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Risk Factors of Breast Cancer in Kerala, India - A Case Control Study

Authors:
  • Regional Cancer Centre, Thiruvananthapuram, India
  • Sree Gokulam Medical College and Research Foundation Thiruvananthapuram,India

Abstract

Breast cancer is the most common malignancy among women in Kerala state of India. This study tried to determine the strength of association of known risk factors of Breast Cancer among women in Kerala. An unmatched Case control study was conducted at Regional Cancer Center, Thiruvananthapuram, among 660 newly detected breast cancer patients admitted for surgery during 2003-2004 and 920 controls selected from the hospital and community. Advancing age, delayed first child birth, nulliparity, history of previous breast biopsies and family history of breast cancer among first degree relatives were found to be associated with increased risk of breast cancer. History of breast feeding was found to reduce the risk. This study concludes that age and parity play a major role in the occurrence of breast cancer in Kerala. It also suggests that past history of breast symptoms requiring biopsy is associated with increased risk of breast cancer. Longer duration of breast feeding was found to be protective against breast cancer. Keywords: Breast biopsy, Breast cancer, Breast cancer risk, Breast feeding, Cancer screening, Crude and adjusted odds ratios, Kerala
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... Studies conducted by Balasubramaniam et al and Augustine et.al also found similar prevalence of breast cancer in these age groups. 5,6 This emphasize the need for attention toward the development of breast cancer in Indian women at their younger age. Most of the cases were from rural areas. ...
... Even though there are study reports showed high prevalence of breast cancer among patients from urban area, this difference may be explained through the regional variations in the study sites. 6 A few Indian studies have shown higher prevalence of breast cancer in rural areas. [7][8][9][10][11] Awareness, education, early detection, and screening of breast cancer are less in rural areas. ...
... Study reports from Augustine et al, Kamath et al, and Das et al from various parts of India found high prevalence breast cancer cases among the patients with low socioeconomic status.6,11,16 This difference in observations might be due to the variation of socioeconomic levels of the region selected for the study. ...
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Background: Breast cancer is the most common diagnosed cancer in women. Regional assessment of risk factors may help to increase awareness and management of breast cancer. The aim was to evaluate the risk factors of breast cancer among women.Methods: A total of 210 women were included with 42 newly diagnosed breast cancer cases, and 84 women each as hospital and community controls. The data were analyzed using SPSS. Multinomial logistic regression and odd’s ratio was used to find the association of risk factors with breast cancer. The association between the risk factors and breast cancer was analyzed using chi-square test.Results: The most prevalent age-group was 41–50 years. Significant association was observed between breast cancer and area of residence, religion, education, occupation, type of family, socioeconomic status, attainment of menopause, and breastfeeding when compared among cases and community controls (p<0.05). Significant association was observed between breast cancer and education, occupation, socioeconomic status, attainment of menopause, age at first child, breast feeding, and body mass index among cases and hospital controls (p<0.05). The risk of breast cancer was more in illiterates, women who attained menopause, women in joint family, and high socioeconomic class women when compared among cases and hospital controls and community controls.Conclusions: The important risk factors of breast cancer include literacy level, occupation and socioeconomic status, attainment of menopause, and breastfeeding. There is a strong need for general public-awareness policies and programs to reduce the prevalence, risks, morbidity, and mortality.
... Study by Balasubraminum et al., and his group found 3.14 times risk with family history of any cancer [4]. Paul Augustine et al., mentioned around 2 times risk with family history of breast cancer itself [5]. Many other studies from different parts of the world reported significant risk in women with a positive family history [6][7][8][9][10]. ...
... Many studies found significant risk with early menarche out of which two were conducted in the eastern India [2,[12][13][14][15]. Some studies did not observe any significant risk with early menarche [5,11]. Surprisingly one study observed protective effect with early (< 11 years) menarche (OR = 0.321; 95% CI: 0.106-0.971) ...
... Balasubramanium et al., reported around 2 times higher risk with > 25 years age at first childbirth [4]. Study by Paul Augustine et al., also reported 1.85 times risk at 26 -30 years and 2.96 times at ≥ 30 years compared to < 25 years of age [5]. Two others studies also reported odds of 2 for first childbirth at > 21 years and > 30 years of age [3,15]. ...
... In the current study cases with age group of 46-55 years had higher chance than the younger ones. Our finding is consistent with other studies done in India and also among studies done in other parts of world [7][8][9][10] . The reason for the above difference could be due to the various ethnic, socio-demographic, geographical and life style factors that are associated with advancement in the age which needs further exploration. ...
... [11] The important risk factors include nulliparity, advancing age, and family history of breast cancer. [12] In our study, we found that all the breast cancer patients were above 30 years of age, and the prevalence increased in the fifth and sixth decades. In the study, 95% of the women were unaware of performing breast self-examination. ...
... [11] The important risk factors include nulliparity, advancing age, and family history of breast cancer. [12] In our study, we found that all the breast cancer patients were above 30 years of age, and the prevalence increased in the fifth and sixth decades. In the study, 95% of the women were unaware of performing breast self-examination. ...
