Awareness about cancer in Baluchistan

Background;Propose of presence study was to evaluate the knowledge of Baluchistan’s people about cancer. Cancer is a disease which can occur at any time, any age and anywhere in the world. It is caused basically by certain types of disease, infection, mutation and due to genetic abnormalities. Method; For purpose to check the basic awareness of people of Baluchistan province (Pakistan) a randomized survey was design. Almost 1200 subjects from district Quetta, Killa Abdullah and Zhob were interviewed. Results; Results showed that people of living in urban areas had more basic awareness about cancer than other rural ones. Conclusion; It has been concluded that it is because of educational difference the awareness level is also different. As there is more educational development in urban areas as compare to rural areas so people living in rural lack basic awareness about cancer.


Background
Cancer is a disease in which uncontrolled growth of normal cells Occur, (over growth of normal cells occur. Due to certain types of mutation (UV rays, X rays, DNA changes due to change in nucleotide or due to some carcinogenic chemicals) cancer occur. It is not the disease of classical or modern era rather it very ancient one and founded in fossil and Egyptian mummies and other death remains. From the history we found that oldest narratives of cancer are back to 3000 BC in Egypt, even though we didn't nd the word cancer in records, the origin of word cancer is attribute to Hippocrates (370-400 BC), rst a word from Greek carcino was used after that carcinoma to disturb nger like structure originated from cancer cells. After him Latin word cancer was used by physician Celus (28-50 BC) [1].
Carcinoma was also used for some other types of cancer include (cancer of lungs, colon cancer, cancer of breast cancer and caner of ovaries), Sarcoma (Cancer of bones and cancer of cartilage), Lymphoma (Cancer of lymph nodes) and, Leukemia (cancer of blood). Many other kinds of cancer in addition to these are also present name depending after the body part affected by it. i.e Kidney cancer, Bladder cancer, Skin cancer, Prostate cancer, Bone marrow cancer and many more. There many risk factors Smoking or air pollination in environment give rise to lung cancer, alcohol and a particular type of infection can also cause cancer, for example helicobacter pylori and hepatitis type B and type C [2]. Now a day's life style and diet also be thread and risk factor for cancer development. said that there are more than 300 genes that can cause mutation resulting to genetic cancer and abnormal protein production [3].
Genetic mutation cancer occurs when certain (cancer causing) genes transfer from parents to offspring.
When cell pass through cell division and expose to certain chemicals or rays that damage the DNA or Couse DNA nucleotide deletion, inversion, subtraction, or miss matching occur, resulting the abnormality in DNA and ultimately protein disturbance occur. In cell different properties may accumulate which might assist in uncontrolled growth of the cell [4]. Most important cancer cells need blood supply for continuous growth and escape the cells from expiry, new blood vessels are formed by tumor cells for this purpose endothelial cells are activated, scientist called this a process angiogenesis [5]. GLOBOCAN estimated that there will be 17.0 million cases in 2018 in all over the world, In Pakistan the numbers are 148.041 people are going to have this disease. According to the institute of health metrics and evaluation (IHME) the 9.6 million people are estimated, which are going to die due to cancer. In Pakistan 100.000 out of 148.041 are going to die.
Depending upon sex, both male and female are equally affected by different types of cancer. In female breast cancer is more common than colorectal and lung cancer and in men lung cancer follows by prostate and colorectal cancer are more common. Long is more common in male about with the percentage of 11.6% and in female the breast cancer which the percentage of 11.6%. Cancers for all agestandardized rate (containing non-melanoma cancer for skin) both for males and females in combination was 197.9 per 100,000 people in 2018. The higher rate was observed for males (218.6 per 100,000) than females (182.6 per 100,000). Highest cancer rate was observed in Australia for both males and females (468.0 people per 100,000). Age-standardised rate in 12 countries Australia, the US, New Zealand, Ireland, Cancer symptoms include Breath problems, Unexplained bleeding from vagina, Very heavy sweats at night times, Rough or harsh voice, Persistent heartburn or indigestion, Ulcer of mouth or tongue that won't heal easily or never heal, Persistent bloating, swallowing di culty, changes in bowel pattern, i.e. constipation, looser poo or pooing more often, Sore which won't heal, loss of appetite, Unfamiliar changes in breast, poo contain blood, blooding during pee, complication while peeing, unexplainable loss in weight, occurs of new mole or deviations to a mole, hacking with blood, Persistent cough, inde nable pain or ache in different body parts, Unusual lump observation or swelling of lump nodes anywhere in body. Objective of survey and presence study was to assess the knowledge of people of Baluchistan regarding cancer.

