Breast cancer in the Wardha district of the Maharashtra state in India: incidence and delays in seeking health care
Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
The main aim was to estimate trends, risk factors and to assess if education is a social inequality marker in breast cancer in the Wardha district in rural India. Since the incidence in breast cancer in India is increasing, this study was carried out to see if the same pattern could be observed in the rural district of Wardha as well. The data used were a population based cancer registry as well as a survey both administered by the Mahatma Gandhi Institute of Medical Sciences. The methods applied were standardization, logistic regression, relative index of inequality (RII) and slope index of inequality (SII).
The age-standardized total incidence rates were in 2010, 2011, 2012 and 2013 13, 18, 19 and 25/100 000 respectively. Based on the TNM-system (tumour-nodes-metastases) and another classification system referring to how spread the cancer is (Cancer Research UK, 2014) stage at diagnosis were classified as early or late. In the population based registry, 48% of the women had later presentation of cancer when diagnosed and of the women interviewed in the survey 60%.
In the logistic regression different risk factors were tested against stage of cancer, thus testing if the women differing in risk factors had higher or lower odds for having late presentation of cancer. Two results were significant. It was a protective factor from having later cancer stage if a woman had 5-7 alive children compared to 1-2 (OR 0.2, 95% CI 0.04-0.99) and it was a risk factor if a woman did not know if she could afford health care if she needed it (OR 4.9, 95% CI 1.49-15.76).
In 2010 the RII and SII showed a significant inequality, there are more cases (Coefficient -0.6 95% CI -1.09 - -0.09) and risk (RII 0.1 or 90% more risk, 95% CI 0.04 – 0.20) of late presentation of breast cancer in the least educated group. The RII and SII for the rest of the years were insignificant, but indicated higher risk and more cases in the most educated group.
The conclusion of these results are that although many of the results were insignificant there still were some interesting results. There seems to be an increase in the standardized incidence, but not statistically tested in the Wardha region, the incidence from the literature indicating an increase in India as well, the results this in accordance to this. The mere percentage of women seeking help when their cancer have already developed, maybe because they did not know what breast cancer was or how to self-screen for it. And there was a significant educational inequality in late presentation of breast cancer in 2010. More research should be performed, also qualitative, in continuing the work on trying to understand this phenomena. From the literature we can learn that educating and empowering women is important for them to understand the disease and make them seek help early.
Place, publisher, year, edition, pages
2015. , 36 p.
, Centre for Public Health Report Series, ISSN 1651-341x ; 2015:7
breast cancer, incidence, Wardha district, India, rural, delay, risk factors
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-107728OAI: oai:DiVA.org:umu-107728DiVA: diva2:849258
Master's Programme in Public Health
2015-05-25, Umeå, 13:48 (English)
San Sebastian Chasco, Miguel, Professor
Lindholm, Lars, Professor