Observational Study Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 538-546
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.538
Knowledge, attitude, practice and factors that influence the awareness of college students with regards to breast cancer
Qiao-Ni Zhang, Hui-Xia Lu
Qiao-Ni Zhang, Clinical Medical College, Dali University, Dali 671003, Yunnan Province, China
Hui-Xia Lu, Gynecology and Obstetrics, Clinical Medical College, Dali University, Dali 671003, Yunnan Province, China
ORCID number: Qiao-Ni Zhang (0000-0001-9980-580X); Hui-Xia Lu (0000-0002-1244-4587).
Author contributions: Zhang QN contributed to the project development. Data collection and manuscript writing; Lu HX contributed to the manuscript revision; all authors reviewed the manuscript.
Supported by the grant from the Master's Scientific Fund Project of Education Department of Yunnan Province (No. 2020Y0583) and the Yunnan Provincial University Joint Fund (No. 2018FH001-073).
Institutional review board statement: All subjects provided informed consent and participated voluntarily. This study was approved by the Ethics Committee of the first affiliated hospital of Dali University (No. DFY20200712).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at haohao021021@foxmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Xia Lu, MD, Senior Researcher, Gynecology and Obstetrics, Clinical Medical College, Dali University, No. 32 Jiashibo Street, Dali 671003, Yunnan Province, China. haohao021021@foxmail.com
Received: June 17, 2021
Peer-review started: June 17, 2021
First decision: July 26, 2021
Revised: August 6, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: January 14, 2022

Abstract
BACKGROUND

Breast cancer has the highest incidence of all global cancers. Recent data show that breast cancer is becoming more prevalent in the younger population. Therefore, preventing breast cancer in young populations is a significant priority for public health. Relevant investigations of the incidence of breast cancer in young females have already been undertaken in China; however, none of these previous studies investigated the awareness of female college students with regards to breast cancer.

AIM

To investigate the knowledge, attitude, and practice (KAP) of female college students in Yunnan with regards to breast cancer and a series of influential factors.

METHODS

A random sample of 1387 female college students from two universities in Dali city were investigated by questionnaires.

RESULTS

The total KAP scores for breast cancer were 9.86 ± 2.50, 3.19 ± 2.01 and 13.31 ± 2.49, respectively. Multiple linear regression analysis showed that educational grade was the most significant influential factor underlying the level of knowledge female college students had with regards to the treatment of breast cancer (P < 0.05). Registered residence and educational grade were the most significant factors that influenced attitude (P < 0.05). Age, registered residence, grade and major, were the most significant factors that influenced behavior (P < 0.05). The KAP of female college students in western Yunnan with regards to breast cancer were low.

CONCLUSION

There is an urgent need to provide standardized publicity and educational strategies in China to improve the knowledge, attitude, and practice, of college students with regards to breast cancer.

Key Words: Breast cancer, Regression analysis, Rejuvenation, Western Yunnan, College students, Knowledge, attitude and practice

Core Tip: By applying self-designed questionnaires that specifically targeted the knowledge, attitude, and practice of college students at two universities, we were able to ascertain that the knowledge levels of college students in Yunnan with regards to breast cancer were low. Collectively, our data indicated that we should strengthen publicity and educational strategies on university campuses with regards to breast cancer, particularly in terms of prevention, self-examination and examination methods. These strategies will reduce the incidence of breast cancer, specifically in the younger population.



INTRODUCTION

In 2020, 2.26 million new cases of female breast cancer were diagnosed; consequently, breast cancer replaced lung cancer and became the most common form of cancer in the world. The early onset of breast cancer can be indicative of a familial case of breast cancer. According to the annual report of China cancer residence in 2017, there are 210000 new cases of breast cancer in China each year, with an annual growth rate of 2%[1]. By 2020, there were 420000 new cases; furthermore, data showed that patients were younger[2-5]. The screening guidelines for breast cancer recommended by the American Cancer Society indicate that the incidence rate of breast cancer is higher among women aged 20-39 years, and that the preventing the occurrence of breast cancer in younger age groups should be the key focus for the formulation of public health policies[6,7].

