Bridging the Knowledge-Practice Gap in Breast Cancer Screening Among Non-medical Female University Students in Riyadh: A Cross-Sectional Study

Abstract

Background Breast cancer is the most prevalent female malignancy in Saudi Arabia and globally, with early detection being the cornerstone of improved survival. This study assesses breast cancer screening awareness, knowledge of risk factors and signs, and screening practices among non-medical female university students in Riyadh, Saudi Arabia. Methods A cross-sectional study (July-September 2025) enrolled 679 non-medical female students aged 18 years and above from four Riyadh universities using multistage sampling. Data were collected using a structured, bilingual 58-item questionnaire adapted from previous studies, culturally modified, pilot-tested, and reviewed by experts. Knowledge and practice domains were classified as sufficient when scores exceeded 60% and insufficient when scores were ≤60%. Knowledge scores were analyzed using Mann-Whitney U and Kruskal-Wallis tests with Bonferroni correction; chi-square tests and multivariate logistic regression identified significant predictors. Results Despite 85% (n = 578) demonstrating sufficient attitudes toward screening, only 44% (n = 299) had adequate general awareness, 19% (n = 132) had sufficient knowledge of risk factors and signs, and 23% (n = 158) achieved sufficient screening practice. The median knowledge score was 19/43 (IQR: 16-22). Family history (65.5%, n = 445) and increasing age (56.7%, n = 385) were the most recognized risk factors, while early puberty (16.2%, n = 110) and nulliparity (23.6%, n = 160) were the least. While 90.9% (n = 617) identified a breast mass as a sign, only 5.9% (n = 40) correctly recognized that a painful mass is not a typical early presentation. Breast self-examination and clinical breast examination uptake were low at 40.4% (n = 274) and 23.4% (n = 159), respectively. However, these screening practice findings should be interpreted considering the young age distribution of participants, with many being below the recommended age for routine mammography screening. AlMaarefa University affiliation was the strongest predictor of knowledge (OR = 2.718; 95% CI: 1.398-5.282; p = 0.003) and screening practice (OR = 5.488; 95% CI: 2.863-10.519; p < 0.001), with family history also predicting sufficient screening practice (OR = 2.384; 95% CI: 1.488-3.819; p < 0.001). Conclusion A striking knowledge-attitude-practice gap exists in this population. Universities are underutilized platforms for breast cancer health education, and structured, culturally sensitive interventions are urgently needed to convert attitudinal willingness into consistent screening practice.