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  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 153-155

The cancer awareness assessment project: A small-scale survey across people with different levels of education in Mysore, India

1 Independent Researcher, Bangalore, India
2 Viral Oncology Group, Research Department of Cancer Biology, University College London, UK

Date of Web Publication3-Feb-2016

Correspondence Address:
A Sheshachalam
Independent Researcher, Bangalore
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.175574

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 » Abstract 

Aim: To assess the cancer awareness in respondents, their knowledge about the nature of cancer as a disease, its diagnosis and treatment, warning signs, environmental risk factors and conceptions of how risk factors work, as well as willingness to participate in screening programs if available. Methodology: Cancer awareness is an increasingly important issue in light of increasing incidence and associated healthcare costs, as well as the presence of risk management strategies. In this study, 453 people, drawn from several educational institutes/workplaces, were surveyed with respect to cancer awareness. The test sample included pre university students, undergraduates, and postgraduate students/workers. We checked for variations in cancer awareness across multiple educational levels to determine whether there was variation in levels of cancer awareness across educational classes. Results: We found that confidence in perception of cancer awareness, and awareness itself, was not very high, and only postgraduates had a nuanced appreciation of some of the complexities of cancer epidemiology, and even then only moderately. Conclusion: The conclusions of the study point towards the need for optimal policymaking in the development of cancer awareness in the population.

Keywords: Cancer awareness, risk factor knowledge, statistical analysis of cancer awareness

How to cite this article:
Sheshachalam A, Chakravarthy A R. The cancer awareness assessment project: A small-scale survey across people with different levels of education in Mysore, India. Indian J Cancer 2015;52:153-5

How to cite this URL:
Sheshachalam A, Chakravarthy A R. The cancer awareness assessment project: A small-scale survey across people with different levels of education in Mysore, India. Indian J Cancer [serial online] 2015 [cited 2022 May 17];52:153-5. Available from:

 » Introduction Top

Cancer awareness has been shown to contribute to improvements in the early detection and management of disease, especially in the context of cervical cancer in an Indian population.[1] The importance of cancer awareness has also been emphasized as a means of ensuring behaviors that facilitate early detection and the absence of cancer awareness has been seen as a detriment to this end.[2] To this end, we decided to carry out a survey across an educational cross-section in Mysore to determine the levels of cancer awareness across people with different levels of educational attainment. The study was carried out to demonstrate that awareness can be estimated on a small-scale and this potentially has implications for policymaking with regard to awareness programs, because it may facilitate the tailoring of such programs to suit the target population with education level serving as a surrogate.

 » Methodology Top

We recruited, arbitrarily, 453 respondents to the study in a semi-targeted manner (i.e., respondents were selected by place of study/employment but the groups themselves were not controlled for other demographics) from a Pre University College, an office of an IT Company, Engineering Colleges, and Postgraduate Departments of the University of Mysore. The respondents consisted of 151 pre university students, 151 undergraduate students, and 151 respondents either in postgraduate education or with prior postgraduate education, constituting three distinct subgroups for analysis. The survey was anonymized and informed consent was obtained.

The respondents were given a nine-question multiple-choice questionnaire. Each question was designed to estimate the respondents' level of knowledge about the nature of the disease, their own assessment of their knowledge, diagnosis, risk assessment, and their willingness to attend screening programs if the option was available. We asked respondents to rate their awareness of cancer on a 5-point scale (0-4), with zero being almost none and four being very good. This was followed by a question that tested the respondents on the nature of the disease, known factors that could significantly increase the risk of cancer, and also a list of signs that, if recognized, would make the respondents contact an oncologist, mainly based on the American Cancer Society's seven warning signs with the addition of three other signs: Extremely frequent infections; chronic bone pain; and persistent fatigue, nausea, and/or vomiting.

A few of the questions asked were also targeted at understanding the respondents' assumptions regarding the progress of the disease with age and to know whether they believed diagnosing the disease at an early stage helped during the treatment. We also asked respondents about their willingness to attend screening programs and finally checked whether they understood how risks work by asking them if they agreed that an example of a smoker not getting cancer would falsify the notion that smoking is a strong causal factor for lung cancer, a proposition supported by epidemiological studies,[3] and data from the molecular biology of tumors supporting the increased incidence of carcinogenic mutations [4] and epimutations.[5] We calculated mean scores and standard deviations overall for the survey and for areas covered by the questionnaire; [Figure 1]. Subgroup analysis was also carried out to examine the impact of educational level on the differences in cancer awareness using Wilcoxon's Rank Sum Test for statistical significance.
Figure 1: Graph of mean scores and standard deviations for the entire body of respondents and subgroups based on educational level. The x-axis indicates question number on the questionnaire and the y-axis indicates scores. The maximum possible value is indicated by the first column for each question on the questionnaire. Error bars represent one standard deviation of the mean scores for each group