The knowledge, attitude, and practice (KAP) of young women is very important if we are to reduce the morbidity and mortality associated with breast cancer. If we can reduce the trend for breast cancer by primary prevention in the younger groups, then it will be possible to reduce the incidence rate significantly over the next 30 years[3-5]. China has already carried out a survey on young women with regards to understanding breast cancer and self-examination[8]. Research studies have also been published that describe regional differences and ethnic characteristics with regards to breast cancer awareness[9-11]. However, many female college students are not aware of breast cancer, thus resulting in a lower self-examination rate; this is because they do not feel that breast cancer is likely to affect them.

Yunnan is in the western borderland of China; this area is associated with more minorities and poorer medical conditions. Public health care should be provided first to college students, who would be the main force behind the transmission of health knowledge and behavior. However, the KAP of female college students about breast cancer in Yunnan was unknow. In this study, we aimed to investigate the KAP of female college students in Yunnan of breast cancer and investigate associated influential factors. Our findings should provide an appropriate foundation for the development of effective health education programs for young women in China with regard to breast cancer.

MATERIALS AND METHODS
Participants

Between October 2020 and February 2021, we randomly selected 1346 female college students from two university campuses in western Yunnan, including those studying different majors (medicine, non-medical science, non-medical arts) and those achieving different grades. All subjects provided informed consent and participated voluntarily. This study was approved by the Ethics Committee of the First Affiliated Hospital of Dali University (No. DFY20200712).

Research methods

Design of the questionnaire: Promoting our questionnaire included 5 items of basic information (age, nationality, registered residence, grade and major), 16 items related to preventative behaviors (including time, method, and motivation for breast self-examination), and eight items relating to the basic knowledge of breast cancer according to the KAP. "No", "Uncertain" and "Yes" were allocated scores of 0-2; "Oppose", "Uncertain", "Understand" and "Agree" were allocated scores of 0-3. The total score for the knowledge dimension (question numbers 1-2; question numbers 4-11) ranged from 0-20; the total scores for the attitude dimension (question numbers 14-18) ranged from 0-10; and the total scores for the practice dimension (question numbers 3, 12-13, and 19-20) ranged from 3-19. Forms were completed anonymously by the participants and then analyzed.

The content validity of the questionnaire was 0.780, the total Cronbach's alpha coefficient was 0.702, and the Cronbach's alpha coefficients for each dimension were 0.533, 0.697, and 0.563.

Quality control

The returned questionnaire was first coded and verified. Those that were missing > 10% of data were invalid. In total, 1390 questionnaire were sent out to students and 1346 valid questionnaire were returned. This represented an effective recovery rate of 96.83%.

Statistical analysis

Solutions SPSS version 25.0 software (IBM, Armonk, N.Y., United States) was used for real-time data entry and statistical analysis. A histogram was used to test the normality of raw data. Data were then described as means, standard deviations, standard errors, frequencies, and percentages. Statistical comparisons were carried out with the t-test and one-way analysis of variance. Multivariate linear regression analysis was also performed. Tests were two-way and P < 0.05 was statistically significant.

RESULTS
KAP scores for breast cancer in college students

The full marks of the three dimensions were different, in order to increase the reliability of the conclusion, the full marks for each dimension were standardized to 100 and then compared with the standardized mean. The scores for knowledge and practice for breast cancer in female college students in western Yunnan were significantly higher than the score for attitude (P < 0.05). As the age of the college students increased, the three items that make up the KAP score also increased significantly (P < 0.05). We also identified significant differences in the KAP scores when compared between students of different nationalities (P > 0.05). The KAP scores of senior students were significantly higher than those of junior students (P < 0.05). The scores for attitude and practice for urban students were significantly higher than those of rural students (P < 0.05); there was no significant difference with regards to knowledge score (P > 0.05). However, there was significant difference in terms of the attitude and practice scores between students with different majors (P < 0.05), although there were no significant differences in the knowledge scores (P > 0.05) (Tables 1 and 2).

