Background: In alignment with the World Health Organization’s Global Breast Cancer Initiative objectives, this rapid review sought to determine the extent to which breast cancer understanding is being researched globally in undergraduate student populations, and review recent findings, to inform policy makers and practitioners on the baseline level of student understanding by world region.
Methods: Four academic databases were searched, and 114 studies meeting the search criteria were assessed based upon Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines and comprehensiveness of coverage for the factors of interest. Finally, 33 were selected as representing quality research from all world regions producing recent research of this topic. Their findings were narratively synthesized.
Results: The majority of recent research emanates from regions with accelerating breast cancer mortality rates, corresponding with lower economic resources, primarily within Africa and Asia. Most focus on breast cancer understanding in female participants, with little data available for males or minority gender groups. Disparity between medical and non-medical students’ breast cancer understanding is widely reported, though breast cancer understanding is found to be inadequate for most students. Interventions to improve breast cancer understanding indicate promising results, though a lack of standardized measures, together with inadequate reporting of effect sizes, makes meta-analysis of prevailing data challenging.
Conclusion: Evidence suggests undergraduate students’ breast cancer understanding globally is inadequate, showing the necessity of increased rigor in research design and reporting to facilitate reliable knowledge generation. Systematic reviews are recommended to widen the scope and depth of this rapid review in support of WHO targets.
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Moslemi M, Moradi Y, Dehghanbanadaki H, Afkhami H, Khaledi M, Sedighimehr N, et al. The association between ATM variants and risk of breast cancer: a systematic review and meta-analysis. BMC Cancer. 2021;21(1):27. doi: 10.1186/s12885-020-07749-6.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. doi: 10.3322/caac.21660.
Benson JR, Jatoi I. The global breast cancer burden. Future Oncol. 2012;8(6):697-702. doi: 10.2217/fon.12.61.
World Health Organization. The Global Breast Cancer Initiative (GBCI): World Health Organization; 2022. Available from: https://www.who.int/publications/m/item/the-global-breast-cancer-initiative-gbci.
Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. Current Breast Cancer Reports. 2018;10(3):179-86. doi: 10.1007/s12609-018-0286-7.
Hackshaw AK, Paul EA. Breast self-examination and death from breast cancer: a meta-analysis. Br J Cancer. 2003;88(7):1047-53. doi: 10.1038/sj.bjc.6600847.
Weiss NS. Breast Cancer Mortality in Relation to Clinical Breast Examination and Breast Self-Examination. The Breast Journal. 2003;9(s2):S86-S9. doi: 10.1046/j.1524-4741.9.s2.9.x.
Albeshan SM, Hossain SZ, Mackey MG, Brennan PC. Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis? Clinical Breast Cancer. 2020;20(3):194-200. doi: 10.1016/j.clbc.2020.02.001.
Wang YJ, Wang F, Yu LX, Xiang YJ, Zhou F, Huang SY, et al. Worldwide review with meta-analysis of women’s awareness about breast cancer. Patient Education and Counseling. 2022;105(7):1818-27. doi: 10.1016/j.pec.2021.12.012.
Hosseini MS, Arab M, Nemati Honar B, Noghabaei G, Safaei N, Ghasemi T, et al. Age - specific incidence rate change at breast Cancer and its different histopathologic subtypes in Iran and Western countries. Pak J Med Sci. 2013;29(6):1354-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905388/
Anastasi N, Lusher J. The impact of breast cancer awareness interventions on breast screening uptake among women in the United Kingdom: A systematic review. Journal of Health Psychology. 2019;24(1):113-24. doi: 10.1177/1359105317697812.
Britt KL, Cuzick J, Phillips K-A. Key steps for effective breast cancer prevention. Nature Reviews Cancer. 2020;20(8):417-36. doi: 10.1038/s41568-020-0266-x.
Naja F, Nasreddine L, Awada S, El Sayed Ahmad R, Hwalla N. Nutrition in the Prevention of Breast Cancer: A Middle Eastern Perspective. Frontiers in Public Health. 2019;7. doi: 10.3389/fpubh.2019.00316.
