Breast Cancer Knowledge and Preventive Practice Among Graduate Students: A Scoping Review
Simple Summary
Abstract
1. Introduction
- Does knowledge about breast cancer risk factors, signs and symptoms, and screening methods differ based on graduate students’ sociodemographic characteristics and academic discipline?
- How prevalent are breast cancer preventive practices (e.g., screening) among graduate students globally?
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria and Study Selection
2.3. Data Extraction
2.4. Variables of Interest
2.4.1. Factors Examined Across Studies
2.4.2. Outcomes of Interest
2.4.3. Classification of Breast Cancer Knowledge Levels
2.5. Data Synthesis
3. Results
3.1. Study Characteristics
3.2. Knowledge of Breast Cancer
3.2.1. Knowledge of Breast Cancer Risk Factors
3.2.2. Knowledge of Breast Cancer Signs and Symptoms
3.2.3. Knowledge of Breast Cancer Screening Methods
3.3. Preventive Practices of Breast Cancer Among Students
3.4. Factors Associated with Knowledge of Breast Cancer and Preventive Practices
3.5. Gap Between Knowledge and Practice
3.6. Barriers to Screening Practices Among Students
4. Discussion
4.1. Strengths
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
| BSE | Breast Self-Examination |
| BC | Breast Cancer |
| CBE | Clinical Breast Examination |
| CDC | Centers for Disease Control and Prevention |
| JBI | The Joanna Briggs Institute |
| PCC | Population, Concept, Context |
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| Study ID | Title | Location | Aim of Study | Knowledge Prevalence | Practice Prevalence |
|---|---|---|---|---|---|
| Das et al. (2022) [34] | Knowledge and awareness of breast cancer (BC) and breast self-examination (BSE) among college-going female students in Delhi-NCR: a cross-sectional study. | India | To determine the extent of knowledge and awareness of breast cancer, its risk factors, early signs and symptoms, and BSE. | Prevalence was not reported, and there were no significant differences in the levels of education and knowledge. | Only 29.8% of graduate students had ever practiced BSE and age was significantly associated with BSE practice (p < 0.001). |
| Deeb et al. (2024) [35] | Nutrition knowledge, attitudes, and lifestyle practices that may lead to breast cancer risk reduction among female university students in Lebanon. | Lebanon | To assess nutrition knowledge, attitudes, and lifestyle practices (KAP) that may lead to BC risk reduction among female university students in Lebanon. | The study found that knowledge score was significantly associated with BSE practice (adjusted OR: 1.48, 95% CI: 1.29–1.70). | Almost 97% of the graduate students had poor practice, and only 3% had good prevention practices for breast cancer. |
| Haque et al. (2016) [36] | Cognizance and utilization of breast cancer screening among the health professional female students and staff of the University Kuala Lumpur, Royal College of Medicine Perak, Malaysia. | Malaysia | This study aimed to determine the relationship between sociodemographic factors and knowledge, attitude, and perception on BC screening. | The graduate medical students’ knowledge score was 62, which was higher than the undergraduates. | No separate prevalence for graduate students, but no significant relationship between any of the sociodemographic factors and BSE practice among graduate students. |
| Hussain et al. (2022) [37] | A national survey to assess breast cancer awareness among female university students in Pakistan | Pakistan | To assess the awareness of female university students about breast cancer’s risk factors, signs and symptoms, and breast cancer exam. | Insufficient knowledge of breast cancer risk factors (52.6%), signs and symptoms (69.45%). | Not measured. |
| Ishtiak et al. (2022) [38] | Knowledge, practice, and associated factors of breast self-examination among female university students of Bangladesh. | Bangladesh | To explore knowledge, practice, and associated factors of BSE among female university students of Bangladesh. | 83.3% of the master’s students had a low total knowledge score, while 100% of the PhD students had a low total knowledge score. | Each additional year of education was associated with a 1.42 times higher chance of having knowledge about BSE (95% CI: 1.02–1.97, p = 0.036). |
| Mohammed et al. (2023) [39] | Knowledge, attitudes, and practices related to breast cancer self-examination among medical students at the University of Khartoum, Sudan. | Sudan | To assess the knowledge, attitudes, and practices of Sudanese medical students regarding breast self-examination (BSE). | High awareness of some breast cancer risk factors (e.g., aging, family history) but poor knowledge of others (e.g., early menarche). | Three-quarters (n = 222; 75.3%) of the 295 respondents in this study practiced BSE because they do not want to be diagnosed with BC. |