Table 1 Knowledge, attitude, and practice scores for 1346 female college students with regards to breast cancer (n = 1346, mean ± SD).
Dimension
Score
Lowest score
Highest score
Score
Standard score
Knowledge0-200209.86 ± 2.5049.28 ± 12.48
Attitude0-100103.19 ± 2.0131.95 ± 20.08
Practice3-1931913.31 ± 2.4963.36 ± 11.86
Table 2 A comparison of knowledge, attitude, and practice scores for breast cancer among 1346 female college students (n = 1346, mean ± SD).
Project

Knowledge score
t/F
P value
Attitude score
t/F
P value
Practice score
t/F
P value
Age≤ 20 9.72 ± 2.4211.5480.0003.07 ± 1.9310.4600.01413.14 ± 2.4416.9870.000
21-2510.53 ± 2.723.82 ± 2.2114.17 ± 2.55
≥ 2512.67 ± 5.136.00 ± 4.0015.33 ± 3.51
NationalityHan 9.89 ± 2.451.1310.3353.18 ± 2.020.4850.90113.31 ± 2.510.9160.522
Yi 9.42 ± 2.613.19 ± 2.0013.48 ± 2.16
Bai 10.20 ± 2.743.39 ± 1.7313.27 ± 1.97
Hui 10.11 ± 2.763.00 ± 2.5013.22 ± 3.51
Zhuang 9.74 ± 3.292.80 ± 1.4912.42 ± 2.38
Ha Ni 9.63 ± 2.113.74 ± 1.9913.26 ± 2.09
Dai 10.82 ± 2.463.31 ± 2.0613.59 ± 2.58
Miao 8.93 ± 2.253.47 ± 2.0013.07 ± 1.62
Li Su 9.83 ± 2.332.83 ± 1.1913.58 ± 2.87
Na Xi 10.36 ± 2.663.27 ± 1.6214.63 ± 2.29
Others9.67 ± 2.473.31 ± 2.1913.10 ± 2.68
GradeFirst 9.32 ± 2.3045.9960.0002.80 ± 1.7336.4800.00012.87 ± 2.2939.0170.000
Second 10.35 ± 2.393.51 ± 2.2213.25 ± 2.72
Third 10.69 ± 2.643.84 ± 2.2214.21 ± 2.53
Registered residenceUrban9.84 ± 2.560.1690.8663.60 ± 2.233.6470.00013.79 ± 2.523.8500.000
Rural9.86 ± 2.483.08 ± 1.9313.17 ± 2.46
MajorMedicine9.88 ± 2.511.6570.1913.20 ± 1.983.7810.02413.44 ± 2.376.5050.002
Nonmedical science9.53 ± 2.272.85 ± 1.7912.60 ± 2.79
Nonmedical arts9.98 ± 2.593.39 ± 2.2013.25 ± 2.68
An analysis of factors that influence KAP scores for breast cancer

When taking age as the measurement data and using multiple linear regression analysis, we found that the knowledge score could be predicted by the student’s grade (P < 0.05) with a regression coefficient of 0.635. We also found that attitude score could be predicted according to the student’s registered residence and grade (P < 0.05) with regression coefficients of -0.542 and 0.448 respectively. Practice score could be predicted according to the student’s age, registered residence, grade and major (P < 0.05); the regression coefficients were 0.156, -0.691, 0.522, and -0.217, respectively (Table 3).

Table 3 Multiple linear regression analysis of the factors that influence knowledge, attitude, and practice scores for breast cancer, age was included directly in this analysis as a form of measurement data.
Project

B
SE
β
t
P value
KnowledgeConstant term7.3351.228-5.9760.000
Grade0.6350.0980.2266.4940.000
AttitudeConstant term1.6270.985-1.6520.099
Registered residence-0.5420.129-0.112-4.2120.000
Grade0.4480.0790.1985.7130.000
PracticeConstant term11.0051.218-9.0380.000
Age0.1560.0680.0802.2880.022
Registered residence-0.6910.159-0.115-4.3430.000
Grade0.5220.0970.1865.3760.000
Major-0.2170.084-0.068-2.5690.010