Peacey V, Steptoe A, Davídsdóttir S, Baban A, Wardle J. Low levels of breast cancer risk awareness in young women: An international survey. European Journal of Cancer. 2006;42(15):2585-9. doi: 10.1016/j.ejca.2006.03.017.
Peltzer K, Pengpid S. Awareness of breast cancer risk among female university students from 24 low, middle income and emerging economy countries. Asian Pac J Cancer Prev. 2014;15(18):7875-8. doi: 10.7314/apjcp.2014.15.18.7875.
Almutairi AH, Tamrin SBBM, Wirza R, Ahmad NB. Systematic Review on Knowledge and Awareness of Breast Cancer and Risk Factors Among Young Women. Advances in Bioscience and Clinical Medicine. 2019;7(1):7. doi: 10.7575/aiac.abcmed.v.7n.1p.41.
Garritty C, Gartlehner G, Nussbaumer-Streit B, King VJ, Hamel C, Kamel C, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol. 2021;130:13-22. doi: 10.1016/j.jclinepi.2020.10.007.
Kotera Y, Lyons M, Vione KC, Norton B. Effect of Nature Walks on Depression and Anxiety: A Systematic Review. Sustainability. 2021;13(7):4015. doi: 10.3390/su13074015.
Elm Ev, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD.
Kotera Y, Van Gordon W. Effects of Self-Compassion Training on Work-Related Well-Being: A Systematic Review. Frontiers in Psychology. 2021;12. doi: 10.3389/fpsyg.2021.630798.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.
Rızalar S, Avcı İ A, Żołądkiewicz P, Altay B, Moraczewska I. University Students' Awareness of Breast and Cervical Cancers: A Comparison of Two Countries and Two Different Cultures. J Breast Health. 2017;13(2):77-82. doi: 10.5152/tjbh.2017.3117.
Akhtari-Zavare M, Aliyan-Fini F, Ghanbari-Baghestan A, Mohd-Sidik S. Development and Validation of Breast Cancer Knowledge and Beliefs Questionnaire for Malaysian Student Population. Pertanika Journal of Social Sciences & Humanities. 2018;26(4). Available from: http://www.pertanika2.upm.edu.my/resources/files/Pertanika%20PAPERS/JSSH%20Vol.%2026%20(4)%20Dec.%202018/23%20JSSH(S)-0899-2018.pdf
Kryvoviaz OV, Shcherba IK, Tomashevska YO, Kudria VV. Students' awareness of breast cancer risk factors (results of a sociological study). Farmatsevtychnyi zhurnal. 2019;0(6):14-21. doi: 10.32352/10.32352/0367-3057.6.19.02.
Zuzak TZ, Hałgas M, Kowalska K, Gospodarczyk M, Wdowiak-Filip A, Filip M, et al. Breast cancer–the level of knowledge about epidemiology and prophylaxis among polish medical universities students. EJMT. 2018;1:18. Available from: http://ww.medical-technologies.eu/upload/6_breast_cancer-_zuziak.pdf
Khraiwesh A, Shakarna A, Solimia S. Knowledge, beliefs and attitudes of female university students in Palestine toward breast cancer and breast self-examination. Hebron University Research Journal-A (Natural Sciences)-(مجلة جامعة الخليل للبحوث-أ (العلوم الطبيعيه. 2020;9(1):3. Available from: https://digitalcommons.aaru.edu.jo/hujr_a/vol9/iss1/3
Zhang S, Zhu W, Chen B, Tang T, Tao Z, Li X, et al. Relationship between demographic factors, health education, breast cancer-related knowledge, attitudes, and breast self-examination behavior among Chinese female college student: A structural equation analysis. Journal of Obstetrics and Gynaecology Research. 2021;47(12):4440-9. doi: 10.1111/jog.15064.
Zhang QN, Lu HX. Knowledge, attitude, practice and factors that influence the awareness of college students with regards to breast cancer. World J Clin Cases. 2022;10(2):538-46. doi: 10.12998/wjcc.v10.i2.538.
Onwusah DO, Eboigbe MU, Arute JE, Mgbahurike AA. Knowledge and Awareness of Breast Cancer among University Students In South-South Nigeria. Scholars Academic Journal of Pharmacy. 2017;6(1):4-15. doi: 10.21276/sajp.2017.6.2.