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 » Results Top

Respondents generally perceived their cancer awareness as being somewhat good in general, and there was a statistically significant difference in the mean scores of perceptions between pre university students and graduates (P < 0.05), indicating that these differences were unlikely to be due to chance. There was also a statistically significant difference between pre university students and postgraduates (P < 0.0001) and graduates and postgraduates (P < 0.0001), as estimated using Wilcoxon's Rank Sum Test. When asked what cancer is, 60.48% of the overall sample was able to identify cancer as a disease of abnormal proliferation of cells, 67% and 65% of the postgraduate and graduate respondents, respectively, answered the question correctly, and only 48.34% of the pre university students could do so. There was a statistically significant difference between pre university and graduate students (P < 0.0001), between pre university and postgraduate students (P < 0.0001), and between postgraduates and undergraduates (P < 0.0001). When queried about whether they thought cancer was curable, with special emphasis being laid on the fact that cancers are heterogeneous entities and different cancers may respond differently to treatment, with early diagnosis being a contributory factor, 75% overall agreed with this. Postgraduates showed a better understanding (95% were able to identify the aforementioned nuance) as opposed to either graduates or pre university students (66.8% and 65.5% of the sample, respectively). However, differences were not statistically significant. In response to a question asking people to choose known risk factors/carcinogens from a list, out of a maximum possible score of 12, the mean score was 2.93 (SD = 1.71) overall. Within subgroups, postgraduates scored slightly better, with a mean score of 3.4 (SD = 1.68) as opposed to 2.72 (SD = 1.88) for pre university students and 2.66 (SD = 1.46) for undergraduates. The difference between postgraduates and the other two samples was statistically significant (P < 0.0001 in both instances) and there was no significant difference between graduates and pre university students. One question in the survey listed a set of warning signs of cancer, mostly based on the American Cancer Society's Seven Warning Signs, and asked respondents which of those symptoms would make them consult an oncologist. Out of a maximum possible score of 10, the mean score overall was 2.577 (SD = 2.01) and there were no statistically significant differences between the subgroups. When asked whether the risk of cancer increases with age, which is a well-documented phenomenon, only 53% overall agreed, and postgraduates demonstrated better knowledge of this fact, with 62% answering the question correctly as opposed to 52% for graduates and 43% for pre university students. The difference was not statistically significant between graduates and postgraduates, as opposed to between pre university students and graduates; however, there was a statistically significant difference between pre university students and graduates (P < 0.001). Respondents were also asked whether they believed early diagnosis was important, with 93% overall agreeing it was. (96% of graduates, 95% of postgraduates, and 90% of pre university students answered in the affirmative.) A consequent question on the questionnaire asked whether they would be willing to participate in screening programs, and 77% overall answered in the affirmative. We found that willingness was far higher in the graduate and postgraduate samples (80% and 84%, respectively). The difference in expressed willingness between graduates and pre university students was statistically significant (P < 0.05) and so was the difference relative to postgraduates (P = 0.01). Finally, we tested the comprehension of how risk factors work by putting forth an erroneous assumption based on the idea that there must be a 1:1 correspondence between a risk factor and cancer for there to be a causal link. We asked them whether the fact there were some smokers who never get lung cancer and the existence of nonsmokers who do get lung cancer would falsify a causal association between smoking and lung cancer. Only 47% recognized that the assertion was fallacious thereby conveying an implicit understanding of how risk-factors and carcinogens work. The only subgroup that did not follow this trend was postgraduates, where 59% managed to identify the assertion as incorrect as opposed to 43% of graduates and 39% of pre university students. The differences were statistically significant (pre university students versus postgraduates, P < 0.01 and graduates versus postgraduates, P = 0.01). Overall, out of a maximum possible score of 32, the mean score was 11.48 (SD = 4.29). Postgraduates had higher scores (mean = 12.92105, SD = 3.886684) than graduates (mean = 11.17, SD = 4.13) and pre university students (mean = 10.36424, SD = 4.475837). Differences between postgraduates and graduates and between postgraduates and pre university students were found to be statistically significant (P = 0.01 and P < 0.001, respectively).

