855 subjects refused to 
participate in the study. As shown in Fig 1, out of 624 parti-
cipants, only 22 (3.5%) had good awareness about breast can-
cer. The results   derived after analysis of data are given in the 
following figures (Fig.1-2) and tables (Table 3- 6).
Table 3: Awareness as per the economic status
Awareness   level Income group( in Indian Rupees)<5000 5000-10000 >10000
Poor awareness 243 189 123
Average awareness 10 27 15
Good awareness 02 06 13
Table 4: Awareness as per the educational background
Awareness   level Educational backgroundNo education Primary level Secondary level Graduate and above
Poor awareness 241 128 147 39
Average awareness 1 3 11 32
Good awareness 0 3 7 11
Table 5 : Awareness as per the occupation
Awareness   level Professional  background
Farmers/ laborers Drivers/bus conductors Business men Teachers Students Office goers
Poor awareness 219 18 162 34 21 101
Average awareness 5 0 4 11 9 18
Good awareness 1 0 7 4 3 6
Table 6 : Awareness as per the age group
Awareness   level Age groups( in years)20-30 30- 40 40 -50 50-60 > 60
Poor awareness 43 327 139 38 8
Average awareness 9 14 22 2 0
Good awareness 1 6 14 0 0
2
The reasons for non participation given by 855 subjects who 
refused to answer the questionnaire are as shown in Fig 3.
Discussion:
Breast cancer is the commonest cause of cancer in females in 
most of the states of India as per the recent statistics.5 But the 
facilities of breast clinics for early detection of breast cancer 
are not available to a major percentage of the population. This 
has been found to result  late reporting of patents to healthcare 
facility and ultimately poorer prognosis.  Similar is the scen-
ario in Kashmir valley.6 In such circumstances, the only viable 
method  to  make  early  reporting  of  patients  possible  is  by 
spreading awareness regarding this disease.7 On review of lit-
erature, we found that virtually all the studies are directed at 
detection of the level or  ways and means to improve  breast 
cancer awareness among females and we could not find any 
study where awareness of this disease in males has been stud-
ied. It was against this background, this study was undertaken 
to assess the female breast cancer awareness among male pop-
ulation.
From our study, we found that only 11% of males had average 
to  good  awareness  and 89% had poor  awareness  about  this 
disease. These figures are worrisome keeping in view the fact 
that  like  other  parts  of  Indian  subcontinent,  spouse  is  the 
closest relation physically and emotionally.  Since spouse has 
the privilege to feel the body of his partner, awareness about 
the abnormalities could result in early pickup of pathological 
lesions.  Besides since in our society,  husband plays a major 
role in bringing the patient to the healthcare facility and since 
breast cancer of a lady, affects the male partner emotionally 
and financially, it becomes all the more important to include 
males in awareness programmes regarding this disease.
From our data we could not detect any statistically significant 
difference among the subjects when classified on the basis of 
economic  status  depicting thereby that improvement  in eco-
nomic status does not reflect in improved health related aware-
ness. When studied on the basis of level of formal education, 
graduates and above were better aware than less or uneducated 
group. Similarly teachers, office goers and students were bet-
ter aware though the difference was not  significant.  Besides 
most of these relatively better aware groups also belonged to 
graduate and above educational group. But the fact that about 
68.39% of  teachers had poor  awareness  about  breast cancer 
needs  a  serious  attention  and  improvement  as  it  has  been 
proved in many studies that by improving the health-related 
awareness among the teachers, the level of awareness in chil-
dren improves significantly8,9 who in turn have been found to 
disseminate  health  awareness  in  homes  and general  popula-
tion. But it needs to be mentioned that the literature shows that 
even in economically developed regions of the world, health 
education has not been made a constant part of certification 
programmes of teachers.10 
As far as the sources of information are concerned, health re-
lated programmes on local radio, television and articles in loc-
al newspapers were sources of information of 78.7% of sub-
jects having average and good awareness regarding breast can-
cer. Since these sources are widely available, impetus needs to 
be laid on focused utilization of these means of education to 
improve  breast  cancer  awareness  among  masses.  Special 
teachers  training  sessions  need  to  be  organized  particularly 
during vacations when schools remain closed as these in-ser-
vice training sessions have been found effective in other health 
related issues.10 By establishing a definite role for schools and 
teachers  in  promotion  of  health,  positive  results  have  been 
achieved as is evident from literature.11 
From our results we found that 66.85% of the subjects who 
had been approached for participation in this study refused to 
do so and the reasons given as shown in Fig 3,  show lack of 
interest  among  our  population  regarding  matters  related  to 
health.  This  aspect needs to  be  addressed seriously as  until 
people take interest healthcare programmes cannot meet suc-
cess. The social and religious leaders can be approached, edu-
cated and made part of a programme aimed at health education 
as they have direct access to the population and command re-
spect and can influence their practices.12 
Conclusions:
Breast cancer awareness is very low among Kashmiri men .In 
the absence of breast cancer screening clinics, there is a dire 
need to take measures to improve breast cancer awareness in 
men  so that  they can play a role  in  early detection  of  this 
disease and thereby improve the outcome in this disease.
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2. Rao RS, Nair S, Nair NS, Kamath VG. Acceptabil-
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3. Tjandra JJ, Collins JP. Breast Surgery in the Text 
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4. Ferris L, Shamian J, Tudiver F. The Toronto Breast 
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8. Susan K,  Everret A, James PH. Effects of an in-
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3


Acceptability and effectiveness of a breast health awareness programme for rural women in India.

Asian Indian Women :Knowledge attitude and behavior towards early breast cancer detection

Cancer burden in the year 2000: the global picture.

Changing trends in incidence of breast cancer: Indian scenario.

Development of students attitudes towards school safety measures (SATSSM)

Effects of an inservice workshop on the health teaching self efficacy of elementary school teachers.

Evaluation of a national disease prevention & health promotion strategy – establishing a role for the schools.

Health attitudes of school teachers.

Influence of delay on survival in patients with breast cancer: a systematic review. Lancet

The Toronto Breast Self examination instrument Its Development, Reliability and Validity.

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Awareness regarding female breast cancer in Kashmiri males - A study

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