Abstract
Background: Lack of knowledge, attitude and perception towards breast cancer still a major public health issue disease in many developed and under-developed countries including Pakistan. In 2024 in Pakistan, one in every 8 females is affected by Breast Cancer.
Objective: To determine the awareness, attitude, and practices of Pharmacy (Pharm-D) students towards Breast Cancer (BC) and their correlation with participants’ age and level of study.
Methodology: A cross-sectional study was conducted on 401 female students of Pharmacy from December 2023 to March 2024, using a self-administered questionnaire assessing awareness, attitude, and practices towards BC. For sample size calculation, Raosoft® online sample size calculator with a 5.0% margin of error and a 95.0% confidence interval was used. The respondents were sampled via convenience sampling.
Results: Our sample included 401 participants. The majority gained knowledge about BC from the media (69.8%). About 73.4% of participants did not participate in breast self-examination (BSE), and about 41.3% of them believed they were not at risk. About 92.6% of participants didn’t undergo clinical breast examination (CBE). Nearly half of the participants (44.9%) agreed that BC is more common in older women. About four-fifths of the respondents (79.3%) agreed that regular examination can reduce the risk of BC.
Conclusion: The practice of BSE by the Pharm.D students is lagging. There were notable gaps in CBE by pharmacy students due to the belief that breast cancer predominantly affects older women. Therefore, it is important to make future pharmacists aware of practicing BSE and CBE regularly.
References
Sasada Y, Kimura N, Masumoto A, Emi T, Kadoya K, Arihiro M. Okada, Breast cancer detection by dedicated breast posi-
tron emission tomography according to the World Health Organization classification of breast tumors, Eur J Surg Oncol 2021;47:1588-92. https://doi.org/10.1016/j.ejso.2021.02.026.
Kelsey JL, Horn-Ross PL. Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev 1993;15:7-16. https://doi.org/ 10.1093/oxfordjournals.epirev.a036118.
Sohail S, Alam SN. Alam, Breast cancer in Pakistan-awareness and early detection. (2007). Available at: https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1449&context=pakistan_fhs_mc_radiol (Accessed on: 28/05/2024).
Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world.
Breast Cancer (Dove Med Press) 2019;11:151-64. https://doi.org/10.2147/BCTT.S176070.
Angahar LT. An overview of breast cancer epidemiology, risk factors, pathophysiology, and cancer risks reduction. MOJBM 2017;1:92-6. https://doi.org/10.15406/mojbm.2017.01.00019.
Soomro R, Faridi S, Khurshaidi N, Zahid N, Mamshad I. Age and stage of breast cancer in Pakistan: an experience at a tertiary care center, J Pak Med Assoc 2018;68:1682-5. Available at: https://www.academia.edu/download/88164999/8958.pdf (Accessed on: 28/05/2024).
Khalid A, Hassnain S, H. Gakhar H, B. Khalid B, F. Zulfiqar F, Wahaj A, Breast cancer among young girls: a KAP study conducted in Lahore. Int J Sci Rep 2018;4:166-71. http://dx.doi.org/10.18203.
Liu S, Zheng S, Qin M, Xie Y, Yang K, Liu X. Knowledge, attitude, and practice toward ultrasound screening for breast cancer among women, Frontiers in Public Health 2024; 12:1309797. https://doi.org/10.3389/fpubh.2024.1309797.
Sasada Y, Kimura N, Masumoto A, Emi T, Kadoya K, Arihiro M. Okada, Breast cancer detection by dedicated breast positron emission tomography according to the World Health Organization classification of breast tumors, Eur J Surg Oncol 47(7) (2021) 1588-1592. doi:https://doi.org/10.1016/j.ejso.2021.02.026.
Kelsey JL, Horn-Ross PL. Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev. 1993;15(1):7-16. doi: 10.1093/oxfordjournals.epirev.a036118.
Sohail S, Alam SN. Alam, Breast cancer in Pakistan-awareness and early detection, (2007). Available at: https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1449&context=pakistan_fhs_mc_radiol. Accessed on:28/05/2024.
Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world, Breast Cancer: Targets and Therapy (2019) 151-164. doi:https://doi.org/10.2147/BCTT.S176070.
Angahar LT. An overview of breast cancer epidemiology, risk factors, pathophysiology, and cancer risks reduction, MOJ Biology and Medicine 1(4) (2017) 92-96. doi:https://doi.org/10.15406/mojbm.2017.01.00019.
Soomro R, Faridi S, Khurshaidi N, Zahid N, Mamshad I. Age and stage of breast cancer in Pakistan: An experience at a tertiary care center, J Pak Med Assoc 68(11) (2018) 1682-1685. Available at: https://www.academia.edu/download/88164999/8958.pdf. Accessed on: 28/05/2024.
Khalid A, Hassnain S, H. Gakhar H, B. Khalid B, F. Zulfiqar F, Wahaj A, Breast cancer among young girls: a KAP study conducted in Lahore, International Journal of Scientific Report 4(6) (2018) 166-171. doi: http://dx.doi.org/10.18203.
Liu S, Zheng S, Qin M, Xie Y, Yang K, Liu X. Knowledge, attitude, and practice toward ultrasound screening for breast cancer among women, Frontiers in Public Health 12 (2024) 1309797. doi:https://doi.org/10.3389/fpubh.2024.1309797.
Jamous RM, Sweileh WM, El-Deen Abu Taha AS, Zyoud SH. Beliefs About Medicines and Self-reported Adherence Among Patients with Chronic Illness: A Study in Palestine. J Family Med Prim Care. 2014 Jul;3(3):224-9. doi: 10.4103/2249-4863.141615.
Giuliano AE, Edge SB, Hortobagyi GN. Eighth Edition of the AJCC Cancer Staging Manual: Breast Cancer. Ann Surg Oncol. 2018 Jul;25(7):1783-1785. doi: 10.1245/s10434-018-6486-6. Epub 2018 Apr 18.
Zafar N, Wolf AB, Kepniss JL, Teal AC, Brem RF. Effectiveness of Community Education for Breast Cancer Screening. J Breast Imaging. 2024 Apr 1;6(2):166-174. doi: 10.1093/jbi/wbae002.
Dandash KF, Al-Mohaimeed A. Knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of Buraidah, Saudi Arabia, International journal of health sciences 1(1) (2007) 61. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3068667/. Accessed on:28/05/2024.
Alshahrani M, Alhammam SYM, Al Munyif HAS, Alwadei AMA, Alwadei AMA, Alzamanan SSM, Aljohani NSM. Knowledge, Attitudes, and Practices of Breast Cancer Screening Methods Among Female Patients in Primary Healthcare Centers in Najran, Saudi Arabia. J Cancer Educ. 2019 Dec;34(6):1167-1172. doi: 10.1007/s13187-018-1423-8.
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 6(7) (2019) 2944. doi: http://dx.doi.org/10.18203/2394-6040.
Ahmed S, Pulock O, Chakraborty R, Awal A, Breast Cancer Screening: Knowledge, Attitude and Practice Among Female Doctors and Medical Students in a Tertiary Care Hospital and Medical College in Bangladesh, RMCJ; 2020; 3(1) (2020) 11-16. doi:http://dx.doi.org/10.3329/jcmcta.v31i1.66741.
Alduraidi H, Tarazi A, Theeb L, AlKasaji M. Knowledge, Attitudes, and Practices Toward Breast Cancer and Breast Cancer Screening Among Arab Females in the Middle East: A Literature Review, Public Health Nursing 42(1) (2025) 579-588. doi:https://doi.org/10.1111/phn.13447.
Khan NH, Duan SF, Wu DD, Ji XY, Better reporting and awareness campaigns needed for breast cancer in Pakistani women, Cancer Management and Research (2021) 2125-2129. doi:http://doi.org/10.2147/CMAR.S270671.
