SCPM College of Nursing and Paramedical Sciences, Gonda, Uttar-Pradesh, India 271003
Background: Breast cancer is the most common malignancy affecting women worldwide and a leading cause of cancer-related deaths in India. In rural areas such as Gonda district in Uttar Pradesh, early detection is hindered by limited awareness, social stigma, and inadequate access to screening tools like mammography. Objective: This study aimed to assess the ongoing understanding, perceived barriers, and psychological perspectives surrounding breast cancer and mammography among women in Gonda district. Methods: A descriptive cross-sectional survey was conducted among 420 women aged 18 years and above, selected through simple random sampling. A structured questionnaire assessed knowledge, attitudes, and practices regarding breast cancer, mammography, and breast self-examination (BSE). Data were analyzed using descriptive and inferential statistics, including chi-square tests and Pearson correlations. Results: The results revealed that only 37.9% of respondents had awareness of breast cancer, and 20.2% knew about mammography. Positive attitudes were more prevalent, with 55.2?knowledging the importance of mammography and 62.3% willing to recommend BSE. However, emotional and practical barriers—such as fear (45%), embarrassment (28.4%), and poor access—limited screening behavior. Knowledge was significantly associated with education level, marital status, and urban-rural residence (p < 0.05). Conclusion: Despite a generally positive disposition toward breast cancer screening, knowledge and practice remain critically low among women in Gonda. Targeted health education programs, improved accessibility, and culturally sensitive interventions are urgently needed to bridge the knowledge-practice gap and promote early detection.
Breast cancer is the most common cancer affecting women globally, and it has emerged as the leading cause of cancer-related deaths among Indian women, with an alarming rise in incidence, particularly in younger age groups. According to the Global Cancer Observatory (GLOBOCAN), India reported over 162,000 new cases of breast cancer and approximately 87,000 related deaths in 2018, placing it second only to the United States in mortality rates associated with breast cancer among women [1]. Unlike Western countries, where screening programs are widespread and early detection rates are high, India faces a critical challenge due to late-stage presentation, low awareness levels, and limited access to diagnostic tools like mammography in rural regions [2]. In rural districts such as Gonda in Uttar Pradesh, these challenges are compounded by cultural beliefs, gendered stigmas, financial barriers, and a dearth of trained medical personnel and infrastructure. Mammography, an essential imaging tool for early detection of breast cancer, is grossly underutilized in such areas due to both systemic and perceptual barriers. As the American College of Radiology (ACR) and the National Comprehensive Cancer Network (NCCN) emphasize, annual screening beginning at age 40 significantly reduces mortality by detecting tumors in earlier, more treatable stages [3]. However, despite its proven efficacy, the uptake of mammography screening in India remains limited to urban centers, leaving a vast rural population at higher risk of undetected disease progression. The World Health Organization (WHO) has stressed the importance of integrating breast cancer awareness and early detection strategies into national health agendas, particularly in low- and middle-income countries where the majority of deaths occur due to late diagnosis [4]. In the Indian context, sociocultural norms play a substantial role in shaping women’s health-seeking behavior. Topics related to breast health are often considered taboo, leading to a sense of shame or embarrassment that discourages women from discussing symptoms or seeking preventive care [5]. Moreover, studies have consistently shown that fear of cancer diagnosis, misconceptions about mammography, and a general lack of knowledge about breast cancer risk factors are significant deterrents to screening participation [6]. Many women remain unaware of basic signs such as lumps, nipple discharge, or changes in breast size and texture, which delays medical consultation until the disease has progressed to an advanced stage. In such settings, Breast Self-Examination (BSE) and Clinical Breast Examination (CBE) could serve as valuable early detection tools, particularly where mammography is inaccessible, yet the knowledge and practice of these methods remain critically low [7]. Research in India and other developing nations has demonstrated that educational level, socioeconomic status, and urban-rural divide are strongly associated with breast cancer awareness and screening uptake. For instance, a study conducted in Maharashtra found that educated women were significantly more likely to be aware of BSE and to undergo regular clinical check-ups [8]. Similar findings were reported in studies from Jordan [9], Uganda [10], and Saudi Arabia [11], where rural women exhibited lower participation in screening due to fear, lack of information, and limited access. In addition to these perceptual barriers, infrastructural limitations further constrain breast cancer detection in regions like Gonda. Most Primary Health Centers (PHCs) and Community Health Centers (CHCs) lack mammography machines, and even when equipment is available, trained radiology technicians and female healthcare workers are often in short supply [12]. The financial burden associated with travel, testing, and follow-up consultations further discourages