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1 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
Breast Cancer Knowledge among Students at a
State Comprehensive University
Calvin Odhiambo
University of South Carolina Upstate
Shimia Hunter
University of South Carolina Upstate
Breast cancer is one of the most common cancers affecting women worldwide
and the second leading cause of cancer deaths among women in the United States
(American Cancer Society, 2022a). Over 287,000 new cases of breast cancer occur
in the United States each year, claiming the lives of more than 43,000 women
annually. However, this disease does not affect all woman in the same way. For
instance, black women have higher breast cancer mortality rates than white women,
despite having relatively lower breast cancer incidence (American Cancer Society,
2019; DeSantis et al., 2019; Kroenke et al., 2014). Reasons for the disparities in
breast cancer mortality include cultural barriers, socioeconomic status, access to
health care, tumor biology, lifestyle factors, diet, and knowledge of breast cancer
and its risks, among other factors (Cunningham et al., 2013; Gerend & Pai, 2008;
Komen, 2016). These disparities are widening throughout much of the United
States (American Cancer Society, 2020b).
Breast Cancer in Men. On the other hand, breast cancer in men is considered
rare and is therefore understudied (Giordano, 2018; Thomas, 2010). In fact, most
of the studies that have focused on breast cancer knowledge have focused mainly
on women. This is, in part, due to the gendered construction of breast cancer as a
woman’s disease (Quincey et al., 2016; Skop et al., 2018). In the United States, an
estimated 2,700 new cases of breast cancer in men are diagnosed each year,
resulting in more than 500 deaths annually (American Cancer Society, 2022b).
While breast cancer in men accounts for only 1% of all breast cancers (Faria et al.,
2021), the number of breast cancers in men has been increasing gradually
(Giordano, 2018; Woods et al., 2020) even at a time when breast cancer incidence
rates among women have been declining in the United States (Thomas, 2018).
Furthermore, breast cancer among men is diagnosed at a much later stage than
among women, leading to a worse overall prognosis and survival rate among male
breast cancer patients, compared to their female counterparts (Halbach et al., 2020;
Wang et al., 2019). In addition, breast cancer has been diagnosed in males as young
as 5 years of age (Thomas, 2018), highlighting the risks for breast cancer in young
men. As with women, black men are at a relatively higher risk for breast cancer
compared to non-Hispanic white men (Giordano, 2018; Hassett et al., 2020). Even
though breast cancer may not be as common in men as it is in women, well-
Breast Cancer Knowledge 2
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
informed men can play a critical role in increasing awareness and stemming the
tide of breast cancer in the general population (Sambaje & Mafuvadze, 2012).
For primary prevention of breast cancer, knowledge of the risk factors and
risk reduction strategies are essential. Lack of knowledge about breast cancer is
considered a key factor in breast cancer mortality for both men and women
(Conway-Phillips, 2009; Faria et al., 2021). Lack of adequate breast cancer
knowledge has also been associated with failure to screen, whether through
mammogram, clinical breast examination, or breast self-examination (Faria et al.,
2021). In addition, lack of adequate breast cancer knowledge has also been
associated with delay in seeking treatment, which leads to poor breast cancer
outcomes. Breast cancer that is diagnosed at an early stage when it is not too large
and has not metastasized is more likely to be treated successfully (Rahman et al.,
2019). Conversely, people who delay seeking medical attention for breast cancer
are at risk of developing a more advanced stage cancer, which is often untreatable
(Akinyemiju et al., 2013). Even though studies have consistently shown that breast
cancer knowledge is key to early detection, there is a general lack of knowledge
about breast cancer risk among women, in general, but also more specifically
among men (Hughes, 2013). Previous studies have focused on women above 40
years of age, in part, due to the general notion that breast cancer risks tend to
increase after age 40 (Komen, 2015). This focus on older women invariably means
that younger people, including both males and females, remain underrepresented in
breast cancer research (Elimimian et al., 2021).