When taking age as the ranked data and using multiple linear regression analysis, we found that knowledge score could be predicted according to the student’s grade (P < 0.05); the regression coefficient was 0.704. We also found that attitude score could be predicted according to the student’s registered residence and grade (P < 0.05); the regression coefficients were -0.542 and 0.473, respectively. Practice score could be predicted according to the student’s registered residence, grade and major (P < 0.05); the regression coefficients were -0.677, 0.583, and -0.193, respectively (Table 4).

Table 4 Multiple linear regression analysis of the factors that influence knowledge, attitude, and practice scores for breast cancer, age was included directly in the analysis as ranked data.
Project

B
SE
β
t
P value
KnowledgeConstant term8.6460.379-22.7910.000
Grade0.7040.0870.2508.0960.000
AttitudeConstant term2.9770.304-9.7880.000
Registered residence-0.5370.128-0.111-4.1800.000
Grade0.4730.0700.2096.7770.000
PracticeConstant term13.4070.376-35.6220.000
Registered residence-0.6770.159-0.113-4.2600.000
Grade0.5830.0860.2086.7520.000
Major-0.1930.084-0.061-2.2920.002
Information related to the KAP questionnaire for breast cancer

Analysis showed that 29.7% of respondents were unwilling to communicate with their friends or family with regards to breast-related problems; 30.1% of respondents did not consider that the early onset of menstruation, or a later menopause, were associated with breast cancer; 19.8% did not consider that fertility or infertility was associated with breast cancer after 30 years of age, and 14.6% of respondents did not believe that breastfeeding could reduce the incidence of breast cancer. Analysis also showed that 54.5% of our respondents did not know about breast self-examination and that 76.3% of respondents did not examine their own breasts; 74.2% did not know the best time for self-examination; 72.8% respondents did not know the common technical examination for breast cancer; and 74.5% of respondents did not know how often adult women should undergo clinical examinations of their breasts. Furthermore, 56.3% of respondents did not know that mammography could detect early breast cancer that could not be detected by palpation and 50.0% of respondents had no access to healthcare knowledge related to breast cancer (Table 5).

Table 5 Statistics related to the knowledge, attitude, and practice questionnaire for the breast cancer.
Subject
Number of people (%)

Yes
Uncertain
No
Have a history of breast disease15 (1.1)200 (14.4)1172 (84.5)
Have had a breast mass57 (4.1)334 (24.1)996 (71.8)
Share breast-related issues with friends or family682 (49.2)293 (21.1)412 (29.7)
Have a family history of breast cancer (Female relatives in the family have or have had breast cancer)53 (3.8)204 (14.7)1130 (81.5)
Early menarche and late menopause associated with breast cancer301 (21.7)669 (48.2)417 (30.1)
Fertility or infertility after 30 years old related to breast cancer279 (20.1)833 (60.1)275 (19.8)
Breastfeeding reduce the incidence rate of breast cancer369 (26.6)816 (58.8)202 (14.6)
No mass in the breast but in the armpit be highly vigilant1053 (75.9) 305 (22.0)29 (2.1)
Bloody secretions from the breast a bad sign of breast cancer684 (49.3)660 (47.6)43 (3.1)
If breast pain and/or breast skin changes is breast cancer performance481 (34.7)819 (59.0)87 (6.3)
If nipple invagination should remain viligant992 (71.5)326 (23.5)69 (5.0)
Know about breast self-examination183 (13.2)448 (32.3)756 (54.5)
Have done breast self-examination70 (5.0)288 (20.8)1029 (74.2)
Know the common technical examination methods of breast118 (8.5)259 (18.7)1010 (72.8)
Know how often adult women do breast clinical examination at least70 (5.0)284 (20.5)1033 (74.5)
Accept genetic screening if genetic testing can predict breast cancer1085 (78.2)208 (15.0)94 (6.8)
Know mammography can detect early breast cancer but cannot be detected by palpation187 (13.5)419 (30.2)781 (56.3)
Willing to accept breast disease prevention guidance and take the initiative to carry out breast self-examination1172 (84.5)151 (10.9)64 (4.6)
Find breast abnormality or discomfort, take the initiative to seek medical treatment in time1025 (73.9)253 (18.2)109 (7.9)
A way to acquire breast health knowledge413 (29.8)281 (20.3)693 (50.0)
AgreeUnderstandUncertainOppose
Women should receive health education on breast cancer1279 (92.2)85 (6.1)19 (1.4)4 (0.3)
Take the initiative to prevent breast cancer in daily life1308 (94.3)46 (3.3)31 (2.2)2 (0.1)
Accept breast resection to save life820 (59.1)227 (16.4)288 (20.8)52 (3.7)
DISCUSSION

