HomeAboutusCurrent issuearchivesSearch articlesInstructions for authorsSubscription detailsAdvertise

  Login  | Users online: 25

   Ahead of print articles    Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size  


 
 Table of Contents    
ORIGINAL ARTICLE  
Year : 2013  |  Volume : 38  |  Issue : 2  |  Page : 95-99
 

A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district


1 Department of Public Health, Manipal University, Manipal, Karnataka, India
2 TAPMI Institute of Management, Manipal, Karnataka, India

Date of Submission16-Sep-2011
Date of Acceptance22-Aug-2012
Date of Web Publication23-May-2013

Correspondence Address:
Kamaleshwar S Mahajan
Department of Public Health, Manipal University, Manipal, Karnataka - 576 104
India
Login to access the Email id


DOI: 10.4103/0970-0218.112440

PMID: 23878422

Get Permissions

 

   Abstract 

Background: Cancer has become one of the ten leading causes of death in India. Breast cancer is the most common diagnosed malignancy in India, it ranks second to cervical cancer. An increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimated number of breast cancer deaths worldwide. Aim: To study the factors associated with breast cancer. Objectives: To study the association between breast cancer and selected exposure variables and to identify risk factors for breast cancer. Materials and Methods: A hospital based Case control study was conducted at Shirdi Sai Baba Cancer Hospital and Research Center, Manipal, Udupi District. Results: Total 188 participants were included in the study, 94 cases and 94 controls. All the study participants were between 25 to 69 years of age group. The cases and controls were matched by ± 2 years age range. Non vegetarian diet was one of the important risk factors (OR 2.80, CI 1.15-6.81). More than 7 to 12 years of education (OR 4.84 CI 1.51-15.46) had 4.84 times risk of breast cancer as compared with illiterate women. Conclusion: The study suggests that non vegetarian diet is the important risk factor for Breast Cancer and the risk of Breast Cancer is more in educated women as compared with the illiterate women. Limitation: This is a Hospital based study so generalisability of the findings could be limited.


Keywords: Breast cancer, risk factors, menarche, diet, abortion


How to cite this article:
Kamath R, Mahajan KS, Ashok L, Sanal T S. A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district. Indian J Community Med 2013;38:95-9

How to cite this URL:
Kamath R, Mahajan KS, Ashok L, Sanal T S. A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district. Indian J Community Med [serial online] 2013 [cited 2014 Nov 1];38:95-9. Available from: http://www.ijcm.org.in/text.asp?2013/38/2/95/112440



   Introduction Top


Cancer is one of the major health issues worldwide. At global level it accounted for11.4 million new cases and 7.4 million deaths (around 13% of all deaths) in 2004. [1] Cancer incidence in South East Asia region was 1.7 million in 2004. [2]

Cancer has become one of the ten leading causes of death in India. [3] It is estimated that there are nearly 2 to 2.5 million cancer cases at any given point of time in India. [4] Over 7 to 9 lakh new cases and 3 lakh deaths occur annually in India due to cancer, [5] whereas in Karnataka there are about 1.5 lakh prevalent cases of cancer and about 35,000 new cases are added to this every year. [6] Based on the consolidated report of cancer registries the overall common cancer sites in South India are stomach for males and cervix for females. [7],[8],[9]

Breast cancer is the most common diagnosed malignancy in women worldwide (22%) and in India (18.5%) it ranks second to cervical cancer. The burden of breast cancer is increasing in both developed and developing countries; the peak occurrence of breast cancer in developed countries is above the age of 50 whereas in India it is above the age of 40. [10] In India the age standardized incidence rate of breast cancer varies between 9 to 32 per 1,00,000 women. To generate the reliable data on magnitude and pattern of cancer, India started National cancer registry program in 1981. [11] Upto 2003 the program comprised of sixpopulation based cancer registry and oneregistry serving rural area covering the total population of 35.7 million (only 3.5% of the Indian total population) [12] and an increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimatednumber of breast cancer deaths worldwide. [13],[14]