Bhandari PM, Thapa K, Dhakal S, Bhochhibhoya S, Deuja R, Acharya P, Mishra SR. Breast cancer literacy among higher secondary students: results from a cross-sectional study in Western Nepal, BMC cancer 16 (2016) 1-9. doi:https://doi.org/10.1186/s12885-016-2166-8.
Khokher S, Qureshi MU, Fatima W, Mahmood S, Saleem A, Impact of a breast health awareness activity on the knowledge level of the participants and its association with socio-demographic features, Asian Pacific Journal of Cancer Prevention 16(14) (2015) 5817-5822. doi:https://doi.org/10.7314/APJCP.2015.16.14.5817.
Alwan N, Al Attar W, Eliessa R, Madfaic Z, Tawfeeq F. Knowledge, attitude and practice regarding breast cancer and breast self-examination among a sample of the educated population in Iraq, EMHJ-Eastern Mediterranean Health Journal, 18 (4), 337-345, 2012 (2012). Available at: http://www/emro.who.int/emhj.htm(Accessed on:02/06/2024).
Sachdeva S, Mangalesh S, Dudani S. Knowledge, attitude and practices of breast self-examination amongst Indian women: a pan-India study, Asian Pacific Journal of Cancer Care 6(2) (2021) 141-147. doi:https://doi.org/10.31557/apjcc.2021.6.2.141-147.
Jadhav BN, Abdul Azeez E, Mathew M, Senthil Kumar A, Snegha N, Yuvashree G, Mangalagowri S. Knowledge, attitude, and practice of breast self-examination is associated with general self-care and cultural factors: a study from Tamil Nadu, India, BMC Women's Health 24(1) (2024) 151. doi:https://doi.org/10.1186/s12905-024-02981-9.
Nafissi N, Saghafinia M, Motamedi MHK, Akbari ME. A survey of breast cancer knowledge and attitude in Iranian women, Journal of cancer research and therapeutics 8(1) (2012) 46-49. doi:https://doi.org/10.4103/0973-1482.95173.
Jamal H. Updating Pakistan’s Poverty Numbers for the Year 2019, (5 January 2021). Available at: https://mpra.ub.uni-muenchen.de/105135/(Accessed on:01/07/2024).
Basra MAR, Saher M, Athar MM, Raza MH. Breast cancer in Pakistan a critical appraisal of the situation regarding female health and where the nation stands, Asian Pacific Journal of Cancer Prevention 17(7) (2016) 3035-3041. Available at: https://journal.waocp.org/article_32471.html(Accessed on:01/07/2024).
Seyedkanani E, Hosseinzadeh M, Mirghafourvand M, Sheikhnezhad L. Breast cancer screening patterns and associated factors in Iranian women over 40 years, Scientific Reports 14(1) (2024) 15274. doi:https://doi.org/10.1038/s41598-024-66342-0.
Rabbani SA, Al Marzooqi AMSK, Srouji AEM, Hamad EA, Mahtab A. Impact of community-based educational intervention on breast cancer and its screening awareness among Arab women in the United Arab Emirates, Clinical Epidemiology and Global Health 7(4) (2019) 600-605. doi:https://doi.org/10.1016/j.cegh.2019.01.008.
Farzadfar F, Naghavi M, Sepanlou SG, Moghaddam SS, Dangel WJ, Weaver ND, A. Aminorroaya A, Azadnajafabad S, Koolaji S, Mohammadi E Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet 399(10335) (2022) 1625-1645. doi:https://doi.org/10.1016/.
Rahimi F, Tolouei S, Ravankhah Z, Mohammadi-Sefiddashti F. Evaluating the Impact of a Clinical Breast Examination Screening Program within the IraPEN Project, Asian Pacific journal of cancer prevention: APJCP 25(9) (2024) 3151. doi:https://doi.org/10.31557/APJCP.2024.25.9.3151.
Baig A, Rahat T. Addressing the challenges faced by Pakistan’s healthcare system, Pakistan Journal of Medical Research 63(3) (2024) 115-116. Available at: https://pjmr.org.pk/index.php/pjmr/article/view/843/196. Accessed on: 03/03/2025.