low-income women from pursuing preventive care. For women who are already burdened with domestic responsibilities and childcare, setting aside time for medical appointments is often seen as a luxury rather than a necessity. This results in a paradoxical situation where the disease is common, deadly, and detectable—yet most cases continue to be diagnosed at a late, often incurable stage [13]. The introduction of government initiatives such as the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) has aimed to promote cancer awareness and screening, but implementation remains inconsistent and underfunded in rural belts [16]. Therefore, there is an urgent need to assess and address the existing gaps in knowledge, attitude, and accessibility to breast cancer screening in such areas. The present study seeks to explore the ongoing understanding, perceived barriers, and psychological perspectives surrounding breast cancer and mammography among women in Gonda district. Given the rising burden of breast cancer and the evident discrepancies between urban and rural screening practices, such localized studies are essential to develop region-specific health education models and intervention strategies. By identifying the core obstacles—whether informational, psychological, or infrastructural—this study aims to contribute actionable insights toward enhancing early detection efforts. The inclusion of structured questionnaires and statistical correlation with variables such as education, occupation, and family history of breast cancer helps paint a clearer picture of where awareness gaps exist and how best they can be targeted. Furthermore, understanding local perceptions allows healthcare providers to design culturally sensitive outreach programs that resonate with the community’s values and beliefs. In a district like Gonda, where medical resources are scarce and traditional beliefs are strong, public health initiatives must bridge the knowledge divide with empathy and pragmatism. Thus, this study not only aims to quantify awareness levels but also to humanize the data by exploring the lived experiences, fears, and aspirations of women dealing with the possibility of breast cancer. The long-term vision is to use these insights to inform policy, strengthen local health systems, and empower women to take charge of their breast health.
OBJECTIVES
METHODS
This study employed a descriptive cross-sectional survey design to assess the level of understanding, perceived barriers, and attitudes regarding breast cancer and mammography among women in the Gonda district of Uttar Pradesh, India. The aim was to gather quantitative data on knowledge, beliefs, and practices surrounding breast health, with particular emphasis on mammography and breast self-examination (BSE). The research was conducted over a period of three months, following ethical approval from the institutional ethical review board of SCPM College of Nursing & Paramedical Sciences.
3.1 Research Approach
A quantitative, non-experimental research approach was adopted to collect structured responses from the target population. The design was chosen for its ability to capture measurable data and establish relationships between variables such as education, age, occupation, and knowledge about breast cancer.
3.2 Study Setting
The study was conducted in Gonda district, a predominantly rural area in the Indian state of Uttar Pradesh. The region is characterized by low literacy rates, traditional gender norms, and limited access to specialized healthcare services, making it an appropriate site for evaluating breast cancer awareness and screening barriers.
3.3 Population and Sampling
The target population comprised women aged 18 years and above residing in Gonda, regardless of their educational or marital status.
3.4 Sample Size and Sampling Technique
A sample of 420 women was selected through simple random sampling from various blocks and villages within the district. This sample size was determined using a standard formula for cross-sectional studies:
n=Z2×p×(1-p)d2
Where:
Using this, the sample size was calculated as approximately 384, rounded up to 420 to account for potential non-responses and ensure greater representativeness.
3.5 Variables Under Study
3.6 Data Collection Tool
A structured questionnaire was developed based on existing instruments such as Champion’s Health Belief Model Scale (CHBMS) and modified to suit the local population's literacy and cultural context. The questionnaire had four sections:
The tool was translated into Hindi, the local language, and back-translated to ensure linguistic consistency.
3.7 Pilot Study
A pilot test was conducted with 30 women from a neighboring village not included in the final study to assess the clarity, reliability, and cultural appropriateness of the tool. Minor modifications were made to question phrasing based on participant feedback.
3.8 Validity and Reliability
3.9 Ethical Considerations
Ethical approval was obtained from the Institutional Ethics Committee of SCPM College of Nursing & Paramedical Sciences. Informed consent was obtained from each participant before administering the questionnaire. Participants were assured of confidentiality, anonymity, and the voluntary nature of their participation. No identifying personal data was collected.
3.10 Data Collection Procedure
Trained female field investigators conducted face-to-face interviews using printed questionnaires. Each interview lasted 20–30 minutes, and data collection was conducted in community centers, PHCs, and household settings. Measures were taken to ensure privacy and comfort, especially during sensitive questions related to breast health.