Breast Cancer in Younger People. Breast cancer among younger people
tends to be diagnosed in its later stages, resulting in a more aggressive type. In
addition, young women have higher risk of metastatic recurrence and a higher
breast cancer mortality rate, owing to delayed diagnosis (American Cancer Society,
2020a). Since, according to both CDC and American Cancer Society guidelines and
health insurance practices, people under the age of 40 are not eligible for regular
mammogram or clinical breast exam (CDC, 2022; Durham, et al., 2022), breast
cancer awareness and knowledge among this age group becomes especially critical
for facilitating early warning signs. Knowledge of breast cancer signs, symptoms,
and risk factors is central to seeking medical attention and to the improvement of
breast cancer intervention (Samah et al., 2016). However, there is a paucity of
information in the current literature about breast cancer knowledge among younger
people under the age of 30 in the United States, especially among college students
who form an important segment of this group age group.
College students are at a critical stage in their development since most health
behaviors are developed at this stage in life (Bhandari et al., 2016). Considering
that breast cancer risks increase with increasing age (Bray et al., 2004), an
understanding of breast cancer knowledge and risk among younger populations is
key to the formulation of necessary intervention measures to mitigate their breast
3 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
cancer risks as they grow older. Students who have breast self-awareness are more
likely to take appropriate steps for monitoring and seeking interventions that are
necessary to improve long-term breast cancer outcomes. If adopted at an early age,
behaviors such as breast self-examination are likely to continue into adulthood and
throughout life (Ludwick & Gaczkowski, 2001). When started early, breast self-
awareness can become an important gateway to health promotion behaviors which
set the stage for adherence to clinical breast examination and mammography
screening later in life (Karayurt et al., 2008). On the other hand, a lack of
knowledge, not only about the risks for breast cancer, but, more importantly, about
how to detect the disease at an early stage, invariably leads to misconceptions
regarding its curability and the effectiveness of early detection among the students
(Mafuvadze et al. 2012).
Studies that have assessed breast cancer knowledge and awareness among
college students have mainly been done outside of the United States in countries
such as Angola (Sambanje & Mafuvadze, 2012), Ethiopia (Ameer et al., 2014),
Malaysia (Samah et al., 2016), Jordan (Alsaraireh & Darawad, 2019), Nigeria (Nde
et al., 2016), Pakistan (Noreen et al., 2015), Saudi Arabia (Alomair et al., 2020),
and United Arab Emirates (Rahman et al., 2019), among others. Despite the United
States having one of the highest breast cancer rates in the world, little is known
about breast cancer knowledge and awareness among college students in the U.S.
The current study seeks to fill this gap by investigating the knowledge and
awareness of breast cancer among undergraduate students at a State Comprehensive
University (SCU) in the Southeastern United States.
State Comprehensive Universities. SCUs (also known by other names such
as Regional Comprehensive Universities, Public Regional Universities, and Public
Comprehensive Universities, among others), are four-year institutions with a wide
range of undergraduate programs funded by a state (Henderson, 2009). One major
appeal of SCUs is that they have lowered barriers to admissions and therefore enroll
the largest proportions of marginalized, underrepresented, and economically
disadvantaged students – including women, military veterans, adult learners, racial
minorities, immigrants, first-generation, and low-income students (Fryar, 2015;
McClure, 2018; Orphan & Broom, 2021; Zack, 2018). In addition, SCUs
demonstrate a close relationship with the region and its economy, create a teaching
and student-centered environment, and are more affordable (AASCU, 2002;
Henderson, 2007; Orphan, 2018; Sherman, 2021).
Currently, there are over 400 SCUs in the United States, educating around
70% of undergraduates at four-year public institutions - making SCUs very
significant in educating undergraduate students in the United States (American
Enterprise Institute, 2019; Fryar, 2015; McClure, 2018; Schneider & Deane, 2015).
However, SCUs receive little attention from researchers, policy makers, and the
public (Henderson, 2009). This is, in part, due to the fact that higher education
Breast Cancer Knowledge 4
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
experts and researchers tend to pay more attention to elite liberal arts colleges and
flagship universities (Zack, 2018). This dearth of information on SCUs is what
motivated E. Aldan Dunham’s 1969 book on Colleges of the Forgotten Americans
to bring attention to a sector of higher education in the United States that had largely
been overlooked. According to Dunham (1969), these institutions were overlooked
because of the types of students they typically served – students from working-class
families who sought an accessible, affordable pathway to middle-class stability
(McClure et al., 2020). Even though more research has been conducted on SCUs
within the past 10 years or so, including the creation of Teacher Scholar: The
Journal of the State Comprehensive University, and a special issue in the journal,
New Directions for Higher Education, a lot is still unknown about SCUs in general
and about the students who are enrolled in the institutions, in particular.
