This research proposal aims to assess awareness of breast cancer in Pakistan by surveying female medical and non-medical students in two cities. A questionnaire will evaluate participants' knowledge of early warning signs, risk factors, and general information about breast cancer. The study hopes to highlight the need for awareness campaigns and education to promote early detection and reduce breast cancer mortality in Pakistan.

1. SAIRA REHMAN
MLT
RESEARCHPURPOSALOF AWARENESS OF BREAST CANCER IN PAKISTAN

2. AWARENESS OF BREAST CANCER IN PAKISTAN
INTRODUCTION:
Non communicable disease cancer causes death worldwide. Cancer have broad region multiple
types of cancer exists (Shaukat et al., 2013). Most common cancer in women worldwide is breast
cancer (Badar et al., 2007) (Jamel et al., 2011).Breast cancer begins in the cells of breast
(Shaukat et al., 2013). Tumor originating from breast tissue is a breast cancer most commonly
from the lobules supplying ducts with milk or the inner lining of milk ducts .Different types of
breast cancer exist on the basis of shape, genetic makeup and aggressiveness. However remain
unknown the exact causative agent but yet primary risk factors identified are sex, age, genetics,
lack of child bearing, breast feeding, higher hormonal levels and individual lifestyle (Uzma S et
al., 2013). Due to high rate of malignancies it has become the fifth most common reason for
death in females all over the world (Shaukat et al., 2013). In the twenty first century beginning
more than one million women were diagnosed with breast cancer out of which 373,000 died in
the year 2000 and in 2004 519,000 women died (Farlay et al.,2010). There were an estimated
that 189,000 deaths in the developed countries 184,000 in developing countries in the year 2000
(Narayn Singh et al., 2010). So according to statistical data breast cancer in developing countries
is greater than in developed countries. In Asian countries including Pakistan the high rate of
breast cancer gives an alarming signal.So according to this the breast cancer incidence in
Pakistan is 2.5 times more than in other countries of Asia such as India and Iran ( Shaukat et al
.,2013 ). In Pakistan women the second most cause of death is due to genetic mutation and
increasing age (American cancer society, 2013). District of dir medical records of 1,105 patients
registered at the institute of radiotherapy and nuclear medicine in Peshawar were traced to

3. evaluate incidence of cancer . In information age , gender and affected sites were obtained . It
was reported in 2008 the incidence of cancer was alarmingly increasing with the mean incidence
of 15.04 per 100,000 in 2000-2004 ( Zeb et al ., 2008 ). It is elaborated among every nine women
, one woman is expected to be the sufferer of breast cancer and this ratio increases after
menopausal age of 45 years ( Rasheed et al ., 2013 ). There are multiple causes and risk for
suffering from breast cancer but the family history due to mutation in breast cancer 1 ( BRCA
1) and breast cancer 2 ( BRCA 2 ) genes is a central key factor ( Siddique et al .,2014 ). Recent
studies elaborate that environment play an Important role in increasing the breast cancer for
example due to high fat diet breast tissues compact , Late night work changes the level of
melatonin , By using of oral contraceptives, Sedentary life style due to higher socioeconomic
status , Higher level of sex hormones in the blood stream of alcohol consumer , Women smoke
less than 20 years or before delivery a baby ( Tariq et al., 2013 ). Furthermore reduced number
of female oncologists and lake of medical facilities for timely treatment is concerning issue in
Pakistan (American cancer society 2013). The another important highlighted aspect of breast
cancer is age. In Pakistan the high rate of breast cancer in middle age women of average age 48
years whereas in western countries the breast cancer is mostly common in old age after 60 years.
Therefore these two factors have important relationship to the occurrence of breast cancer in
Pakistani females. Another factor include is over exposure to estrogen due to early period of
twelve years , Late menopause after 55 years , late child birth after 30 years or no child birth ,
previous breast benign lesion of one breast that have metastasized to another non diseased breast
, previous chest radiation mostly at the time of adolescence are at a high risk , due to continuous
growth of chest ( Shaukat et al., 2013). In worldwide one million new cases female breast cancer
are diagnosed each year. Breast cancer is the most common neoplasm in women . 4.7 million