Ismail H, Shibani M, Zahrawi HW, Slitin AF, Alzabibi MA, Mohsen F, et al. Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study. BMC Medical Education. 2021;21(1):251. doi: 10.1186/s12909-021-02673-0.
Salim KS, Al Attar WM, Jassim RA, Abdullaa NT. Knowledge and awareness about breast cancer among male and female students in Al-Bayan University in Iraq. Annals of Tropical Medicine and Public Health. 2020;23:23-103. doi: 10.36295/ASRO.2020.23103.
Faria EH, Kim D, Sisconetto RM, Cucio VFM, Dos Reis Ferreira PPG, Alves BSR, et al. Analysis of Knowledge About Male Breast Cancer Among Higher Education Male Students. Eur J Breast Health. 2021;17(4):333-40. doi: 10.4274/ejbh.galenos.2021.2021-4-6.
Saritas S, Aslan Dogan B, Gul E. Knowledge and attitudes of male nursing students towards male breast cancer and breast self-examination: An example from Turkish society. Annals of Medical Research. 2021;27(10):2592-8. doi: 10.5455/annalsmedres.2020.06.570.
Ghazi HF, Elnajeh M, Azri A, AbdalQader MA, Baobaid MF, Al-abed A-aAA. Knowledge and beliefs on female breast cancer among male students in a private university, Malaysia. Malaysian Journal of Public Health Medicine. 2017;17(1):8-13. Available from: https://www.mjphm.org.my/mjphm/index.php?option=com_content&view=article&id=774:knowledge-and-beliefs-on-female-breast-cancer-among-male-students-in-a-private-university-malaysia&catid=113:2017-volume-17-1&Itemid=128
Terui-Kohbata H, Egawa M, Yura K, Yoshida M. Knowledge and attitude of hereditary breast cancer among Japanese university female students. Journal of Human Genetics. 2020;65(7):591-9. doi: 10.1038/s10038-020-0743-9.
Xie T, Sun W, Chen D, Liu N, Wang X, Zhang W. Self-efficacy and its influencing factors of breast cancer screening for female college students in China. J Obstet Gynaecol Res. 2019;45(5):1026-34. doi: 10.1111/jog.13931.
Raji Lahiji M, Dehdari T, Shokouhi Shoormasti R, Hosseini AF, Navaei M, Zarrati M. Nutrition knowledge, attitudes, and practice towards breast cancer prevention among the female population of Iran University of medical science students. Nutrition and Cancer. 2019;71(8):1355-64. doi: 10.1080/01635581.2019.1607410.
Balakrishnan P, Kodamanchili SPDR, Kumar AA, Raju K, Gabunia L. Breast Cancer Awareness among Medical Students in Georgia. International Journal of Progressive Sciences and Technologies. 2022;33(1):58-73. doi: 10.52155/ijpsat.v33.1.4399.
Zainul Azlan N, Azhar AA, Abd. Jalil MA. Knowledge Level on Breast Cancer and Breast Self-Examination (BSE) Practice Among Female University Students. International journal of care scholars. 2022;5(2):46-57. doi: 10.31436/ijcs.v5i2.249.
Cichomska J, Sak-Dankosky N, Czarkowska-Pączek B. Knowledge of nursing students about breast cancer prevention. Pielegniarstwo XXI wieku / Nursing in the 21st Century. 2020;19(2):102-9. doi: 10.2478/pielxxiw-2020-0012.
Elzahaf R, Mekraz E, Arhaim S, Almansouri M. Knowledge, attitude, and practice regarding breast cancer among female students at college of medical technology/Derna. Libyan Journal of Medical Sciences. 2018;2(4):142-6. doi: 10.4103/ljms.Ljms_21_18.
Gebresillassie BM, Gebreyohannes EA, Belachew SA, Emiru YK. Evaluation of Knowledge, Perception, and Risk Awareness About Breast Cancer and Its Treatment Outcome Among University of Gondar Students, Northwest Ethiopia. Frontiers in Oncology. 2018;8. doi: 10.3389/fonc.2018.00501.
Qasim S, Tayyab H, Zulqadar K, Masood S, Qasim TB, Zubair Z. Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study. BMC Medical Education. 2020;20(1):222. doi: 10.1186/s12909-020-02132-2.
