Assessment of the knowledge, attitude, and practice of general surgeons in the management of breast cancer in Rwanda: A cross-sectional survey study

Abstract Background: Breast cancer is the second most common cancer among women in Rwanda, and surgery is a central component of its management. Breast surgery for benign and malignant disease is performed predominantly by general surgeons, as specialist breast and surgical oncologists remain few and dedicated breast surgical oncology training was still under development at the time of this study. Assessing general surgeons' knowledge, attitudes, and practices is therefore essential to identify gaps and improve breast cancer care. Methods: We conducted a cross-sectional electronic survey of general surgeons practicing across referral, teaching, and district hospitals in Rwanda. The survey was distributed among general surgeons via a REDCap-based instrument that assessed training, practice patterns, self-reported confidence (5-point Likert scale), and case-based knowledge, and was informed by national and institutional breast cancer protocols and COSECSA examination questions. Data were analyzed in JASP using descriptive statistics, chi-square or Fisher's exact tests, and Spearman's rank correlation. Results: From 67 eligible general surgeons, 27 responded (40% response rate; 93% male). Most (78%) had received breast cancer surgical training during residency, predominantly through lectures (70%), and operative exposure was limited: 74% had performed 1–20 breast cancer procedures during training, and 11% had performed none. Breast ultrasound was the most available diagnostic tool (93%), whereas MRI was available in fewer than 20% of facilities, and 38% of surgeons referred more than half of their patients to tertiary centers. Confidence was highest for diagnosing breast cancer (mean; 4.3 of 5) and lowest for treatment (3.6 of 5). The mean case-based knowledge score was 9.5 of 15 (63%), with the largest gaps in management of early-stage disease, non-carcinomatous malignancies, and isolated chest-wall recurrence. Conclusion: General surgeons deliver the majority of breast cancer surgical care in Rwanda but report limited operative exposure and specific knowledge gaps. Strengthening structured, hands-on breast cancer training during and after residency, establishing multidisciplinary tumor boards, and developing national management guidelines could improve the quality and consistency of care. To our knowledge, this is the first study to assess the knowledge and practice of general surgeons in breast cancer management in Rwanda.