| Oudsema (2020) [40] | Screening mammography: Guidelines versus clinical practice. | United States | To understand the medical students’ and practitioners’ comprehension of breast cancer screening guidelines and the existing literature on breast cancer screening. | Good understanding among medical graduates. | Not measured. |
| Pirzadeh (2018) [41] | Application of the health belief model in breast self-examination by Iranian female university students. | Iran | To apply the Health Belief Model (HBM) in breast self-examination among female university students in Iran. | - | Results indicated significant associations between the education level and practice of BSE (p = 0.031). |
| Prachishre et al. (2024) [42] | Awareness and knowledge about breast cancer and breast self-examination among female students: A hospital based study. | India | To assess the awareness and knowledge about breast cancer and BSE among female students from SLN Medical College and a nearby women’s college. | Only 23.8% of graduate students correctly identified family history as a risk factor. | Not measured. |
| Samah et al. (2014) [43] | Relationship between body image and breast self-examination intentions and behavior among female university students in Malaysia. | Malaysia | To examine the relationship between body image satisfaction and both breast self-examination (BSE) intentions and behaviors. | Only 36.8% correctly identified the symptoms of BC. | 54.5% never performed BSE in the past year, and 25.2% intended to perform BSE monthly in the next year. |
| Samah et al. (2016) [44] | Insufficient knowledge of breast cancer risk factors among Malaysian female university students. | Malaysia | This study aimed to evaluate breast cancer literacy among young female university students in the Klang Valley and Selangor, Malaysia. | The proportion of individuals with knowledge scores greater than the 50th percentile regarding breast cancer was 43.9%. | Graduate students (master’s and PhD) had a higher rate of performing BSE compared to undergraduates. |
| Sarker et al. (2022) [45] | Effectiveness of educational intervention on breast cancer knowledge and breast self-examination among female university students in Bangladesh: a pre-post quasi-experimental study. | Bangladesh | To assess the effect of an educational intervention program on breast knowledge and the practice of breast self-examination among young female students at a university in Bangladesh. | 36% know how to perform BSE, the majority (63%) of the students do not know how to perform BSE, and 60.62% are aware of breast cancer symptoms. | The percentage of students performing BSE increased from 21.3% (pre-test) to 33.8% (post-test). |
| Sarker et al. (2022) [46] | Knowledge of breast cancer and breast self-examination practices and its barriers among university female students in Bangladesh: Findings from a cross-sectional study. | Bangladesh | To assess the knowledge of symptoms, risk factors, treatment modalities, and screening methods of breast cancer among female students and to examine the practice of BSE and the factors that hinder the practice of BSE. | 55% of the graduate students had a poor level of knowledge, and 45% of the graduate students had a good level of knowledge. | Only one in five students (21%) have ever practiced breast self-examination. |
| Satapathy et al. (2022) [47] | Breast self-examination ractice among medical postgraduate female students of Southern Odisha: A cross-sectional study. | India | To assess the knowledge, attitude, and practice of postgraduates on BSE. | Pre-test mean scores: symptoms (2.99), risk factors (3.35), treatment (1.79), prevention (3.82), screening (1.82), BSE process (1.57). Post-test mean scores: symptoms (6.35), risk factors (7.56), treatment (4.63), prevention (7.14), screening (3.98), BSE process (3.94). All significant p < 0.001. | 75.61% practiced BSE and only 23.17% practiced BSE monthly. |
| Sedrak et al. (2016) [48] | Cancer screening knowledge and attitudes of under and post-graduate students at Kasr Al Ainy School of Medicine, Cairo University, Egypt. | Egypt | To assess the level of knowledge concerning cancer screening among medical students, house officers (interns), and residents, and to explore their attitudes toward cancer screening practices. | A total of 96.6% of the respondents had heard about BSE before, while 99.3% were aware that BSE should be performed monthly. | Not measured. |
| Zhang et al. (2021) [49] | Relationship between demographic factors, health education, breast cancer-related knowledge, attitudes, and breast self-examination behavior among Chinese female college students: A structural equation analysis. | China | This study aimed to create a structural equation model to evaluate the associations among demographic factors, health education, breast cancer-related knowledge, attitudes, and breast self-examination in Chinese female college students. | On average, about 36.41% of the participants rightly identified the different BC risk factors. | Prevalence of BSE among postgraduate students: 45.5% (5 out of 11). Educational level was significantly associated with BSE performance (p < 0.05). |