 » Discussion Top

The sample in the study did not rate their knowledge of cancer as only being somewhat good, and their performance in tests of their knowledge about cancer tended to agree with this perception. Understanding of the biology of cancer tended to improve with educational level and was the highest in postgraduates. Postgraduates were also able to express a nuanced understanding of cancer treatment, accounting for the heterogeneity of the disease and the importance of early diagnosis and possibility of cure in that context; however, this difference was not statistically significant. Knowledge of risk factors and carcinogens was consistently poor, but postgraduates did score slightly better than graduate students and pre university students. Lack of knowledge regarding warning signs that should encourage a person to see an oncologist across the study sample is particularly concerning, given that the respondents indicated an understanding of the value of early diagnosis but failed to recognize factors that would facilitate such an improved diagnosis. This suggests a lack of information on the risk factors and signs and symptoms; thus, information dissemination needs to be improved.

Cancer awareness by itselfhas been shown to be a strong determinant of the uptake of screening programs,[6] even when other confounding factors such as education or ethnicity may be involved. Indeed, increased awareness has also been proposed as a mechanism to facilitate the increased uptake of screening for other malignancies, such as colorectal cancer.[7] Furthermore, increased awareness has been shown to be strongly associated with self-examination practices pertaining to the detection of melanoma.[8] All these examples highlight the utility of awareness in contributing to the efforts to preventing cancer, thus highlighting the significant deficiencies we identified in our study sample as requiring remediation. Although screening programs have been issues of hot debate in recent years, especially in the context of breast cancer,[9],[10] there has been recent evidence that screening interventions can decrease the rates of incidence and increase survival, as evidenced by the efficacy of flexible sigmoidoscopy for colorectal cancer detection in a British setting.[11] The substantial lack of affirmation of willingness to participate in screening programs as opposed to recognizing the importance of early diagnosis in successful treatment, as well as the relatively suboptimal recognition of the association of age with cancer incidence is worrisome from the perspective of successful preventative and early intervention programs.

In addition, only postgraduates were generally able to convey an understanding of the nature of risk factors and carcinogens; therefore, we believe that future programs for cancer awareness should emphasize the nature of the risk. Finally, we conclude that cancer awareness in the examined sample was found to be unsatisfactory. There is a clear role to be played by programs that emphasize the epidemiology of cancer and signs and symptoms that may contribute to reducing the clinical burden that advanced disease invariably places.[12] Early interventions to prevent the uptake of smoking may also be beneficial and may create a niche for awareness programs targeted at students before they commence pre university education. This study demonstrates that it should be possible to obtain information easily from the local population, and the resulting data could be used for tailoring awareness programs to meet this requirement. The use of survey-based data collection methods should facilitate better implementation of awareness programs and maximize the effects of auxiliary programs that depend on it for uptake.

 » References Top

Jayant K, Rao RS, Nene BM, Dale PS. Improved stage at diagnosis of cervical cancer with increased cancer awareness in a rural Indian population. Int J Cancer 1995;63:161-3.  Back to cited text no. 1
Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J, et al. Public awareness of cancer in Britain: A population-based survey of adults. Br J Cancer 2009;101:S18-23.  Back to cited text no. 2
Carbone D. Smoking and cancer. Am J Med 1992;93:13-7S.  Back to cited text no. 3
Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst 1999;91:1194-210.  Back to cited text no. 4
Kim DH, Nelson HH, Wiencke JK, Zheng S, Christiani DC, Wain JC, et al. p16 (INK4a) and histology-specific methylation of CpG islands by exposure to tobacco smoke in non-small cell lung cancer. Cancer Res 2001;61:3419-24.  Back to cited text no. 5
Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P. The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol 2002;186:938-43.  Back to cited text no. 6
Katičić M, Antoljak N, Kujundžić M, Stamenić V, Skoko Poljak D, Kramarić D, et al. Results of National Colorectal Cancer Screening Program in Croatia (2007-2011). World J Gastroenterol 2012;18:4300-7.  Back to cited text no. 7
Miller DR, Geller AC, Wyatt SW, Halpern A, Howell JB, Cockerell C, et al. Melanoma awareness and self-examination practices: Results of a United States survey. J Am Acad Dermatol 1996;34:962-70.  Back to cited text no. 8
Thornton H, Edwards A, Baum M. Women need better information about routine mammography. BMJ 2003;327:101-3.  Back to cited text no. 9
Rao RS, Nair S, Nair NS, Kamath VG. Acceptability and effectiveness of a breast health awareness programme for rural women in India. Indian J Med Sci 2005;59:398-402.  Back to cited text no. 10
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Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: A multicentre randomised controlled trial. Lancet 2010;375:1624-33.  Back to cited text no. 11
Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.  Back to cited text no. 12


  [Figure 1]

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