Delgado-Díaz N H-TM, Ramos-Becerra A, Samillán-Jara L, Sánchez-Carranza M, Iglesias-Osores S, Arce-Gil Z. Level of knowledge on risk factors and preventive measures for breast cancer in health science students. Rev Fac Med Hum July. 2020;20(3):412-8. doi: 10.25176/RFMH.v20i3.2900.
Yang S, Li P, Yu L, Liu N, Wang J, Guo P, et al. Breast Cancer Awareness Based on Health Information Literacy and Influential Factors among Female Nursing Students in China. Journal of Cancer Education. 2022;37(3):546-54. doi: 10.1007/s13187-020-01844-9.
Mahmoud MH, Sayed SH, Ibrahim HA-F, Abd-Elhakam EM. Effect of Health Belief Model-Based Educational Intervention About Breast Cancer on Nursing Students' Knowledge, Health Beliefs and Breast Self-Examination Practice. International Journal of Studies in Nursing. 2018;3(3):77. doi: 10.20849/ijsn.v3i3.503.
Rezano A, Utama MS, Wiraswati HL, Ekawardhani S, Adha MJ, Patahuddin NM, et al. Knowledge Level towards Breast Cancer and Breast Self-Examination among Medical Students of Indonesia. Global Medical and Health Communication. 2022;10(1):35-42. doi: 10.29313/gmhc.v10i1.8942.
Carlson-Babila S, Bonaventure D, Jules K, Cyril J, Ekabe, Brice V, Naomi L, Abua, et al. Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. Pan African Medical Journal. 2017;28. doi: 10.11604/pamj.2017.28.91.10986.
Justice MF, King KA, Vidourek RA, Merianos AL. Breast Cancer Knowledge Among College Students: Influencing Factors and Resultant Behaviors. American Journal of Health Education. 2018;49(2):86-93. doi: 10.1080/19325037.2017.1414645
Nimbannavar SM, Mane VP. Breast cancer: knowledge, attitude and practices among undergraduate female students at a government college in Koppal, Karnataka. International Journal of Community Medicine and Public Health. 2019;6(7):2944. doi: 10.18203/2394-6040.ijcmph20192830.
Elsayed AA, Mohammed H. Prevention of breast cancer: Effects of early education on knowledge and practice of university students in Saudi Arabia. IOSR JNHS. 2019;8(5):1-9. doi: 10.9790/1959-0805090109.
Sarker R, Islam MS, Moonajilin MS, Rahman M, Gesesew HA, Ward PR. Effectiveness of educational intervention on breast cancer knowledge and breast self-examination among female university students in Bangladesh: a pre-post quasi-experimental study. BMC Cancer. 2022;22(1):199. doi: 10.1186/s12885-022-09311-y.
Vasishta S, Ramesh S, Babu P S, Ramakrishnegowda AS. Awareness about breast cancer and outcome of teaching on breast self examination in female degree college students. Indian Journal of Medical Specialities. 2018;9(2):56-9. doi: 10.1016/j.injms.2018.03.002.
Islam T, Su TT, Musthaffa S, Din NA, Rahman Z, Mohamed KN, et al. Improving Breast Health Literacy Through an Innovative Breast Cancer Awareness Campaign Using the Know Your Lemons (KYL) Materials in Malaysia. Journal of Global Oncology. 2018;4(Supplement 2):36s-s. doi: 10.1200/jgo.18.59400.
Linsell L, Forbes LJ, Burgess C, Kapari M, Thurnham A, Ramirez AJ. Validation of a measurement tool to assess awareness of breast cancer. Eur J Cancer. 2010;46(8):1374-81. doi: 10.1016/j.ejca.2010.02.034.
Champion VL. Instrument refinement for breast cancer screening behaviors. Nurs Res. 1993;42(3):139-43. doi: 10.1097/00006199-199305000-00003.
Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med. 2014;11(2):101-15. doi: 10.7497/j.issn.2095-3941.2014.02.005.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492.
