Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Breast Cancer Risk Stratification and Screening Practices of Women in South Kerala, India: A Cross-sectional Study
Correspondence Address :
Dr. Susanna John,
Associate Professor, Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Thiruvananthapuram-695607 Kerala, India.
E-mail: suston14@gmail.com
Introduction: The incidence of breast cancer is increasing in India, making it the most common cancer among women. Early detection of breast cancer is crucial for reducing morbidity, mortality, and improving the quality of life for patients. However, breast cancer mortality rates are higher in India compared to other parts of the world, possibly due to late-stage diagnosis. Regular screening is key to early detection, but population screening is not feasible in India due to limited resources. Therefore, high-risk screening is a more practical approach. Assessing individual risk using a breast cancer risk calculator can help identify asymptomatic women at high-risk and motivate them to undergo regular screening, leading to early detection.
Aim: To assess the risk of developing breast cancer among women in Kerala using a breast cancer risk calculator and to describe their screening practices.
Materials and Methods: A cross-sectional survey was conducted among 1861 women aged over 30 years in Thiruvananthapuram, Kerala, India. Personal details of the participants, major known risk factors of breast cancer, and information about breast cancer screening practices were collected using a questionnaire. Breast cancer risk stratification was performed using the Snehita breast cancer risk calculator.
Results: According to the breast cancer risk calculator, 12.74% of the women were classified as high-risk and 65.18% had a normal risk of developing breast cancer. Among the participants, 82.64% stated that they had never undergone any breast cancer screening procedures.
Conclusion: Despite Kerala being a state with high female literacy rate, the screening practices for breast cancer were found to be very low (17.36%). Additionally, 12.74% of the women were identified as being at high-risk of developing breast cancer. Breast cancer risk calculators can serve as a motivational tool to encourage women to undergo regular screening.
Breast neoplasms, Early detection, India, Risk factors, Risk assessment tool
Breast cancer has become the most common cancer among women worldwide. It affects over 1.5 million women annually around the globe and is the leading cause of cancer-related deaths among women. Although the incidence of breast cancer is higher among women in developed countries compared to women in developing regions, this trend is slowly changing. The increasing incidence of breast cancer in developing countries is attributed to factors such as increased life expectancy, urbanisation, and the adoption of western lifestyles (1),(2).
According to GLOBOCAN 2020, there were 2.3 million new cases of breast cancer diagnosed globally (3). Population-based cancer registries in India also show an upward trend in breast cancer incidence (4),(5). About 15% of all cancer deaths among women in India are due to breast cancer (6). In Kerala, the incidence of breast cancer is increasing, and Thiruvananthapuram has emerged as the nation’s breast cancer capital, with the highest crude incidence rate of 40 per 100,000 women, according to the estimation of the Population-Based Cancer Registry for Thiruvananthapuram at the Regional Cancer Centre (7). Breast cancer accounts for 31% of all cancers among females in Thiruvananthapuram, and 35% of patients are under 50 years old (7). Additionally, the major cause of higher breast cancer mortality rates is attributed to late-stage diagnosis (8).
This study included the major known risk factors of breast cancer from research literature, such as early menarche, nulliparity, late age at childbirth, shorter duration of lactation, late menopause, family history of breast or ovarian carcinoma, and any invasive procedures on the breast (9),(10),(11),(12).
Breast cancer has become the most common cancer among women in Kerala, with increasing morbidity and mortality rates over the past two decades. Thiruvananthapuram, the capital city of Kerala, has the highest incidence rates. Early detection and proper treatment of breast cancer improve cure rates and survival rates. Identifying women at a higher risk of breast cancer and motivating them for screening can detect the disease at earlier stages and contribute to early treatment (13). Studies in BRICS countries, which are in a transition stage, have shown that the early diagnosis approach is better in downstaging the tumour and improving survival at a fraction of the cost needed for population screening (13),(14),(15).
Knowledge regarding the prevalence of known risk factors and screening practices in a community helps in formulating strategies for interventions leading to early detection (16),(17). Currently, there is limited data regarding the prevalence of known risk factors for breast cancer among women, their breast cancer screening practices, and the high-risk population for this disease in Thiruvananthapuram, Kerala. The objectives of this study were to assess the risk of developing breast cancer among women in Kerala using a breast cancer risk calculator and to describe the prevalent breast cancer screening practices in the community.