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Background: The estimated incidence of cancer cases in Kerala for 2014 was 31,400 and the mortality associated with it was 13,816. Although the treatment of cancer has shown remarkable advances, it has come with increasing costs. Objective: The objective of this study is to estimate the economic burden of cancer in Vypin Block Panchayat at Ernakulam by analyzing the average total direct and indirect cost of cancer care, socioeconomic status, and cost of cancer care between government and private hospitals. Materials and methods: A cross-sectional study was conducted for 2 months from March to April 2018. The study was conducted by utilizing an annotated cost questionnaire for completion by patients. Total direct and indirect cost was estimated. Appropriate statistical tests were used. Results: Direct cost for cancer care contributed 75% toward the cost of illness and the remaining was found to be indirect cost. Loss of income (44%) contributed to the largest chunk of indirect cost. The average direct cost for cancer care was found to be Rs. 25,606 and the average indirect cost was Rs. 8772. The average total cost of cancer care was calculated to be Rs. 34,378. Significant statistical variation was found between the cost of cancer care in private and government hospitals. The economic burden of cancer in this Vypin Block Panchayat was found to be Rs. 218,256,977/. Conclusion: The ratio of average income to average cost in this study is skewed which indicates the lack of affordability for cancer care in this population. A very large gap, therefore, exits between income levels and cost of cancer care clearly indicating a vast gap between affordability and cost of treatment, which clearly necessitates the need for a definite policy and state intervention for a mass cancer care program.
... A case-control study was conducted at Regional Cancer Center, Thiruvananthapuram, to determine the usefulness of Gail Model Breast Cancer Risk Assessment Tool in identifying women at high risk for breast cancer proved that Gail Model cannot be used to predict highrisk women in Kerala. [22] Numerous mathematical models were also made using these risk factors to predict individual women's risk of developing breast cancer. There is a paucity of data regarding the risk factors in our society. ...
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Background: With an estimation of every two women newly diagnosed with breast cancer one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime. Developing a risk prediction tool by assessing the prevalence of known risk factors in the community will be a welcoming approach in this regard. Methods: A cross sectional study conducted among 18- 64 years old women to gather prevalence of breast cancer risk factors. In this multistage random number based cluster sampling study, the results were compiled, collated and analyzed in rates and proportions. Statistical conclusions were converted into ordinal values using modified Likert Scale and median was used to estimate central values. The test of significance was calculated using Crohnbach’s alpha (α). Results: The analysis of 558 participants were performed for the known risk factors for breast cancer which included reproductive factors, nutritional intake and anthropometry. The estimated prevalence of these known risk factors were re-assorted for analysis and this re-assorted data was categorized into range of values across the communities. The community based risk prediction tool was developed with Crohnbach’s α score of medium internal validity. Conclusions: A ten item questionnaire based scoring of community risk was developed by modified 5 point Likert scale with known risk factors of breast cancer. The Crohnbach’s alpha value of 45.5 indicated good internal validity. The risk assessment tool has collated most of the risk factors of breast cancer that are capable of being measured at community level.
... A case-control study was conducted at Regional Cancer Center, Thiruvananthapuram, to determine the usefulness of Gail Model Breast Cancer Risk Assessment Tool in identifying women at high risk for breast cancer proved that Gail Model cannot be used to predict highrisk women in Kerala. [22] Numerous mathematical models were also made using these risk factors to predict individual women's risk of developing breast cancer. There is a paucity of data regarding the risk factors in our society. ...
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Background: Breast cancer is the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 (25% of all cancers). The current study aims at assessing risk factors for breast cancer in the community. Methods: A multistage random number based cluster sampling study was conducted among women in the age group of 20 – 64 years. The estimated sample size was 550 considering the prevalence of risk factors of non-communicable diseases as 15%, and the total sample size was further divided among urban and rural areas with 100 and 450 participants respectively. Results: The rates for ten known risk factors were assessed for the study. This included age above 40 years (40.3%); women married 30 years or above (3.3%); women with age at menarche 13 years or below (44.1%); women with first childbirth at ≥30 years (4.8%) and women who had menopause at ≥49 years (64.4%); women who had ever conceived, had at least one abortion in the community (18%); average fat consumption in the district (2380Kcal/week); BMI of ≥25 (19.5%); prevalence of breast diseases including both benign and malignant in the community was 3.5% and positive family history of breast cancer was found to be 2.5%. Conclusions: The risk assessment tool has collated most of the risk factors of breast cancer that are capable of being measured at community level. A risk assessment tool with scoring system can be used for community surveys for risk assessment and the validity of such assessment results may be taken based on the α Crohnbach’s value.
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