Breast Self-Examination Practices in Rural India: A Study on Early Breast Cancer Detection

Abstract

Background: Breast cancer is the most commonly diagnosed cancer among women in India, with a growing burden in rural areas due to limited awareness, cultural beliefs, and poor access to timely care. Breast Self-Examination (BSE), a low-cost and non-invasive method, supports early detection, particularly in low-resource settings. However, many women do not seek care even after receiving BSE training. Objectives: To explore the barriers and facilitators influencing healthcare-seeking behaviour among suspected breast cancer cases in rural Rajasthan following a large-scale BSE awareness and training program. Methodology: A descriptive qualitative study was conducted in three rural districts of Rajasthan (Pali, Jodhpur, and Jalore) as part of a large-scale breast cancer awareness and BSE training program. Thirteen suspected breast cancer cases who did not seek timely care after program follow-up were purposively selected for in-depth interviews. Data were collected using a semi-structured guide, transcribed, translated, and thematically analysed using NVivo 13 following the Braun and Clarke framework. Results: Six major themes were identified: (1) behavioural attributes including low perceived risk and incentive-driven participation; (2) religious beliefs and reliance on spiritual healing; (3) clinical challenges including delayed diagnosis, high out-of-pocket costs, and poor hospital care; (4) health system gaps such as limited diagnostics and weak referral chains; (5) social support from family members and community health workers; and (6) social barriers including patriarchy, stigma, and lack of autonomy. While some women were encouraged by relatives or health workers, most faced personal and systemic challenges that hindered timely care. Conclusions: Awareness and BSE training alone are insufficient to prompt early care-seeking. Deep-rooted beliefs, gender norms, economic hardship, and weak health systems delay timely diagnosis and treatment. Gender-sensitive, community-driven, and system-strengthening interventions are essential to improve rural breast cancer outcomes.