A descriptive cross-sectional survey was conducted among 1861 women in the Thiruvananthapuram district of Kerala. The data was collected between January 2017 and January 2018. Institutional Ethics Committee approval (SGMC-IEC No: 19/195/2016) was obtained before beginning the study.
All the female participants aged 30 years and above who gave informed consent were included in the study.
Sample size estimation: A pilot study was conducted among 100 women, from which the proportion of high-risk individuals was determined to be 18% (p).
Relative precision of 10% (d) and level of significance 5% (α) was taken. The sample size was estimated to be 1751 using the following formula. Eventually 1861 participants were included in the study.
(Za)2pq/d2 = 1.962×18×(100-p)/(10% of p)2 =1751
Study Procedure
The study participants were selected from fifty-two community-based awareness sessions on breast cancer conducted in different parts of Thiruvananthapuram, covering all municipalities and gram panchayats (urban and rural areas). These sessions were organised by the Department of Community Medicine at Sree Gokulam Medical College, Venjaramoodu, Thiruvananthapuram, Kerala, India. Data was collected through face-to-face interviews using a questionnaire which consisted of three parts: I) Personal details; II) Parameters for the online calculator to compute a risk score using the Snehita breast cancer risk calculator; III) Breast cancer screening practices.
Risk assessment was performed using the Snehita breast cancer risk calculator (17),(18), which is a freely available online tool. The following seven parameters were collected from the participants: 1) Age of the participant; 2) Age at menarche; 3) Age at first live birth; 4) Number of live births; 5) Duration of breastfeeding; 6) Number of previous breast biopsies, if any; and 7) Number of first-degree relatives with breast or ovarian cancer. These parameters were used to compute a risk score (Table/Fig 1), which helped in stratifying the participants into normal, moderate, and high-risk groups. Advice was then given to each group accordingly (18).
Data regarding prior breast cancer screening practices were also collected using a questionnaire [Annexure 1]. The content validity of the questionnaire was checked by experts in the field of Community Medicine, Biostatistics, and Oncology.
Statistical Analysis
Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics, such as mean and Standard Deviation (SD), were used for continuous variables. Categorical data were presented as frequencies and percentages. The chi-square test was utilised to determine the association between categorical variables, and a p-value of less than 0.05 was considered statistically significant.
The mean age of the study participants was 47.18 years (SD 10.74). Among the 1861 study participants, 245 (13.16%) belonged to the upper socio-economic class, 985 (52.93%) belonged to the middle class, and 631 (33.91%) belonged to the lower class. Other major results are summarised in (Table/Fig 2).
Among the 1861 participants, 70 women (3.76%) were nulliparous. A total of 141 participants reported undergoing one of the invasive procedures such as Fine Needle Aspiration Cytology (FNAC), biopsy, lumpectomy, or mastectomy on their breast (Table/Fig 3).
Positive family history in first-degree relatives was found in 90 participants (4.84%). Among these 90 participants, only two women had more than one first-degree relative with a positive history of breast cancer. Only two participants reported a family history of ovarian carcinoma. No family history of male breast cancer was reported (Table/Fig 2). Among the 1861 participants, 731 had attained menopause, out of which 644 naturally attained menopause, and the remaining 87 had surgically attained menopause. The mean age at menopause among these 644 women who attained natural menopause was 47.24 years (SD 4.69).
Breast cancer risk was assessed using the Snehita breast cancer risk calculator (18). Among the study participants, 237 (12.74%) women were in the high-risk category. The risk stratification is presented below in (Table/Fig 4).
The study participants were asked about any breast cancer screening methods they had undergone in the past. It was found that 82.64% of women (1538/1861) had never undergone any breast cancer screening, while the remaining 17.36% (323/1861) had undergone atleast one method of breast cancer screening. (Table/Fig 5) shows the breast cancer screening practices among the study population.
Among the total 237 high-risk individuals, 216 (91.14%) had never screened for breast cancer. The screening practices were significantly associated with the various breast cancer risk strata (p<0.0001) (Table/Fig 6).
