Breast Cancer Awareness and Breast Self-Examination Among Female Undergraduates in the Middle East and North Africa: Implications for Public Health

Abstract In the Middle East and North Africa, breast cancer is detected at a younger age and more advanced stage due to limited screening infrastructure. University students are a pivotal demographic for early prevention, therefore this study aimed to assess awareness of breast cancer warning signs and risk factors, and to evaluate breast self-examination (BSE) knowledge, attitudes, and practices among female undergraduates across the region. A multicentric cross-sectional study was conducted between February and May 2025 among 2,530 female undergraduates from Egypt, Algeria, Saudi Arabia, Jordan, and Syria. Data were collected through an online, self-administered questionnaire using proportionate convenience sampling. Overall only 9.5% practiced BSE regularly. The mean BSE knowledge score was low (47.98, SD = 20.80), with misconceptions about timing and frequency, despite generally positive attitudes. Compared to Egyptian students, those from Algeria, Saudi Arabia, and Jordan had lower odds of regular BSE. However, higher knowledge and positive attitudes independently predicted practice. Major barriers to BSE practice are lack of knowledge (59.6%), limited time (32.0%), and fear of discovering a health problem (18.3%). Culturally tailored educational initiatives that address misconceptions, mitigate fear, and provide practical training are urgently required to bridge this knowledge-practice gap.