3.11 Data Analysis Plan
Data were entered into Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize demographic and response data. Inferential statistics were used to test hypotheses:
RESULTS
Table 1: Descriptive Statistics for Age and Number of Children
|
Variable |
Mean |
Standard Deviation |
Minimum |
Maximum |
|
Age (years) |
33.5 |
8.4 |
18 |
65 |
|
Number of Children |
2.6 |
1.2 |
0 |
5 |
Interpretation:
The average age of participants was 33.5 years, indicating a relatively young adult female population, predominantly within the reproductive and early middle-aged group. The standard deviation of 8.4 shows variability in age across participants. Most women had approximately 2 to 3 children, showing a demographic trend typical of rural India, where childbearing starts early. This data reflects a population likely responsible for family care, potentially limiting time or priority for self-health screening like mammography or BSE.
Fig 1: Demographic Characteristics of Participants
The majority of participants (42.9%) were aged between 31–45 years, aligning with the age of increased risk for breast cancer. A substantial proportion (73.8%) were married, reflecting a population group likely to have household responsibilities and caregiving roles. Furthermore, 71.4% were from rural areas, which reinforces the study's focus on rural health awareness and screening gaps. These demographics highlight the need for rural-targeted awareness programs on breast health.
Fig 2: Knowledge about Breast Cancer and Screening Methods
Only 37.9% of women were aware of breast cancer, and awareness further declined when it came to recognizing symptoms (26.2%) and screening methods like BSE (23.3%) and mammography (20.2%). This data reveals a critical deficit in breast health education, particularly in rural women. The lack of awareness can lead to delayed detection, higher mortality, and limited utilization of diagnostic services, emphasizing the urgent need for community-based educational interventions.
Table 2: Attitudes Towards Breast Cancer Screening
|
Attitude Item |
Agree (%) |
Disagree (%) |
|
Thinks mammography is important |
55.2% |
44.8% |
|
Would recommend BSE to others |
62.3% |
37.7% |
|
Feels embarrassed by screening |
28.4% |
71.6% |
|
Fears cancer diagnosis |
45.0% |
55.0% |
Despite low levels of knowledge, over half (55.2%) of participants acknowledged that mammography is important, and 62.3% would recommend BSE to peers, indicating a generally positive attitude. However, psychological barriers were evident — 28.4% felt embarrassed during screening, and 45% feared a diagnosis, which could hinder screening uptake. Addressing emotional and cultural stigmas around breast health will be essential in improving early detection behaviors.
DISCUSSION
The findings of this study underscore the critical gaps in awareness, knowledge, and practices related to breast cancer and mammography among women in the rural district of Gonda, Uttar Pradesh. With only 37.9% of participants demonstrating basic awareness of breast cancer and an even smaller fraction—20.2%—knowing about mammography, the data reflects an urgent public health concern in rural India. This lack of knowledge is further exacerbated by low rates of breast self-examination (23.3%), indicating that early detection behaviors are not being practiced widely. These figures align with the findings from previous international studies such as those conducted by Abu-Helalah et al. (2010) in Jordan, which also showed extremely low mammography usage (only 8.6%) and identified fear, cost, and religious beliefs as key barriers [9]. The results in Gonda similarly highlight fear of cancer diagnosis (45%) as a major deterrent, followed by lack of awareness (40%), financial constraints (30%), cultural stigma (25%), and accessibility issues (20%). These psychosocial and logistical barriers appear to be universally shared among women in low-resource settings, suggesting the need for global and localized strategies to promote breast cancer screening. Interestingly, while knowledge levels were poor, attitudes showed relative optimism—over 55% of women believed mammography to be important, and more than 62% said they would recommend breast self-examination (BSE) to others. This positive attitude amidst poor knowledge indicates a latent willingness among women to adopt preventive health behaviors if given the correct information and access. This finding echoes results from a study in Saudi Arabia by Alqahtani et al. (2015), where over 90% of women expressed positive perceptions about BSE, but only 6.37% actually practiced it. The gap between knowledge and practice is often fueled by lack of empowerment, misconceptions, and insufficient health communication [11]. In Gonda, cultural sensitivity remains an essential factor. Many women reported feeling embarrassed by screening procedures (28.4%) or feared a positive diagnosis, which reflects deep-rooted stigma associated with cancer and female anatomy in traditional communities. This points to the urgent need for culturally appropriate education models, preferably led by female community health workers like ASHAs, who can communicate in local dialects and create a more trusting environment for discussing breast health. The demographic profile of the respondents—mainly women aged 31–45, married, and predominantly from rural backgrounds—further contextualizes the findings. This age group is particularly vulnerable to developing breast cancer, and yet, only a small minority had ever undergone mammography or clinical breast examination. The education level and socioeconomic status showed significant correlation with awareness levels, reinforcing the idea that literacy and access to resources are key determinants of health-seeking