Knowledge, attitude and practice towards breast cancer and screening among women in northwestern China: a cross-sectional study

Background: Breast cancer constitutes the most common cancer among women and has been a major, life-threatening, public health concern. The knowledge, attitude and practice towards breast cancer and screening among women should be assessed in order to guide current breast cancer interventions, especially under the background that many cities in China are carrying out free breast cancer screening programs for urban and rural women. Methods: A cross-sectional survey was conducted from July 2023 to September 2024, in nearly 100 medical institutions in Xi’an, the largest city in northwestern China. All women asking for medical services related to breast diseases were invited to participate in the survey. Descriptive statistics, multiple linear regressions, and binary logistic regressions were performed. Findings: Of 26,586 women aged 20-60 years, the average knowledge scores on risk factors, signs and symptoms, and prevention methods of breast cancer were 6.20 (S.D. 3.98, range 0-10), 4.65 (S.D. 2.89, range 0-7), and 6.58 (S.D. 3.40, range 0-9), respectively. The average score on the overall knowledge of breast cancer was 17.44 (S.D. 9.63, range 0-26). However, 17.1% (4,553)-21.8% (5,801) of women still had no knowledge of risk factors, signs and symptoms, and prevention methods of breast cancer. The average score of attitudes towards breast cancer screening was 4.11 (S.D. 1.13, range 1-5). 56.2% of women had received breast cancer screening services. After adjusting for potential confounding factors, having a higher knowledge score of breast cancer was significantly associated with a more positive attitude towards breast cancer screening among women (b 0.01, t 8.72), and women who had a higher knowledge score of breast cancer (OR 1.01, 95% CI 1.00-1.01) and had a more positive attitude towards breast cancer screening (OR 1.19, 95% CI 1.16-1.21) were more likely to receive breast cancer screening services. Meanwhile, women’s attitudes towards breast cancer screening played a partial mediating role in the association between their knowledge of breast cancer and having received breast cancer screening services. Besides, education and occupation are two significant influencing factors associated with the knowledge, attitude and practice towards breast cancer and screening among women. Interpretation: The study revealed a lack of awareness and comprehensive knowledge about breast, as well as low self-risk perception and low uptake of breast cancer screening services among women in Xi’an. The scaling-up of breast cancer information and dissemination should be prioritized by the government, hence improving the uptake of breast cancer screening services. Funding: National Natural Science Foundation of China (72204199); Research Project of Humanities and Social Sciences of the Ministry of Education of China (22XJC630001).