Enhancing breast cancer knowledge and clinical breast examination skills among healthcare providers at the polyclinics in Misrata, Libya

Of all world regions, countries in the Eastern Mediterranean region report the highest breast cancer mortality rates. In Libya, 65.5% of patients are diagnosed at advanced stages (III-IV). To address this, in 2023 we trained 46 female healthcare providers from four centers (three polyclinics and one hospital) in Misrata on breast cancer early detection. These healthcare providers were trained as master trainers. They first received theoretical training on breast cancer risk factors, early detection, and clinical breast examination (CBE). They then received practical training with silicone breast models and were trained to perform clinical examinations on female volunteers while under supervision. We assessed Knowledge, Attitude, and Practices using pre- and post-study questionnaires. Clinical skills were evaluated during examinations using a standardized CBE skills checklist. We saw significant improvements in knowledge scores following training (73.3%-84.3%, p-value <.001). Understanding of risk factors increased substantially, including early menarche (34.1%-86.4%, p < .001); late menopause (27.3%-77.3%, p < .001); and obesity (50%-86.4%, p = .002). "CBE master trainer" status was achieved by 85% (n = 39) on their first assessment, with the remaining 15% (n = 7) succeeding after completing additional training. This study is the first on breast cancer early detection through primary health care services in Libya. We show that structured training significantly improves knowledge of risk factors and CBE skills. This training provides a foundation on which Libya can implement a sustainable breast cancer early detection strategy to reduce the burden of this disease.