Knowledge, Attitude, and Early Detection Practices of Breast Cancer Among Employed Women in Selected Cities of the Amhara Regional State, Ethiopia: A Cross-Sectional Study.

BACKGROUND AND AIMS: Breast cancer is the most common malignancy among women globally and a leading cause of cancer-related mortality in Ethiopia. Early detection and awareness of risk factors are critical for improving outcomes, yet knowledge gaps and sociocultural barriers persist. The objective of this study was to assess awareness of breast cancer risk factors, symptoms, diagnostic methods, and preventive practices among Ethiopian women.

METHODS: A community-based cross-sectional study was conducted from September 2024 to May 2025 among women employed in governmental, non-governmental, and private organizations in Bahir Dar, Dessie, Debre Berhan, and Gondar. A multistage random sampling technique selected 473 participants. Data were collected using a semi-structured questionnaire covering socio-demographic characteristics, knowledge of breast cancer, attitudes toward screening, and early detection practices. Data were analyzed using SPSS version 20.0 and Epi Info 3.5.1. Binary and multivariable logistic regression analyses were performed to identify factors associated with knowledge, attitude, and practice. Adjusted odds ratios (AORs) with 95% confidence intervals were used to determine the strength of associations, and statistical significance was declared at p < 0.05.

RESULTS: Participants were predominantly young (≤ 30 years) and well-educated (48.0% diploma, 41.2% BSc or higher). Commonly recognized symptoms were breast pain (86.3%), swelling (83.3%), lumps (79.5%), and size changes (78.4%). Self-breast examination was practiced by 68.7%, but knowledge of correct timing and frequency was low. Awareness of Clinical-breast examination (88.6%) and pathological diagnosis (54.1%) was higher. Risk factor knowledge was uneven, with better recognition of smoking, alcohol, and inactivity, but poor understanding of diet, obesity, reproductive factors, hormones, and radiation. Sunlight was commonly misperceived as a risk. Main information sources were mass media, health workers, and teachers. Participants aged 36-40 years had significantly better knowledge (AOR = 2.21, 95% CI: 1.51-3.14, p = 0.002). Family history of breast cancer was associated with higher odds of good knowledge (AOR = 2.13, 95% CI: 1.24-3.61, p = 0.004), good attitude (AOR = 2.35, 95% CI: 1.26-4.46, p = 0.004), and good practices (AOR = 1.64, 95% CI: 0.96-2.31, p = 0.041). Having a current breast problem was the strongest predictor, associated with better knowledge (AOR = 2.24, 95% CI: 1.48-3.84, p = 0.004), better attitude (AOR = 3.64, 95% CI: 2.62-8.24, p = 0.001), and good preventive practices (AOR = 3.54, 95% CI: 1.87-6.25, p = 0.003).

CONCLUSION: Breast cancer knowledge among Ethiopian women remains poor with notable gaps in understanding risk factors, symptoms, and preventive practices. Sociocultural and structural barriers further impede early detection. Implementing targeted, culturally sensitive health education, integrating breast cancer awareness into routine healthcare, and utilizing mass media and educational institutions are essential strategies to enhance knowledge, promote screening, and improve early detection, ultimately reducing morbidity and mortality.