Factors associated with breast self-examination and mammography screening among women attending primary healthcare centers in central Tunisia

BACKGROUND: Breast cancer remains a major public health concern in Tunisia. Despite national efforts, significant gaps persist in women's knowledge and uptake of early detection practices. Understanding the determinants of these behaviors is critical for improving screening coverage. This study aimed to identify factors associated with breast self-examination (BSE) and mammography screening among women attending primary healthcare centers in Monastir, Tunisia. METHODS: We conducted a cross-sectional study in the governorate of Monastir from May to October 2023. Data were collected using a structured questionnaire specifically developed for the study objectives. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of BSE and mammography uptake. Data were analyzed using IBM SPSS statistics version 21. RESULTS: Among 439 women included, 80.6% reported awareness of BSE as an early detection method and 53.1% reported performing it monthly. In multivariate analysis, awareness of BSE (Adjusted odds ratio: AOR = 6.38; 95% CI: 3.41-11.90), having a family history of breast cancer (AOR = 2.03; 95% CI: 1.07-3.87) and older age (AOR = 1.042; 95% CI: 1.024-1.060) were independent associated factors with BSE practice. Among 192 women aged over 45 years, 35% had undergone mammography at least once. In multivariate analysis, the factors associated with mammography screening were BSE practice (AOR = 2.60; 95% CI: 1.22-5.55) and the knowledge of the recommended age for mammography initiation (AOR = 2.28; 95% CI: 1.17-4.45). CONCLUSION: The practice of BSE and especially mammography among participants remains relatively low. Targeted education and awareness-raising efforts are therefore essential to increase the use of breast cancer screening and early detection methods.