behavior. This is consistent with the findings from Kiguli-Malwadde et al. (2010) in Uganda, where higher literacy and employment status were linked to better awareness and uptake of mammography [10]. In Gonda, where over 70% of women were from rural backgrounds with limited access to healthcare facilities, the physical unavailability of diagnostic infrastructure such as mammography units remains a major challenge. Most Primary Health Centres in such districts lack radiological services, and even when present, women face the dual burden of travel costs and social restrictions, such as needing spousal or family permission to seek care. The findings also revealed that women with a family history of breast cancer were more likely to be aware of the disease and screening methods. However, even among this subgroup, mammography uptake was low, indicating that awareness alone is not enough—it must be paired with accessible services, economic feasibility, and emotional support. This observation is supported by the study from E.A. Grunfeld et al. (2002), which emphasized the impact of socio-economic status and perceived risk on breast cancer screening behaviors in the UK [14]. Grunfeld’s study showed that even in a developed country, lower-income and older women were more likely to delay seeking medical attention for breast symptoms. In Gonda, these factors are further compounded by limited health literacy, patriarchal norms, and the absence of a robust cancer screening program. The correlation analysis from the present study showed a statistically significant relationship between understanding, way of thinking, and cumulative knowledge scores. This means that as knowledge increased, so did positive attitudes toward screening and willingness to participate in preventive behaviors. This finding validates the Champion’s Health Belief Model, which posits that perceived benefits, cues to action, and self-efficacy are key determinants of health behavior. In the case of Gonda, the perceived benefits of early detection are not well understood, and cues to action—such as community campaigns or family encouragement—are virtually absent. Therefore, increasing awareness through community-based interventions, school and college programs, and mobile mammography vans could serve as strong cues to action, especially when paired with low-cost or subsidized services. Another important observation is the low percentage (15%) of women who had ever performed BSE. Despite its low cost and ease of use, BSE remains underutilized, primarily due to lack of training and confidence. Most women reported not knowing how to perform BSE correctly, and this was consistent with studies from Pakistan [15] and Africa. Since mammography is not always feasible in rural India due to high costs and lack of infrastructure, promoting BSE through training camps and workshops could serve as a pragmatic alternative for early detection. The WHO recommends that in low-resource settings, BSE and clinical breast exams should be promoted as preliminary steps until mammography becomes more widely available. From a policy perspective, the data calls for a multi-pronged approach involving the health system, education sector, and community stakeholders. Government schemes like the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) need stronger implementation at the block level. This includes not only infrastructure investment but also the training of nurses, radiology technicians, and community health educators. Outreach campaigns using visual media, storytelling, and local influencers could help demystify mammography and break cultural taboos. Collaboration with NGOs and women’s self-help groups could further expand the reach and credibility of such programs. Furthermore, establishing female-only screening days or camps may reduce embarrassment and increase participation.
CONCLUSION
The study clearly reveals a significant gap in awareness, knowledge, and screening practices related to breast cancer and mammography among women in Gonda district, Uttar Pradesh. Despite a generally positive attitude toward early detection methods, the uptake of mammography and breast self-examination remains critically low due to fear, stigma, limited access, and poor health literacy. Education level and socioeconomic status were found to be strong determinants of awareness. These findings highlight the urgent need for culturally tailored awareness campaigns, improved access to affordable screening services, and the integration of breast health education into primary healthcare to promote early detection and reduce breast cancer-related mortality in rural communities.
DECLARATION
I hereby declare that the research work entitled “A Survey of Ongoing Understanding, Boundaries and the Way of Thinking on Breast Cancer and Mammography in Gonda (U.P.)” has been carried out by me as part of the fulfillment of the requirements for the degree. This work is original and has not been submitted previously for any degree or diploma in any other institution or university. All sources of information and data used in the study have been duly acknowledged.
CONFLICT OF INTEREST
The author declares no conflict of interest in the publication of this research. The study was conducted independently and was not influenced by any external funding agency, organization, or individual. There are no financial, personal, or professional relationships that could have influenced the outcomes or interpretations of this research.
REFERENCE
Deeksha Jaiswal*, Sandhya Verma, A Survey of Ongoing Understanding, Boundaries and the Way of Thinking on Breast Cancer and Mammography in Gonda (U.P.), Int. J. Sci. R. Tech., 2025, 2 (9), 96-103. https://doi.org/10.5281/zenodo.17111944
10.5281/zenodo.17111944