For a country like India with a huge population, diverse cultures, geographical variations, diets and habits, sources of information on cancer risk factors are considerably limited. The reasons for varying incidence of breast cancer among women are not fully understood, which are likely to be explained by reproductive and lifestyle factors such as Literacy, Diet, Age at menarche and menopause, Age at first delivery, Abortion, Family history of Breast Cancer. [15],[16],[17],[18],[19],[20],[21],[22],[23],[24]

The present study attempts to find out some of the various risk factors of Breast Cancer among patients attending the tertiary care hospital in Udupi District.


   Materials and Methods Top


The case control study was conducted at Shirdi Sai Baba Cancer Hospital and Research Center, Manipal, Udupi District. Delayed age at first delivery was considered as a risk factor [24] with an exposure of 30% in control group and an anticipated OR of 2 for a power of 80% and 5% level of significance the calculated number of cases was 94. For 1:1 allocation ratio the required number of controls was 94, hence total 188 individuals were included in the study. All type of histopathologically confirmed cases of breast cancer irrespective of their degree, between the age group 25 to 69 years were included in the study as cases and ± 2 years age matched individuals; patients other than breast cancer in the hospital were selected as controls. Patients, who were not willing to participate in study, or those cases who were seriously ill and male breast cancer patients were excluded from the study. First degree relatives of cases, controls having personal history of breast disease, pregnant women, and women with gynecological problems were excluded from the study. The cases and controls were personally interviewed by investigator using a structured questionnaire. The study participants were informed about the purpose, method and possible discomforts related with the study and written consent was obtained. Due clearance was obtained from Institutional ethics committee and hospital Administration. Data analysis was done using statistical package for social sciences software and stata software. The data is summarized in the form of tables. Univariate Conditional Logistic Regression analysis was used to evaluate the significant factors associated with breast cancer. Multivariate Analysis was used to calculate the adjusted Odds Ratio with 95% CI.


   Results Top


Total 188 participants were studied 94 were cases and 94 were controls. The cases and controls were selected from Shirdi Sai Baba Cancer Hospital, Manipal. The participants were interviewed with the help of a structured questionnaire and the information regarding age, religion, education, residence, diet, and history of breast cancer in family, reproductive factors, family planning and habits were obtained. All the study participants were between 25 to 69 years of age group. The cases and controls were matched by ± 2 years age range. The maximum cases (21.3%) were between 50 to 54 years of age group. The mean age of the cases was 45.64 years (SD 9.336) and that of controls was 44.9 years (SD 9.446). Most of the cases and controls belonged to Hindu Religion. The cases had a better education as compared with the controls. The study population included the participants from urban and rural areas of 15 different districts. Udupi district had the maximum number of cases (43.6%).Univariate conditional Logistic Regression Analysis was done to evaluate the factors significantly associated with breast cancer. [Table 1] reports the results of Univariate conditional logistic regression for exposure variables education monthly income, Diet and Family History with breast cancer. More than seven to twelve years of education was observed as a significant risk factor and the non vegetarian diet was also observed an important risk factor. The unadjusted risk of breast cancer was more among the women who had non vegetarian diet (OR 1.93, CI 1.05- 3.44) as compared with the vegetarian women. [Table 2] reports the results of univariate conditional logistic regression for reproductive factors. Age at menarche, age at first child birth and abortion reported significant risk for breast cancer. Use of Oral contraceptive pills did not report any significant risk in present study population. In this study habits of pan chewing, tobacco chewing, aerecanut chewing and snuffs use were not significantly associated with breast cancer risk. [Table 3] reports the adjusted Odds Ratio of the variables which reported significant risk for Breast Cancer in univariate analysis. The women with more than 7 to 12 years of education had 4.84 times risk of breast cancer (OR 4.84 CI 1.51-15.46) as compared with the illiterate women. The adjusted risk of breast cancer was more among the women who had non vegetarian diet (OR 2.80, CI 1.15-6.81) as compared with the vegetarian women.
Table 1: Univariate conditional logistic regression for socio-demographic variables, diet and family history