Much of the recent literature on SCUs has focused on what can be described
as the “structural” aspects of these institutions. These include the origin and
evolution of SCUs (McClure, 2018), their defining criteria, values, or mission
(Orphan, 2020; Schneider & Deane, 2015; Warshaw et al., 2020), graduation,
enrollment, or retention rates (McElroy & McElroy, 2017; McClure & Fryar, 2020),
faculty experience or welfare (Henderson, 2011; Orphan & Broom, 2021),
institutional challenges and how the SCUs are coping (Zeig, 2016), academic
programs or curriculum (Kaplin, 2013), student services or support (Kastle et al.,
2021), and SCUs which are part of historically black colleges and universities
(Commodore & Njoku, 2020).
Few studies have actually focused on SCU students themselves. These studies
have focused on SCU students as African American bidialectal students
(Chambers, 2014), first-generation college students (King et al., 2017), adult
learners or non-traditional students (Zack, 2018), international students (Olt & Tao,
2020; Yakaboski et al., 2017), advising experiences of graduate and undergraduate
learners (Powers & Wartalski, 2021), and their career preparedness (Woodard &
McDonald, 2021). However, there has been little to no attention on the health-
related knowledge of the students in these institutions. In light of the important
role that SCUs play in educating post secondary students in the United States, the
dearth of information on these students’ health knowledge and beliefs creates a
vacuum of information that makes these institutions a fertile ground for studying
breast cancer knowledge among university students.
Methodology
Setting. This study was conducted among undergraduate students at a SCU
in the Southeastern United States. Like most SCUs, this was a four-year public
educational institution serving primarily undergraduates who live within the region,
often commute, and pursue a mix of arts, sciences, and professional degrees. The
university has approximately 6000 students, spread across six different colleges.
5 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
The university has a diverse student body. Around 40% of the students are black,
while around 50% are white. The remainder are divided between Hispanic (around
5%), Asian (around 2%) and others (around 3%). A majority of the students are
female (around 68%) while around 32% are male.
Study Design and Sample. The study sample consisted of 265 students
selected through a convenience sample of respondents representing each of the six
colleges at the University. The students were drawn from 27 different disciplines,
both biological/medical-related and non-biological/non-medical related
disciplines. Emails requesting permission to recruit study participants were sent to
instructors representing each college and students who voluntarily agreed to take
part in the study were recruited. Participants were assured anonymity and informed
of their right to voluntary participation and withdrawal from the study at any stage.
Informed written consent was obtained from each student who agreed to participate.
Participants were given a self-administered questionnaire in a classroom setting and
asked to complete the questionnaire anonymously. Necessary IRB approval was
sought and received prior to selection of study participants and administering of the
questionnaire.
Instruments. This study used a modified version of the Breast Cancer
Perceptions and Knowledge Survey previously used by Sambanje and Mafuvadze
(2012). We dropped the questions that did not apply to our context and replaced
those with relevant questions that had been used in previous studies on breast cancer
awareness. The instrument was first pilot tested on a convenience sample of 20
students. Results of the pilot test were used to revise the questionnaire prior to being
administered to the target population.