Francies FZ, Hull R, Khanyile R, Dlamini Z. Breast cancer in low-middle income countries: abnormality in splicing and lack of targeted treatment options. Am J Cancer Res. 2020;10(5):1568-91. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269781/
World Health Organization. Breast cancer 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer.
Konduri S, Singh M, Bobustuc G, Rovin R, Kassam A. Epidemiology of male breast cancer. Breast. 2020;54:8-14. doi: 10.1016/j.breast.2020.08.010.
Hilton BA, Crawford JA, Tarko MA. Men's perspectives on individual and family coping with their wives' breast cancer and chemotherapy. West J Nurs Res. 2000;22(4):438-59. doi: 10.1177/019394590002200405.
Harrow A, Wells M, Barbour RS, Cable S. Ambiguity and uncertainty: The ongoing concerns of male partners of women treated for breast cancer. European Journal of Oncology Nursing. 2008;12(4):349-56. doi: 10.1016/j.ejon.2008.04.009.
Al-Musa HM, Awadalla NJ, Mahfouz AA. Male Partners' Knowledge, Attitudes, and Perception of Women's Breast Cancer in Abha, Southwestern Saudi Arabia. Int J Environ Res Public Health. 2019;16(17). doi: 10.3390/ijerph16173089.
Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men With a “Woman’s Disease”: Stigmatization of Male Breast Cancer Patients—A Mixed Methods Analysis. American Journal of Men's Health. 2018;12(6):2194-207. doi: 10.1177/1557988318799025.
de Blok CJM, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KMA, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652. doi: 10.1136/bmj.l1652.
Amgad M, Shash E, Gaafar R. Cancer education for medical students in developing countries: where do we stand and how to improve? Crit Rev Oncol Hematol. 2012;84(1):122-9. doi: 10.1016/j.critrevonc.2012.01.003.
Stubbings S, Robb K, Waller J, Ramirez A, Austoker J, Macleod U, et al. Development of a measurement tool to assess public awareness of cancer. British Journal of Cancer. 2009;101(2):S13-S7. doi: 10.1038/sj.bjc.6605385.
Momayyezi M, Fallahzadeh H. Construction and Validation of Breast Cancer Awareness Scale in Iranian Women. J Caring Sci. 2020;9(3):140-7. doi: 10.34172/jcs.2020.021.
Al-Khasawneh EM, Leocadio M, Seshan V, Siddiqui ST, Khan AN, Al-Manaseer MM. Transcultural adaptation of the Breast Cancer Awareness Measure. International Nursing Review. 2016;63(3):445-54. doi: 10.1111/inr.12265.
Heidari Z, Feizi A. Transcultural adaptation and validation of the Persian version of the breast cancer awareness measure (BCAM) questionnaire. Cancer Medicine. 2018;7(10):5237-51. doi: 10.1002/cam4.1740.
Wachira J, Busakhala A, Chite F, Naanyu V, Kisuya J, Otieno G, et al. Refining a questionnaire to assess breast cancer knowledge and barriers to screening in Kenya: Psychometric assessment of the BCAM. BMC Health Services Research. 2017;17(1):110. doi: 10.1186/s12913-017-2058-x.
Liu N, Li P, Wang J, Chen D-d, Sun W-j, Guo P-p, et al. Psychometric properties of the Breast Cancer Awareness Measurement among Chinese women: a cross-sectional study. BMJ Open. 2020;10(3):e035911. doi: 10.1136/bmjopen-2019-035911.
Moodley J, Scott SE, Mwaka AD, Constant D, Githaiga JN, Stewart TS, et al. Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer. Plos one. 2019;14(8):e0220545. doi: 10.1371/journal.pone.0220545.
Kotera Y, Ozaki A, Miyatake H, Tsunetoshi C, Nishikawa Y, Kosaka M, et al. Qualitative Investigation into the Mental Health of Healthcare Workers in Japan during the COVID-19 Pandemic. Int J Environ Res Public Health. 2022;19(1). doi: 10.3390/ijerph19010568.
Kotera Y, Kaluzeviciute G, Lloyd C, Edwards AM, Ozaki A. Qualitative Investigation into Therapists' Experiences of Online Therapy: Implications for Working Clients. Int J Environ Res Public Health. 2021;18(19). doi: 10.3390/ijerph181910295.
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