Click here to view
Table 2: Conditional logistic regression for reproductive factors

Click here to view
Table 3: Adjusted odds ratio of factors associated with breast cancer risk

Click here to view



   Discussion Top


The present study conducted at Shirdi Sai Baba Cancer Hospital Manipal, included 94 breast cancer cases and 94 control subjects. The cases and controls were between 25 to 69 years of age. Ozmen, et al., conducted a similar study with the cases and controls between 18 to 70 years of age. [25] Ahmed, et al., conducted a similar study with study population between 20 to 65 years age group. [26] In the present study maximum numbers of subjects (21.3%) were observed between 50 to 54 years of age group. The average age of the cases was 45.64 years (SD 9.336) and that of controls was 44.9 years (SD 9.446), similar findings were noted in the study conducted by Meshram et al., the study reported most of the patients between 40 to 49 years of age with the average age of 48.4 years for cases. [15] Abbasi, et al., reported average age of cancer cases 47.49 years in a similar study conducted Iran. [27]

The present study reported 34% of the cases with less than age 40 years. In the present study no case or control reported the habits of smoking or drinking, Pakseresht, et al., reported the similar findings in the study conducted in delhi. [18]

The study reported significant unadjustedrisk of breast cancer for the women with education between more than 7 to 12 years, non vegetarian diet, age at menarche more than 13 years, age at first child birth more than 30 yearsand induced abortion ( P < 0.05). The study conducted by Abbasi, et al., reported significant association between age at menarche and breast cancer. [27] The study done by Gajalakshmi, et al., reported that higher education is associated with increased risk of breast cancer. [20] The study conducted by Rai, et al., reported that education and socio-economic status of the cases was higher as compared to cases, the study reported significant association between abortion and breast cancer. [28]

The present study showed an increased adjusted risk of breast cancer with increase in education (>7 to 12 years). This may be because of better awareness of educated women regarding detecting the Breast Cancer or may be due to education brings about the lifestyle changes such as late age of marriage, late age at child birth which are not incremented in the study. Similar finding was reported by Gajalakshmi, et al., in a multicentric case control study in both premenopausal (>12 years education OR 1.52 CI 1.09-2.13) and postmenopausal women (>12 year education OR 2.46 CI 1.46-4.13). [20]

The non vegetarian diet was observed an important risk factor. The adjusted risk of breast cancer was more among the women who had non vegetarian diet (OR 2.80, CI 1.15-6.81) as compared with the vegetarian women. A similar study conducted by Harrison et al., noted that diet was significantly associated with breast cancer. [29] The Risk level for non-vegetarian diet was higher than vegetarian diet because non vegetarians consume more fat than vegetarians and a diet with a high animal fat intake has been shown to increase the risk of breast cancer. [21] Hence education and awareness about the beneficial effects of consuming fresh vegetables and fruits will be helpful in controlling Breast Cancer.


   Conclusion Top


The study results are in accordance with the results of previous investigations on risk factors of Breast Cancer. Breast Cancer occurs a decade earlier in Indian Women as compared with the women of developed countries and is a leading cause of mortality in developing countries like India so raising awareness about the screening procedure and treatment of Breast cancer can help reducing mortality.


   Acknowledgments Top


The authors gratefully acknowledge all the support extended by Head of the Department Oncology and Medical Superintendent Kasturba Hospital. Authors would also like to thank the ShirdiSai Baba Cancer Hospital staff for their co-operation.