Early detection remains the cornerstone of effective breast cancer management as it allows for timely intervention and improved treatment outcomes. To achieve this, there is a need to improve risk-based screening practices in our society (19). According to the present study, only 17.4% of the participants had undergone any method of breast cancer screening. The breast cancer risk calculator provided the distribution of risk categories among the participants: 12.74% were identified as high-risk, 22.08% as moderate-risk, and 65.18% as normal-risk individuals.
According to NFHS-5 data, the status of breast cancer screening in India is alarmingly low (20). In a study by Jones M et al., on cancer screening behaviours among women aged 30-65 years in Thiruvananthapuram, 14.2% of women reported undergoing prior cancer screening (16), which aligns with the results of the present study. This percentage underscores the need for enhanced efforts to promote breast cancer awareness and the importance of regular screening in India. These numbers fall short of the recommended screening rates in Western countries, highlighting potential gaps in breast health education and accessibility to screening facilities. To improve screening rates, it is imperative to implement targeted awareness campaigns, reduce barriers to accessing screening facilities, and educate both healthcare professionals and the public about the importance of early detection in breast cancer management. Socioeconomic factors (17), geographic location, and healthcare access play crucial roles in determining screening rates, emphasising the need for targeted interventions to reach underserved communities (21),(22).
Breast cancer risk assessments can be done using online tools such as the Breast Cancer Risk Assessment Tool (BCRAT/Gail model) (23), BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) (24), or International Breast Cancer Intervention Studies (IBIS)/Tyrer-Cuzick Claus model (25). These models utilise different predictors to stratify breast cancer risk. According to Paige JS et al., breast cancer risk estimates for individual women vary depending on the risk assessment model used (26). The Snehita Breast Cancer Risk Calculator (18),(27), based on the modified Gail score for the Indian population, provides recommendations for each risk category based on the risk score. Scott DM states in her article on breast cancer screening that a formal risk calculator is very useful for assessing a person’s lifetime risk of developing breast cancer and determining eligibility for high-risk screening, contributing to early detection (28). Studies in South India (27) and Western India (29) suggest that the Gail model is not an appropriate risk assessment tool for the Indian population, highlighting the need for a local tool (30).
Recent studies have emphasised the clinical significance of risk-based screening. High-risk individuals may benefit from more frequent and specialised screening modalities, such as Magnetic Resonance Imaging (MRI) and genetic counseling, which can improve early detection and risk management (31),(32). Conversely, normal-risk individuals can follow standard screening guidelines, reducing the potential harms associated with over-screening. This risk stratification offers a personalised approach to screening and prevention, ensuring effective allocation of resources. Breast cancer risk assessment models are continually evolving, incorporating additional risk factors such as genetics, family history, and lifestyle factors, which can enhance the accuracy of risk stratification (33),(34). Recent advances in genomics and artificial intelligence may hold promise in further improving the accuracy of risk prediction and personalising screening recommendations (35).
Limitation(s)
Since the study was conducted among the general population, there is a possibility of recall bias occurring in certain risk factors.
In the present study, 12.74% (237) women were in the high-risk category, and 82.64% of women had never undergone any breast cancer screening. The screening practices significantly associate with the various breast cancer risk strata. This study highlights the importance of enhancing breast cancer screening participation and adopting risk-based stratification approaches. Given Kerala’s high female literacy rate, there is a unique opportunity to address this issue by promoting community awareness regarding the benefits from early detection of breast cancer. The breast cancer risk calculator can serve as a vital motivational tool in this context, empowering women to understand their personalised risk categories and encouraging their participation in screening programs. This approach is especially significant in financially constrained healthcare systems as it allows for targeted resource allocation to those at higher risk, thus improving the burden and overall quality of care.
DOI: 10.7860/JCDR/2023/64274.18781
Date of Submission: Apr 06, 2023
Date of Peer Review: Jul 18, 2023
Date of Acceptance: Sep 28, 2023
Date of Publishing: Dec 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 08, 2023
• Manual Googling: Aug 16, 2023
• iThenticate Software: Sep 21, 2023 (16%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com