| Study | Knowledge of BC Reported by Study Authors | Knowledge of BC Risk Factors (%) | Knowledge of BC Signs and Symptoms (%) | Knowledge of Breast Cancer Screening Methods (%) | How Knowledge Was Measured |
|---|---|---|---|---|---|
| Das et al. (2022) [34] | Poor | 36.41% rightly identified different BC risk factors. | 42.02% had knowledge of one or other BC signs and symptoms. | 51.2% know about BSE. | No total “knowledge score” was computed per participant; knowledge levels were reported as % of participants who answered each item (risk factors, sign and symptoms and BSE) correctly. 1 = has knowledge; 0 = no knowledge/do not know. |
| Deeb et al. (2024) [35] | Poor | 68.3% of students had poor knowledge regarding nutrition-related breast cancer (BC) risk factors. | Not assessed. | Not assessed | Knowledge score was measured with 18 questions on modifiable and non-modifiable risk BC risk factors (0–18), categorizing knowledge levels as good knowledge = score ≥ 14 out of 18 and poor knowledge score: <14. |
| Haque et al. (2016) [36] | Good | 87.7% identified genetic factors as a risk factors, 54.2% cited smoking and 52.2% cited sedentary lifestyle. | Not assessed. | 76.8% know about mammograms. | Total knowledge score, categorized as low, average and high; items measured were risk factors and screening methods. Exact scoring rubric is not provided. A structured questionnaire was used. |
| Hussain et al. (2022) [37] | Poor | 23.8% correctly identified family history as a risk factor. | 24.2% correctly identified breast lumps as a symptom. | 24.5% of PG students correctly stated that breast examination by a doctor/midwife should start after age 20. | No specific cutoff score but concluded poor level based on percentages as knowledge level was assessed item by item (risk factors, signs and symptoms, breast cancer examination), not as a composite score or categorized level. |
| Ishitiak et al. (2022) [38] | Moderate | Not assessed. | Not assessed. | Proportion was not calculated but the average knowledge score was 7.41 ± 3.27 out of 15. | Scored knowledge from 12 specific questions related to BSE. Each correct answer = 1 point. Incorrect or “Don’t know” answers = 0 points with a total score of 15. |
| Mohammed et al. (2023) [39] | Satisfactory | Not assessed. | Not assessed. | 96.6% had heard of BSE. | Knowledge score derived from correct response to questions about knowledge items specific to general awareness of BSE and responses were summarized using frequencies and percentages that reflect the general knowledge level of the participants, which the authors described as “satisfactory” in the discussion section. |
| Oudsema (2022) [40] | Poor | Not assessed. | Not assessed. | 74.7% felt very to somewhat uncomfortable with their knowledge of breast cancer screening. | No cutoff score but measured the % of correct responses of knowledge items on screening and mammography. |
| Pirzadeh (2018) [41] | Poor | 77.6% correctly identified aging as a risk factor. | Not assessed. | 17.6% know the correct steps of BSE. | Knowledge was measured using a questionnaire with 12 items focused on risk factors for breast cancer, higher scores indicating good level. |
| Prachishree et al. (2024) [42] | Poor | Not assessed. | 60.2% of participants reported awareness of breast cancer symptoms. | 42.8% had heard of mammography. | A structured questionnaire was used including questions on symptoms and preventive methods. Percentages and frequencies are used to present responses to individual knowledge-related questions. |
| Samah et al. (2014) [43] | Not measured | Not assessed. | Not assessed. | Not assessed. | Not measured. |
| Samah et al. (2015) [44] | Satisfactory | Only 5 out of 18 risk factors were correctly identified by over 60% of participants. | 89.3% identified a lump in the breast as symptoms. | Not assessed. | Knowledge was measured using questions related to BC risk factor and symptoms. Median score was 52.6, > median score, considered satisfactory. |
| Sarker et al. (2022a) [45] | Poor | 33.5% correctly identified risk factors in pre-intervention and 75.6% correctly identified risk factors in post intervention. | 33.5% correctly identified risk factors in pre-intervention and 75.6% correctly identified risk factors in post intervention. | 33.5% correctly identified risk factors in pre-intervention and 75.6% correctly identified risk factors in post intervention. | Total score of 43, greater score indicated good knowledge, 43 questions (symptoms—8 items, risk factors—10 items, treatment—6 items, prevention—8 items, screening methods—5 items, and process of BSE—5 items). |