The number of younger patients (≤ 35 year of age) accounts for 7% of patients with breast cancer. These younger patients with breast cancer are associated with high levels of malignancy, rapid progression, early metastasis, and a poor prognosis[12]. Screening and prevention strategies are known to exert a significant effect on reducing the incidence rate of breast cancer[3-5]. Research studies have also focus on the prevention of breast cancer in younger women[13].

In the present study, we demonstrated that the main factor that influences breast cancer knowledge in female college students in western Yunnan was their grades. We identified a correlation between age and grade, as reported previously by Zhou et al[3]. Irrespective of whether age was included in our calculations as ranked data or measurement data, the influence of grade, as an independent variable, on the knowledge score was statistically significant. Therefore, the imbalance in breast cancer knowledge and education among female college students between different ages and grades is a critical factor that needs to be addressed. Other population characteristics should also be considered; female college students with a low age, low grade, and a low educational background, can be regarded as a key population for health education. In addition, we found that 14.4%-24.1% of respondents were not sure about their breast history and their family history of breast cancer. Familial cases of breast cancer can result in changes in the KAP values of women from affected families when compared to unaffected families; this was not considered in the present study.

Furthermore, 30.1% of respondents did not believe that the early onset of menstruation and a later menopause was associated with breast cancer. Analysis also showed that 19.8% of respondents did not consider that fertility or infertility was associated with breast cancer after 30 years of age, and 14.6% did not believe that breastfeeding could reduce the incidence rate of breast cancer. The total awareness rate of breast cancer among female college students was 54.66%; this was higher than the rates that have been published previously (32.8%-51.38%)[14], but still demonstrated imbalance (20.1%-85.6%). In particular, the insufficient awareness of high-risk factors for breast cancer should represent a key aspect of primary prevention and needs to be addressed.

In this research study, we found that the main factors that influenced attitude scores were registered residence and grade. The attitude scores for senior and urban female college students were higher than those who were junior and rural; these findings were consistent with previous findings[9,15]. Female college students in western Yunnan are more considerate with regards to seeking health care for the precancerous signs of breast cancer, although 56.3%-74.5% of respondents lacked a positive attitude for common technical examination methods, examination times, and mammography examinations. With regards to the early screening of breast cancer, mammography is considered to be the only screening method that can reduce the mortality rate associated with breast cancer[16] as this method can accurately detect small lumps along with typical granular and tiny burry calcifications. However, mammography is highly sensitive to the location of pathological tissue and breast morphology, and is not unsuitable for Chinese women with dense glands and small breasts[17]. In a previous study, Guo et al[18] reported that breast ultrasound is an easy technique to carry out and is both safe and non-invasive; however, mammography is widely used due to its high levels of sensitivity and specificity. Both of these techniques have their own advantages and limitations. Therefore, we advocate that the combined application of mammography and ultrasound should be used to screen for early breast cancer. With regards to the female college students in western Yunnan, and especially for those with lower grades and who reside in rural areas, it is particularly important that we increase publicity relating to early breast cancer screening and introduce more rigorous preventive education strategies. For young women with a family history and the presence of a breast mass, we advocate the use of a combination of mammography and ultrasound as a routine physical examination.