The questionnaire consisted of three sections. The first section consisted of
questions relating to respondents’ sociodemographic characteristics such as gender,
age, annual household income, race, marital status, academic major, and academic
year. Our review of existing literature suggested that these specific factors would
influence participants’ knowledge of breast cancer and their understanding of its
risks (Table 1). The second section included 13 questions/statements which
assessed basic knowledge and perceptions about breast cancer (Table 2). The third
and final section consisted of 14 questions/statements which assessed basic
understanding of breast cancer risk factors (Table 3). With regards to the questions
in the last two sections of the questionnaire, participants were asked to indicate
which statements were true or false. Each correct answer was assigned a score of
1, while incorrect or “I don’t know” answers were assigned a score of 0. The
answers were scored based on established facts about the disease as stated by the
American Cancer Society, Centers for Disease Control and Prevention, and the
Susan G. Komen Organization (Appendices 1 and 2). To assess overall breast
cancer knowledge, we combined the 13 scores from the second part of the
questionnaire with the 14 scores from the third part of the questionnaire to create a
Breast Cancer Knowledge 6
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
single variable with a maximum score of 27. Using this combined score of 27 items,
we further created three categories of “poor overall knowledge” (scores of 0-8),
“satisfactory overall knowledge” (scores of 9-18), and “good overall knowledge
(scores of 19-27).
Statistical Analysis. Statistical analysis was done using the Statistical
Package for Social Sciences (SPSS) version 24. Descriptive statistics with cross-
tabulations were performed and frequencies generated for correct and incorrect
answers for each measurement of breast cancer knowledge and risk factors.
Association between the variables was analyzed using multiple logistic regression
with the significance level set at p < 0.05 for all variables used in the analysis.
Results
Socio-demographic Characteristics. As presented in Table 1, out of the 265
students who were included in the study, a majority were women (63%), under 20
years of age (52%), single (92%), white (55%), in their freshman or senior year
(28% each), and from families with a household income of $25,000-$49,999 (34%).
Perceptions and Knowledge of Breast Cancer. Regarding perceptions and
knowledge of breast cancer, our results show that there was a good basic knowledge
about breast cancer among study participants (see Table 2). A majority of the
students gave correct answers to 11 out of 13 (or 85%) of the statements used to
assess basic knowledge and perceptions about breast cancer. The only statements
where a majority of students did not exhibit correct basic knowledge were
statements relating to whether black women are more likely to develop breast
cancer than white women (where only 37% of the students gave the correct answer)
and whether the students personally knew someone who had died from breast
cancer (only 42% of the students answered in the affirmative).
Understanding of Breast Cancer Risk Factors. While a majority of our
study participants correctly answered questions about basic knowledge and
perceptions about breast cancer, there was, at the same time, a widespread lack of
knowledge about the risks for breast cancer, as shown in Table 3. Out of the 14
statements used to assess breast cancer risks, a majority of our participants
demonstrated a correct understanding in only 5 (36%) of the statements. For
instance, a majority of the students incorrectly assumed that physical height (i.e.
being tall), wearing tight bras, or a hard blow to the breast could lead to breast
cancer. On the other hand, a majority of students were generally not aware of breast
cancer risks or predispositions associated with obesity, breast implants,
race/ethnicity, or physical inactivity. The best-known risk factor was a family
history of breast cancer, where 90% of our respondents provided the correct answer
(see Appendices 1 and 2 for the correct answers to each of the statements used to
assess basic breast cancer knowledge and risks).
7 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
Table 1. Socio-demographic Characteristics of Participants
Characteristics
N=265
%
Gender
Male
37
Female
63
Age (Years)
<20
52
21-25
40
26-30
4
Over 30
4
Marital Status
Single
92
Married
7
Divorced
1
Race
Black
34
White
55
Asian
3
Hispanic
4
Other
4
Class
Freshman
28
Sophomore
21
Junior
22
Senior
28
Family Income
Less than $25,000
23
$25,000-$49,999
34
$50,000-$99,000
26
$100,000 or more
17
Breast Cancer Knowledge 8
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
Table 2. Perceptions and Knowledge of Breast Cancer
Question
Study Participants
(n=265)
%
Correct
Incorrect
Don’t
Know
Breast cancer can affect men
89
5
6
Women younger than 30 years of age
cannot get breast cancer
92
4
4
*I personally know someone who has
been diagnosed with breast cancer
76
11
13
Even if found early, the chance of
surviving breast cancer is low
71
11
18
Black women are more likely than white
women to develop breast cancer
37
17
46
Only women with large breasts can get
breast cancer
95
1
4
A lump always means having breast
cancer
92
2
6
Breast Cancer is the second most
common cancer among women in the
U.S.