4. cancer diagnoses in females and the second most common tumor after lung cancer in both sexes.
(Farley J et al., 2001).
MAIN OBJECTIVE:
Despite huge efforts to increase the level of breast cancer awareness, breast self-examination
(BSE) is still poorly practiced across Pakistan. This baseline study aimed to assess the awareness
of female Pakistani students about breast cancer and their practice of (BSE).This study highlights
the need to formulate an awareness campaign and to organize conferences to promote awareness
of breast cancer in this region.
MATERIAL AND METHODS
STUDY DESIGN:
Study design a community based cross sectional descriptive analysis will carried out with the
objective to assess the knowledge that young females possess regarding early warning signs and
the risk factors involved in breast cancer.
STUDY AREA AND TARGET POPULATION:
The study will conducted in two major cities; Abbottabad and Haripur in the KPK region of
Pakistan. We involved female non medical students of University of Haripur and Post Graduate
Colleges in Abbottabad. Medical graduates will from Ayub Medical College, Abbottabad and
Women Medical College , Abbottabad.

5. SAMPLING:
The sampling frame included both medical and nonmedical students. Female students having a
mild mental disability or learning disorders will be excluded from the study population. The
probability systematic random sampling method will used to choose the samples. The
hypothesized proportion of outcome factors of the study population will 50%, confidence limits
95%, and absolute precision was 5% and design effect of 2. The required sample size will be
found to be 316 non-medical and 235 medical students. We added 5% for non-respondents thus
the sample size will be finalized as 332 and 247 for the non-medical and medical female students
respectively. Those students, who would not willing to participate, would not given the
questionnaire. Questionnaires from nonmedical students and from medical students will be
excluded from the study due to insufficient information being provided by the respondents. The
results of 326 non-medical and 240 medical students will include in the final study.
INSTRUMENTS:
The questionnaire will developed by the researchers to assess basic knowledge about early
warning signs and risk factors of breast cancer among female students. Content validity will
ascertained by experts. The questionnaire consisted mainly of four sections. The first part
included five questions about demographic characteristics of the participant such as age, ethnic
origin, religion, marital status and residency. The source of their knowledge regarding breast
cancer will also requested from students. The second part included five questions concerning
general knowledge about breast cancer. A third portion included seven questions about the early
warning signs of breast cancer. The fourth and final section consisted of twenty questions which

6. will designed to assess the knowledge about the potential risk factors of breast cancer. Thus, a
total of 32 questions were included in the last three portions of the questionnaire each carrying 1
mark. A score of 1 will be awarded to each correct answer while 0 will assigned in the case of a
wrong answer. Therefore, 32 will be the maximum score one could get. The response of
participants will be categorized into “poor”, “insufficient”, “satisfactory” and “good” on the
basis of obtained score of ≤8, ≤16, ≤24 and ≤32 respectively.
STATISTICALANALYSIS
Participants will be grouped into non-medical and medical sets. Percentage and frequency
distribution will be calculated to illustrate categorical variables. Data will statistically analyzed,
the results would tabulated and graphs were plotted using Graph Pad Prism Version 5. The
association between variables will calculated by performing a Chi-Square test with a significance
level set at p < 0.05.
SOURCEOF INFORMATION
Television and school/college education were the most cited sources of information about breast
cancer among non medical and medical students of the university, respectively
SIGNIFICANCE OF STUDY:
Raising awareness of breast cancer issues and educating all women about breast health is
important. Breast cancer is the most common female cancer with approximately 2,800 women
being diagnosed with breast cancer each year.Also committed to raising awareness and educating
people of the importance of early detection of breast cancer, promoting the practice of breast

7. awareness and encouraging regular breast screening mammograms from the age of 40. We do
this through our Awareness campaigns and our research awareness study.
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