In this research, we found that the main influencing factors for behavior included age, registered residence, grade and major. Therefore, the behavior of female college students in western Yunnan is both comprehensive and multifactorial. However, low age, a rural residence, a low grade, a non-medical major, and a reluctance to talk about breast cancer and self-examination are identified as key factors, particularly self-examination. Overall, 13.2% of our respondents knew more about breast self-examination; this was greater than the proportion reported by Wang et al[15] (12%) but less than that reported by Jiang et al[9] (41.10%). Analysis further showed that 14.8% of our respondents had examined their breasts; this was less than the proportion reported by Jiang et al[9] Moreover, 5.0% of respondents knew the best time for breast self-examination; this was less than the proportion reported previously by Lei et al[19] (6.7%). We also found that 29.7% of respondents were unwilling to communicate with friends or family about breast-related problems.

It is evident, therefore, that female college students in western Yunnan were seriously lacking in the knowledge and skills required for breast examination. It is suggested that publicity should be strengthened through audio-visual media, classroom education, practical training, and other methods. These students should also be encouraged to overcome their shyness and carry out early self-examination.

Over recent years, breast cancer has become a very common form of tumor. Differences in culture, lifestyle, and social demography, are known to affect the biological expression of breast cancer, thus leading to different incidences and mortality rates. The responses to our questionnaire demonstrated that female college students in western Yunnan have low awareness of breast cancer, cognitive deficiencies and imbalances, and a low rate of breast self-examination. To improve the physical qualities of our female population of students, it is vital that we improve breast cancer knowledge on university campuses and develop more ways to improve the understanding of breast cancer among young female college students; this will reduce incidence rates in the younger population. It is also important that we use plain language and concise words to carry out health education strategies for female college students relating to breast cancer, symptoms, therapeutic methods, and how to prevent this condition.

Familial cases of breast cancer can result in changes in the KAP values of women from affected families when compared to unaffected families; this was not considered in the present study.

CONCLUSION

In conclusion, there is an urgently needs to provide standardized publicity and educational strategies in order to improve the knowledge levels of breast cancer of college students so as to reduce the incidence of breast cancer.

ARTICLE HIGHLIGHTS
Research background

Morbidity of breast cancer become younger, many female college students have insufficient awareness of breast health care and breast cancer.

Research motivation

It’s not reported that knowledge of breast cancer and health care of female college students in western Yunnan.

Research objectives

We want to know about knowledge of breast cancer in female college students and take some measures.

Research methods

We designed the questionnaire and totally 1387 questionnaires were sent out.

Research results

Influence factor of breast cancer knowledge is grade, influence factors of breast cancer attitude are registered residence and grade, influence factors of breast cancer practice are registered residence, grade and major.

Research conclusions

The knowledge, attitude, and practice level of female college students in western Yunnan were low, health education and self-examination of breast cancer is necessary.

Research perspectives

Using specific questionnaires, we identified a low awareness for breast cancer in female college students in west Yunnan, along with cognitive loopholes and imbalance in different ages and different grades.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Medicine, research and experimental

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C, C, C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Al-Afandi N, Liehr T S-Editor: Wang JJ L-Editor: A P-Editor: Wang JJ