69
7
24
A family history with breast cancer
increases risk
83
6
11
The risk of developing breast cancer
increases with age
57
15
28
About 1 in 8 women will develop breast
cancer in the course of their lifetime
55
8
37
Chemotherapy is the only form of
treatment for breast cancer
66
11
23
*I personally know someone who has
died from breast cancer
42
43
15
Note:
*See explanatory note on these two statements in Appendix 1
9 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
Table 3. Understanding Breast Cancer Risk Factors
Risk Factor
Study Participants
(n=265)
%
Correct
Incorrect
Don’t
Know
A stressful life
57
20
23
A hard blow to the breast
29
41
30
Having children before age 30
50
10
40
Being overweight
47
22
31
A family history of breast cancer
90
5
5
Breast implants
28
38
34
Wearing tight bras
31
30
39
Breast feeding
57
11
32
Radiation to the chest or face before age 30
69
9
22
Race/ethnicity
43
30
27
Eating grilled food; food containing chemicals
40
25
35
Height (being too tall)
8
62
30
Smoking
67
14
19
Physical activity
32
43
25
Overall Knowledge. Our study found a low overall knowledge of breast
cancer among the students. As shown in Table 4, only 24% of the respondents had
“good” overall breast cancer knowledge. The majority (76%) had poor or only
satisfactory overall knowledge about breast cancer.
Table 4. Distribution of Students’ Overall Breast Cancer Knowledge
Level of Knowledge
Scores
Study Participants
(n=265)
%
Poor
1 – 9
7
Satisfactory
10 – 18
69
Good
19 – 27
24
Breast Cancer Knowledge 10
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
To better understand the factors associated with overall breast cancer
knowledge, we ran a multiple logistic regression analysis using the forward method.
Of the predictors tested (see Table 5), the two factors that had a statistically
significant effect on overall breast cancer knowledge were gender (OR = 2.563,
p = 0.017) and race (OR = 0.450, p = 0.044). Female students were more than twice
as likely to have good overall breast cancer knowledge compared to males. With
regards to race, overall breast cancer knowledge decreased by 55% among racial
minority groups, compared to whites. However, no significant relationship was
seen between academic major (p = 0.597), marital status (p = 0.196), age
(p = 0.358), family household income (p = 0.119), and overall breast cancer
knowledge.
Table 5. Logistic Regression Analysis of Predictors of Overall Breast Cancer
Knowledge
Variable
B
S.E.
Wald
df
Sig.
Exp(B)
95% C.I. for
Exp(B)
Lower
Upper
Gender
.941
.396
5.664
1
.017
2.563
1.181
5.566
Academic Major
-.279
.504
.307
1
.579
.756
.282
2.031
Marital Status
1.509
1.166
1.674
1
.196
4.520
.460
44.430
Age
.703
.764
.846
1
.358
2.019
.452
9.026
Family Household
Income
-.653
.418
2.435
1
.119
.520
.229
1.182
Race
-.798
.396
4.054
1
.044
.450
.207
.979
Constant*
1.569
.958
2.679
1
.102
4.800
Notes:
*Predicted probability is high breast cancer knowledge.
Reference categories for predictors: Gender=Males; Academic Major=Bio/Med
Students; Marital Status=Single; Age=Age 25 or younger; Household Income=Under
$50k; Race=White.
B – This is the unstandardized regression weight.
S.E. – This is the standard error
Wald –This is the test statistic for the individual predictor variables.
Df – This is the degree of freedom.
Sig – This is the significance level.
Exp(B) – This are the odds rations for the predictors
11 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
Discussion
This study was designed to assess breast cancer knowledge and awareness
among undergraduate university students at a state comprehensive university in the
Southeastern United States. As previous studies have argued, lack of adequate
breast cancer knowledge negatively affects whether one will seek breast cancer
care, the timing of the care, the development of the disease, and the prognosis
(Caplan, 2014; Peek et al., 2008). In addition, lack of awareness of breast cancer
also results in failure to seek medical care or to undergo treatment (Kaiser et al.,
2013), thus resulting in a more aggressive cancer (Caplan, 2014). Our results show
a widespread lack of adequate knowledge about breast cancer among undergraduate
college students. In this sense, our results are consistent with studies that have
investigated breast cancer knowledge among college students in other countries
(Ameer et al., 2014; Samah et al., 2016; Alsaraireh & Darawad, 2019; Alomair et
al., 2020; Nde et al, 2016; Noreen et al., 2015; Sambanje & Mafuvadze, 2012).
