# Knowledge, Attitudes, and Practices Regarding Breast Cancer and Its Prevention Among Female Doctors at a Tertiary Care Hospital in Pakistan

## TL;DR

This study explores breast cancer knowledge and screening practices among female doctors in Pakistan, finding that while they have strong symptom recognition and positive attitudes, their screening practices are suboptimal.

## Contribution

The study provides new insights into breast cancer awareness and screening behaviors specifically among female doctors in Khyber Pakhtunkhwa province, Pakistan.

## Key findings

- Female doctors showed strong knowledge of breast cancer symptoms but limited understanding of risk factors and screening methods.
- Despite positive attitudes toward screening, only a minority of participants adhered to recommended screening practices.
- Busy schedules and lack of institutional screening programs were the most commonly reported barriers to screening.

## Abstract

Background and objectives

Breast cancer is the leading cause of cancer mortality among women, yet screening remains underutilized in low-resource settings. Despite the central role of physicians in patient counselling, early detection, and guideline implementation, most research in Pakistan about breast cancer awareness has focused on nurses, medical students, or the general population. Evidence specifically examining female doctors, particularly in Khyber Pakhtunkhwa province, remains sparse. This study assessed breast cancer knowledge, attitudes, and screening practices among female doctors at a tertiary hospital in Peshawar, examined associations between knowledge and screening behavior, and identified perceived barriers to screening.

Methods

A cross-sectional survey was conducted among 188 female doctors at Khyber Teaching Hospital, Peshawar, Pakistan, in October 2025. Data were collected using a structured, self-administered questionnaire. The instrument assessed knowledge across three domains (risk factors, signs and symptoms, and screening methods) comprising 27 items, attitudes toward breast cancer screening using a six-item Likert scale, current screening practices, and perceived barriers to screening. Statistical analyses included Spearman's correlation to examine relationships between knowledge, attitudes, and practices; Chi-square tests to assess associations between categorical variables; and Mann-Whitney U tests to compare knowledge scores across demographic groups.

Results

Participants had a mean age of 27.47 ± 1.53 years. Knowledge varied substantially across domains: 94.1% demonstrated good knowledge of signs and symptoms, compared to 9.6% for risk factors and 2.1% for screening methods. Attitudes were overwhelmingly positive (mean score: 29.01 ± 1.72 out of 30). Despite favorable attitudes, screening practices were suboptimal: 63.8% practiced breast self-examination (BSE), although only 36.7% performed it monthly; 26.6% had undergone clinical breast examination; and 2.7% reported mammography. Knowledge scores did not differ significantly between BSE practitioners and non-practitioners (p=0.409). Family history of breast cancer was significantly associated with BSE practice (p=0.013), as was lack of guideline awareness with non-practice (p=0.010). The most frequently reported barriers were busy schedules (71.3%), perceived low risk (41.5%), and absence of institutional screening programs (32.4%).

Conclusion

Female doctors demonstrated strong symptom recognition and positive attitudes but had limited knowledge of screening guidelines and suboptimal screening practices. The lack of association between knowledge and practice suggests that educational interventions alone are insufficient. Strategies to improve screening adherence among female doctors should include workplace-based screening programs, continuing medical education on breast health, and targeted counselling for those with identifiable risk factors.