Materials And Methods
A survey study was design to know the basic awareness regarding cancer in the different areas of Baluchistan (District Killa Abdullah area Mazzi Adda, District Zhob and Quetta City). For this purpose, a questionnaire was design with 16 question. Focus of presence survey and study was to appraise the awareness of people of Baluchistan about cancer. Preventions can be adopted to prevent cancer?
A self-interview survey was done in different above mention areas and 1200 hundred individuals were interviewed which include both male and female from rural and urban areas randomly (in which 400 females was from Urban, 300 from rural, 200 male from urban and 300 from rural areas were take part in interview). Both male and female was above 18 years' age which include married, single, student, government employees, farmers, drivers, house wives, widows, and some others were self-interview. Interview design was random (no special area was focused).

Discussion
Results were generated after survey which clearly showed that most of the time is very little awareness level regarding the cancer in Pakistan. Results was prettysimilar to results of Ali and Baig one [6], in which they studied 281 individuals from Agha Khan University, Karachi. However the results of our study are based on the residential area from where they were collected, as in our study data was collect from rural and urban areas of Baluchistan and the results are also based on area which showed different results, and the difference in results are because of difference of educational rate and connection to superior resources regarding awareness. Result shows that people living in urban areas have better literacy rate and mostly people are educated as compare to those living in rural areas. When study was conducted regarding the awareness about breast cancer awareness in Karachi, results of that of that study also concluded that people with high level of education have more awareness about risk factors which are related to cancer [7], these results are different from a study which were about cancer awareness contacted in West Bengal results of that study shows that there is no major difference regarding knowledge index in areas like which may be either rural or either urban [8].
In Pakistan people think that they have to visit the doctor only when the have any disease which is their general understanding. That's why people think regular health checkup are not important and they consider it unnecessary for them. Many types of cancer can be detected on regular checkups because in overall people lack the concept about the symptoms and severity of cancer at early stages. Typically cancer is diagnosed at those stages when there is no cure of disease available [9].
Cross arrangement on grounds of sex exposer and both sex think that cancer is more dominant in them.
When they were ask about the risk factors associated with cancer urban population mostly recognize defects in Genetics (hereditary), smoking or other Tobacco products, drinking Alcohol, Food, and exposure to sun as risk factors of cancer on other hand people from rural areas were not able to give much information regarding cancer risk factors which shown that people from rural area have less awareness regarding cancer risk factors. Related results were shown by a study which were conducted on British population and results reveal that females and people with batter level of education have more awareness about the risk factors [10].
Total six question was selected out of those 16 for analysis to check the basic awareness. The criteria for both male and female were same and same question was asked from both gender (male from urban and rural, female from urban and rural). Some people were well aware of cancer and types and risk factors and all other information in both genders from both rural and urban, as any relative family member suffered from cancer in any way. Male were more aware about cancer in rural but not as much as male from urban and female urban knew more about cancer then female of rural areas, but some don't know even about cancer in rural areas results of low education and knowledge. There was also no basic health information available to both genders in both rural and urban. If there is basic health information and education to both gender equally cancer cases will be reduced in large number.

Conclusion
At the end of our survey and all analysis we concluded that rural area lack the basic knowledge about cancer, few people know about cancer and all things related to it but many don't, the urban area know about cancer and its basic more than rural and they have more knowledge about cancer but still they lack more advance information and knowledge. All these difference were due to lack education especially rural area (female education), and results are not good in urban regarding females. More basic knowledge to males and females has to be provided in both urban and rural area to have better results regarding cancer and its survival.

Declarations
Availability of data and materials All data was collected from area with approval of people