While other studies had found that age, level of educational, household income, and
family history of breast cancer were significantly associated with the knowledge
level (Bhandari et al., 2016), the only two factors that had a significant effect on
breast cancer knowledge in our study were respondents’ gender and race.
Regarding gender, our study found that being female was associated with
increased breast cancer knowledge. It is not surprising that female students have a
better overall breast cancer knowledge than male students. Although male breast
cancer is rare, as we have already seen, males do develop breast cancer (Chavez-
Mcgregor et al., 2013; Ottini, 2014; Weiss et al., 2005). In many ways, the risks for
breast cancer among men mirror some of the risk factors in women, though there
are some differences as well. Some of these risks include aging, family history of
breast cancer, radiation exposure, obesity, race, estrogen treatment, and presence
of a rare genetic condition known as Klinefelter Syndrome, among other factors
(Khan et al., 2015). Lack of awareness of the risk of breast cancer in men
contributes to late diagnosis and poor prognosis (Wang et al., 2019). This highlights
the need to increase breast cancer awareness among male students. Such awareness
could include information on how to identify symptoms, perform breast self-
examination, and seek early health intervention (Al-Haddah, 2010). In addition to
using this knowledge for their own breast health, breast-cancer literate men can also
play a critical role in early detection in their female partners and to help reduce the
barrier to appropriate breast health intervention for those partners.
Regarding race, our study found that white undergraduate students
demonstrated better overall breast cancer knowledge than racial minority students.
For instance, our study found that 54% of the white students had “good” overall
breast cancer knowledge, compared to only 40% of black students. In addition, the
odds of having good breast cancer knowledge decreased by 55% among non-white
students, compared to their white counterparts. In this sense, our finding is
Breast Cancer Knowledge 12
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
consistent with studies in the general population that have found that African
Americans suffer from a deficit in knowledge related to breast cancer (Alpeter,
2005; Freedman et al., 2016; Manning et al., 2013). Since, as discussed earlier,
black women have higher breast cancer mortality rates than their white
counterparts, the observed black-white disparity in breast cancer knowledge among
college students should be of concern. The disparities in breast cancer knowledge
can only exacerbate existing racial disparities in breast cancer mortality, especially
considering the critical role that adequate breast cancer knowledge plays in early
detection, diagnosis, and intervention (Noreen et al., 2015). Since the family is
considered as the primary unit of health socialization, without adequate knowledge
about breast cancer, college students who may themselves be future parents will
not be in a position to disseminate that knowledge to their offspring. This will only
help to perpetuate the cycle of breast cancer illiteracy and the concomitant racial
disparities.
Some research on health socialization has found important racial and ethnic
differences in family discourse regarding certain health experiences. For instance,
in a qualitative study to understand several racial and ethnic group members’
experiences as breast cancer survivors, Ashing-Giwa and her team (2004) found
that there was a code of silence about cancer among certain racial and ethnic
minority families. This sentiment was best captured in a statement made by an
African American respondent in the study who pointed out that historically, when
diagnosed with cancer, African Americans did not openly talk about the disease.
This was due to the cultural belief that in African American families it was
considered “a disgrace to have such a disease as cancer” (p. 421). Other respondents
attributed this “code of silence” to “lack of knowledge about cancer.” It is easy to
see how the culture of silence about breast cancer that Ashing-Giwa and company
found among racial minority families could affect black students’ overall
knowledge about breast cancer. The general lack of breast cancer awareness among
older African American women, coupled with cultural beliefs that inhibit family
discourse about breast cancer, highlight the need for concerted efforts in developing
appropriate health educational programs to increase breast cancer awareness among
younger minority women.