| Sarker et al. (2022b) [46] | Poor | 33.5% correctly identified risk factors. | 36.8% correctly identified risk factors. | 36.4% correctly identified screening methods. | Total score of 43, greater score indicated good knowledge, 43 questions (symptoms—8 items, risk factors—10 items, treatment—6 items, prevention—8 items, screening methods—5 items, and process of BSE—5 items). |
| Satyapathy et al. (2022) [47] | Good | 100% knew family history/inheritance is a risk factor. | 96.3% recognized a painless, hard lump with an uneven edge as a sign. | 100% knew about BSE, CBE and mammograms. | Total knowledge score was 40 and 20 questions items were on knowledge of BSE. (A score of “2” was used for correct responses, “1” for do not know, and “0” for incorrect response in assessment of knowledge.) Those who scored > 50th percentile were categorized as having good knowledge. |
| Sedrak et al. (2016) [48] | Poor | Not assessed. | Not assessed. | 70.7% correctly identified mammography and clinical breast exam as recommended for ages 40–49. | Total knowledge score of 24, scoring > 10 was considered knowledgeable, knowledge (total 24 knowledge questions about screening method), correct response assigned a score = 1 and incorrect or not sure scored = 0. |
| Zhang et al. (2021) [49] | Poor | 68% correctly identified high-fat diet as a risk factor. | 34% correctly identified nipple discharge as a symptom. | Not assessed. | 11-item knowledge questions related to breast cancer symptoms, risk factors, and prevention were assessed using true and false options; total score was 11. Higher score indicates a better knowledge level. |
| Study | Factors Associated with Knowledge | Factors Associated with Preventive Practices | ||
|---|---|---|---|---|
| Significant | Not Significant | Significant | Not Significant | |
| Das et al. (2016) [34] | Age | Smoking status, alcohol consumption, red meat consumption. | Age, pain in breast. | Physical inactivity, gene mutations, large breasts, experiencing a lump in breast or underarm region. |
| Deeb et al. (2024) [35] | Major of study, GPA | Age, smoking status, perceived vulnerability to stress. | Major of the study (e.g., health-related), BMI. | Age, marital status, smoking status, perceived vulnerability to stress. |
| Haque et al. (2016) [36] | Age | Background history of BC, educational qualifications. | - | Education, family history of BC, marital status. |
| Hussain et al. (2022) [37] | Level of education (e.g., undergraduate, graduate) | Marital status, major discipline, residence. | - | - |
| Ishitiak et al. (2022) [38] | Age, university type, education level (e.g., undergraduate, graduate) | Marital status, residence, father’s education, mother’s education, monthly family income. | Age, education (years), residence, fathers’ education, number of family members and knowledge score. | Marital status, university type, current residence, monthly family income. |
| Pirzadeh et al. (2018) [41] | - | - | Marital status and education level, perceived severity, self-efficacy. | Age, major. |
| Samah et al. (2014) [43] | - | - | Educational levels, income and age. | Race. |
| Samah et al. (2015) [44] | - | - | Education levels, ethnicity, and age. | - |
| Sarker et al. (2022) [46] | Age, education level (undergraduate vs. master’s), having family members with breast cancer. | Marital status, source of information. | Knowledge score, having family members with breast cancer. | Age, years of education, marital status, source of information. |
| Satyapathy et al. (2022) [47] | - | - | Knowledge on frequency of BSE. | Family history of breast cancer. |
| Sedrak et al. (2016) [48] | Years of enrollment in medical school. | Exam evaluation score at medical school, gender, age, lack of training about cancer screening. | - | - |
| Zhang et al. (2021) [49] | Academic level (e.g., undergraduate, graduate), age. | Knowledge of BSE, attitudes, health education, university type, major of study, birthplace, education (years), family history of BC, history of benign breast disease. | Ethnicity, mother’s education. | |
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Adhikari, B.; Goodman, X.; Alam, M.M.; Fudolig, M.A.; Buccini, G.; DeVille, N.V. Breast Cancer Knowledge and Preventive Practice Among Graduate Students: A Scoping Review. Cancers 2026, 18, 1147. https://doi.org/10.3390/cancers18071147
Adhikari B, Goodman X, Alam MM, Fudolig MA, Buccini G, DeVille NV. Breast Cancer Knowledge and Preventive Practice Among Graduate Students: A Scoping Review. Cancers. 2026; 18(7):1147. https://doi.org/10.3390/cancers18071147
Chicago/Turabian StyleAdhikari, Binita, Xan Goodman, Md Maksudul Alam, Miguel Antonio Fudolig, Gabriela Buccini, and Nicole V. DeVille. 2026. "Breast Cancer Knowledge and Preventive Practice Among Graduate Students: A Scoping Review" Cancers 18, no. 7: 1147. https://doi.org/10.3390/cancers18071147
APA StyleAdhikari, B., Goodman, X., Alam, M. M., Fudolig, M. A., Buccini, G., & DeVille, N. V. (2026). Breast Cancer Knowledge and Preventive Practice Among Graduate Students: A Scoping Review. Cancers, 18(7), 1147. https://doi.org/10.3390/cancers18071147