References
1.  Department E. The latest data of Chinese cancer in 2017. Chinese Journal of Clinical Oncology and Rehabilitation. 2017;24 (6):760.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Fang Q, Du YP, Gao Q, Wang ZN, Huang XH. Status and influencing factors of knowledge, attitude and practice of female breast cancer screening in Hangzhou. Chinese Journal of preventive medicine. 2017;18 (03):214-218.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Zhou CL, Qu JX, Li XJ, Wu YN, Ji X, Liu Y. Status quo and influencing factors of breast cancer prevention knowledge and behavior among female college students. China health education. 2017;33 (05):461-465.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Liu DQ, Zhang SH, Mei WM, Yang Z, Fang HK. Investigation on knowledge, attitude and behavior of breast cancer among female college students in Bengbu. Journal of Bengbu Medical College. 2019;44 (01):130-134.  [PubMed]  [DOI]  [Cited in This Article: ]
5.  Chang H, Li JB, Chen YL, Chen XL, Chen YM, Zou XN. Investigation and analysis of health education spreading knowledge about prevention and treatment of breast cancer and cervical cancer. Chinese medicine. 2019;14 (07):1029-1032.  [PubMed]  [DOI]  [Cited in This Article: ]
6.  Ruggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, Giordano M, Gianni L, Rabaglio M, Freschi A, Cretella E, Clerico M, Farolfi A, Simoncini E, Ciccarese M, Rauch D, Ramello M, Glaus A, Berardi R, Pellanda AF, Ribi K, Gelber S, Partridge AH, Goldhirsch A, Pagani O. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers. Breast. 2019;47:85-92.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 30]  [Article Influence: 11.0]  [Reference Citation Analysis (0)]
7.  Schaffar R, Bouchardy C, Chappuis PO, Bodmer A, Benhamou S, Rapiti E. A population-based cohort of young women diagnosed with breast cancer in Geneva, Switzerland. PLoS One. 2019;14:e0222136.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
8.  Wang JM, Wang J, Zhao HG, Liu TT, Wang FY. Reproductive Risk Factors Associated with Breast Cancer Molecular Subtypes among Young Women in Northern China. Biomed Res Int. 2020;2020:5931529.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
9.  Jiang L, He Y, Xue HL, Chen XL, Huang XH, Xia ZJ, Hu Y. Analysis on Influencing Factors of breast cancer health belief and prevention behavior among female college students in Hangzhou. School health of China. 2017;38 (09):1388-1390.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Zhou CL, Qu JX, Li XJ, Wu YN. Investigation on knowledge, attitude and practice of breast cancer prevention and treatment among female medical and non-medical college students. China health management. 2018;35 (03):224-227.  [PubMed]  [DOI]  [Cited in This Article: ]
11.  Fazel A, Hasanpour-Heidari S, Salamat F, Rajaie S, Kazeminezhad V, Naeimi-Tabiei M, Jahangirrad A, Sedaghat S, Hosseinpoor R, Ghasemi-Kebria F, Roshandel G, Weiderpass E. Marked increase in breast cancer incidence in young women: A 10-year study from Northern Iran, 2004-2013. Cancer Epidemiol. 2019;62:101573.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
12.  Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol. 2009;36 (3):237-249.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 369]  [Cited by in F6Publishing: 327]  [Article Influence: 28.4]  [Reference Citation Analysis (0)]
13.  Rosenberg SM, Vaz-Luis I, Gong J, Rajagopal PS, Ruddy KJ, Tamimi RM, Schapira L, Come S, Borges V, de Moor JS, Partridge AH. Employment trends in young women following a breast cancer diagnosis. Breast Cancer Res Treat. 2019;177:207-214.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
14.  Wang TT, Yin LH, Ma GX. KAP status and influencing factors of breast cancer screening among women in Nanjing community. China public health. 2015;31 (05):655-659.  [PubMed]  [DOI]  [Cited in This Article: ]
15.  Wang QH  Research on cognition status of breast health care and effect evaluation of health education among female college students in a university in Jiangxi. Nanchang University 2018.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Zhu YR. Application value of ultrasound combined with mammography in early breast cancer screening. Henan Medical Research. 2019;28 (11):2051-2053.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Zhu LL. The value of microcalcification in mammography in the diagnosis of breast cancer. Chinese Medical Sciences. 2019;9 (17):145-148.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Guo MQ. Application of mammography combined with ultrasound in screening early breast cancer. Imaging research and medical application. 2020;4 (14):151-152.  [PubMed]  [DOI]  [Cited in This Article: ]
19.  Lei J, Zhang Y, Tian Y, Wang TT, Chen X, Zhou YH. Breast health awareness and breast self-examination of female college students in Suzhou Vocational College. Jiangsu preventive medicine. 2015;26 (01):35-36.  [PubMed]  [DOI]  [Cited in This Article: ]