 
   References Top

1.Cancer Mortality, The Global Burden Of disease 2004 Update, World Health organization. Available from: http://www.who.int/healthinfo/global burden disease/Global Health Risks report full. Pdf. [Last accessed on 2011 Jan 28].  Back to cited text no. 1
    
2.Disease incidence, prevalence and disability, The global burden of disease 2004 Update, World Health organization. Available from: http://www.who.int/healthinfo/global burden disease/GBD report 2004update part3.pdf. [Last accessed on 2011 Jan 28].  Back to cited text no. 2
    
3.Gupta S, Rao YN, Agarwal SP. Emerging strategies for cancer control for women in India. 50 Years of Cancer control in India; 2003. Available from http://www.medindia.net/education/MinistryofHealth/pg192to203.pdf. [Last accessed on 2013 Jan 14].  Back to cited text no. 3
    
4.Available from: http://webmail.medindia.net/education/MinistryofHealth/pg192to203.pdf. [Last accessed on 2013 May 14].  Back to cited text no. 4
    
5.Rao YN, Gupta S, Agarwal SP. National cancer control programme: Current status and strategies, 50 Years of cancer control in India; 2003. Available from http://www.medindia.net/education/MinistryofHealth/pg192to203.pdf. [Last accessed on 2013 Jan 14].  Back to cited text no. 5
    
6.Available from: http://webmail.medindia.net/education/MinistryofHealth/pg49to55.pdf. [Last accessed on 2012 Oct 16].  Back to cited text no. 6
    
7.Task force Reports for 11 th five year plan 2007-12, National Cancer control Programme, March 2008.  Back to cited text no. 7
    
8.Jagnnatha GV, Hiremath SS. Oral cancer prevalence and assessment of various risk factors among Oral cancer patients attending Kidwai Memorial Institute of Oncology. An Epidemiological Study; 2005. Available from http://119.82.96.198:8080/jspui/handle/123456789/2652. [Last accessed on 2013 May 14].  Back to cited text no. 8
    
9.Reddy KR. Department of epidemiology and statistics Banglore cancer registry. Kidwai Memorial Institute of oncology 2010. Available from: http://kidwai.kar.nic.in/statistics.htm. [Last accessed on 2011 Jan 28].  Back to cited text no. 9
    
10.Population based cancer registries consolidated report (1990-96). Available from: http://www.icmr.nic.in/ncrp/pbcr.pdf. [Last accessed on 2010 Oct 31].  Back to cited text no. 10
    
11.National cancer registry programme report (1981-2001).Available from http://www.icmr.nic.in/ncrp/cancer regoverrview.htm. [Last accessed on 2011 Jan 24].  Back to cited text no. 11
    
12.Siddiqi M, Sen U, Mondal SS, Patel DD, YeoleBB, Jussawala DJ, et al. Cancer statistics from non-ICMR registries: Population based registries. CRAB (Cancer registry Abstract). Newsletter of the National Cancer Registry Project of India 2001;47-59.  Back to cited text no. 12
    
13.National cancer registry programme, Indian council of Medical Research. Available from: http://www.icmr.nic.in/ncrp/ncrp_p/cancer_reg.pdf. [Last accessed on 2011 Jan 24].  Back to cited text no. 13
    
14.Nandkumar A, Gupta PC, GangadharanP, Visweswara RN, Parkin DM. Geographic pathology revisited: Development of an atlas of cancer in India. IntJCancer 2005;116:740-54.  Back to cited text no. 14
    
15.Badwe RA, Gangawal S, Mittra I, Desai PB.Clinico-pathological features and prognosis of breast cancer in different religious communities in India.Indian J Cancer1990;27:220-8.  Back to cited text no. 15
[PUBMED]    
16.Development of an atlas of cancer in India. A Project of National Cancer Registry Programme supported by WHO 2001-2. Available from: http://www.ncrpindia.org/Cancer Atlas Indaia/about.htm. [Last Accessed on 2011 Jan 24].  Back to cited text no. 16
    