Given the number and types of students that attend SCUs, examining ways to
create or increase awareness about breast cancer, in addition to other public health
concerns among the students, is essential. Given that most SCUs are experiencing
financial strain (Street, 2022), a possible inexpensive strategy could be to integrate
health literacy within the general education curriculum. Since all students at SCUs
are required to take general education courses, this could be a very effective, but
relatively inexpensive, pathway for introducing health literacy across the
curriculum. A variant of this could be a required freshman seminar, similar to a
University 101 course, covering selected health literacy themes such as breast
13 Breast Cancer Knowledge
Teacher-Scholar: The Journal of the State Comprehensive University, 12(1), 2023
cancer. Alternatively (or in conjunction with the previous recommendations), since
many SCUs are small and therefore do not have the luxury of hosting a teaching
hospital where health literacy can be taught, like in flagship universities, breast
cancer awareness can be provided through the student affairs offices in such SCUs.
Conclusion
The goal of the current study was to investigate the knowledge and awareness
of breast cancer among female and male undergraduate students attending a SCU
in the southeastern United States. Our results show a widespread lack of overall
breast cancer knowledge and associated risk factors among the students. However,
this general lack of knowledge is more pronounced among males than females, and
among non-white than white students. This underscores the need for effective
breast cancer awareness and prevention programs that reach all students, in general,
but that are also targeted towards specific at-risk groups identified in this study. In
particular, given the observed racial disparity in breast cancer knowledge, it is
evident that existing awareness campaigns are not reaching all racial and ethnic
groups in the same way. This suggests the need to specifically focus such
campaigns on college students, and especially racial minority groups such as
African Americans, using means and measures that are more culturally appropriate,
accessible, and effective. Our findings also suggest that breast cancer awareness
programs should be made more expansive (i.e., integrated in the general education
curriculum) and should not simply focus on females but should also target males,
since well-informed males can play a significant role in stemming the tide of breast
cancer as potential patients, future educators, and caregivers, among others.
Acknowledgements
This research was made possible by a Research Assistantship Grant awarded
through the USC Upstate Office of Sponsored Awards and Research Support
(SARS). In addition, the authors would also like to offer special thanks to Dr.
Bernard Omolo and Dr. Warren “Wren” Bareiss for providing vital comments that
helped to strengthen this manuscript.
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21 Breast Cancer Knowledge
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Appendix 1. Answers to Statements Assessing Basic Perceptions and
Knowledge of Breast Cancer
Statement
+
Correct
/Desired
Answer
Breast cancer can affect men
True
Women younger than 30 years of age cannot get breast
cancer
False
I know personally someone who has been diagnosed with
breast cancer
True*
Even if found early, the chance of surviving breast cancer is
low
False
Black women are more likely than white women to develop
breast cancer
False
Only women with large breasts can get breast cancer
False
A lump always means having breast cancer
False
Breast Cancer is the second most common cancer among
women in the U.S.
True
A family history with breast cancer increases risk
True
The risk of developing breast cancer increases with age
True
About 1 in 8 women will develop breast cancer in the course
of their lifetime
True
Chemotherapy is the only form of treatment for breast cancer
False
I personally know someone who has died from breast cancer
True*
Notes:
*While there is no right or wrong answer to these two statements,
according to the literature, and as explained in the text, a respondent who
answers these two questions in the affirmative, indicating personal
knowledge of someone who has either been diagnosed with, or died
from, breast cancer is considered to have more awareness of breast
cancer than a respondent who does not have such personal knowledge
(taken together with responses to the other questions).
+
See the methodology section for an explanation of how we arrived at the
correct answers
Breast Cancer Knowledge 22
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Appendix 2. Answers to Statements Understanding of Breast Cancer Risk Factors
Statement
+
Correct/
Desired
Answer
A stressful life
False
A hard blow to the breast
False
Having children before age 30
False
Being overweight
True
A family history of breast cancer
True
Breast implants
False
Wearing tight bras
False
Breast feeding
False
Radiation to the chest or face before age 30
True
Race/ethnicity
True
Eating grilled food; food containing chemicals
True
Height (being too tall)
False
Smoking
True
Physical activity
True
NOTE:
+
See the methodology section for an explanation of how we arrived at the
correct answers
