Low Awareness, Late Diagnosis: A Study of Breast Cancer Awareness and Stage at Presentation in India

Background: Breast cancer is the most common malignancy among women in India, with a majority presenting at advanced stages. Delayed presentation is a major contributor to poor outcomes, and inadequate awareness is believed to play a central role. This study aimed to quantify breast cancer awareness using a structured Breast Cancer Awareness Score (BCAS) and to evaluate its association with stage at diagnosis and delay in presentation. Methods: A cross-sectional study was conducted among 200 women diagnosed with breast cancer at a tertiary care center. Data were collected using a structured questionnaire assessing demographics, symptom appraisal, health-seeking behavior, and knowledge of symptoms, treatability, preventive practices, and risk factors. A composite BCAS was calculated and categorized as low, moderate, or high. Associations between BCAS and stage at presentation, age, and delay in seeking care were analyzed using chi-square tests. Results: The mean age was 51.2 years. Most women belonged to lower socioeconomic strata and had limited education. Only 20% sought medical attention within 3 months of symptom onset, while 48% presented after more than 6 months. Advanced-stage disease (Stage III/IV) was observed in 54.5% of patients. BCAS was low in 51%, moderate in 35.5%, and high in only 13.5%. Lower BCAS was strongly associated with advanced stage at presentation (χ² = 57.59; p < 0.001) and longer delays in seeking care (χ² = 133.75; p < 0.0001). Younger women demonstrated significantly higher awareness scores than older patients (χ² = 31.56; p < 0.0001). Conclusion: Poor breast cancer awareness is strongly associated with delayed presentation and advanced-stage disease. Awareness is a clinically relevant and modifiable determinant of outcomes. Targeted, culturally appropriate educational interventions focusing on symptom recognition, treatability, and risk factors are urgently needed to facilitate earlier diagnosis and improve survival in resource-limited settings.