17.Meshram II, Hiwarkar PA, Kulkarni PN. Reproductive risk factors for breast cancer: A case control study. Online J Health Allied Sci 2009;83:5.  Back to cited text no. 17
    
18.Pakseresht S, Ingle GK, Bahadur AK, Ramteke VK, Singh MM, Garg S, et al. Breast cancer among women in Delhi. Indian J Cancer 2009;46:132-8.  Back to cited text no. 18
[PUBMED]  Medknow Journal  
19.Lodha SR, Nandeshwara S, Pal KD. Risk of breast cancer in obese women: A case control study. Natl J Community Med 2010;1:166-7.  Back to cited text no. 19
    
20.Gajalakshmi CK, Shanta V, Hakama M. Risk factors for contralateral breast cancer in Chennai (Madras), India. Int J Epidemiol 1998;27:743-50.  Back to cited text no. 20
    
21.Mathew A, Gajalakshmi V, Rajan B, Kanimozhi V, Brennan P, Mathew BS, et al. Anthropometric factors and breast cancer risk among urban and rural women in south India A multicentric case control study. Br J Cancer 2008;99:207-13.  Back to cited text no. 21
    
22.Gajalakshmi V, Mathew A, Brennan P, Rajan B, Kanimozhi VC, Mathews A, et al. Breast feeding and breast cancer risk in India: A multicenter case control study. Int J Cancer 2009;125:662-5.  Back to cited text no. 22
    
23.Rao DN, Ganesh B, Desai PB. Role of reproductive factors in breast cancer in a low-risk area: A case-control study. Br J Cancer 1994;70:129-32.  Back to cited text no. 23
    
24.Gajalakshmi CK, Shanta V. Risk factors for female breast cancer. A hospital-based case-control study in Madras, India. Acta Oncol 1991;30:569-74.  Back to cited text no. 24
    
25.Ozmen V, Ozcinar B, Karanlik H, Cabioglu N, Tukenmez M, Disci R, et al. Breast cancer risk factors in Turkish women A university hospital based nested case control study. World J Surg Oncol 2009;7:37.  Back to cited text no. 25
    
26.Hussain GA, Rehab MM, Mohmmad ME, Mohmmad OH.Role of some risk factors in etiology of breast cancer in Sudan. Open Breast Cancer J 2010;2:71-8.  Back to cited text no. 26
    
27.Abbasi S, Azimi C, Othman F, Einollahi N, Dashti N, Nabatchian F, et al. Risk factors for breast cancer in Iranian women: A case control study. Int J Cancer Res 2009;5:1-11.  Back to cited text no. 27
    
28.Rai M, Pande A, Singh M, Rai A, Shukla HS. Assessment of epidemiological factors associated with breast cancer. Indian J Prev Social Med 2008;39:71-7.  Back to cited text no. 28
    
29.Harrison AP, Srinivasan K, Binu VS, Vidyasagar MS, Nair S. Risk factors For breast cancer among women attending a tertiary care hospital in southern India. IJCRIMPH 2009;2:109-16.  Back to cited text no. 29
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Abortion-breast cancer study not valid for assessing overall association
Joel Brind
Acta Obstetricia et Gynecologica Scandinavica. 2013; : n/a
[Pubmed]
2 result 2 Document An analysis of selected health behaviours of women as breast cancer risk factors
Authors of Document Kachaniuk, H., Stanisławek, A., Bartoszek, A., (...), Szadowska-Szlachetka, Z., Charzyńska-Gula, M.
Przeglad Menopauzalny. 2013;
[Pubmed]



 

Top
Print this article  Email this article
           

    

 
   Search
 
  
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Article in PDF (411 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
   Acknowledgments
    References
    Article Tables

 Article Access Statistics
    Viewed4085    
    Printed60    
    Emailed0    
    PDF Downloaded504    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

  Sitemap | What's New | Feedback | Copyright and Disclaimer
  2007 - Indian Journal of Community Medicine | Published by Medknow
  Online since 15th September, 2007