Introduction

Breast cancer is one of the most prevalent malignancies affecting women globally and remains a leading
cause of cancer-related morbidity and mortality. While it is often perceived as a disease of older women,
there is growing evidence that breast cancer also significantly impacts younger women aged 20 to 40
years. This age group represents a unique population with distinct challenges in diagnosis, management,
and survivorship. Understanding the epidemiology, risk factors, awareness levels, attitudes, and early
detection practices in this demographic is essential for tailoring effective prevention and treatment
strategies.

Breast cancer is the most commonly diagnosed cancer among women worldwide, accounting for 11.7%
of all cancer cases and 6.9% of cancer deaths globally in 2020 (Sung et al., 2021). While its incidence is
higher among postmenopausal women, approximately 7% of breast cancer cases occur in women
younger than 40 years (Anders et al., 2008). In low- and middle-income countries (LMICs), the
proportion of younger women diagnosed with breast cancer is higher, often due to the younger
demographic structure and limitations in early detection programs (Bray et al., 2018).

Breast cancer in younger women is frequently associated with more aggressive tumor biology, higher-
grade tumors, and poorer prognostic outcomes compared to older women (Azim et al., 2012).
Additionally, younger women often present with advanced stages of the disease due to delays in
diagnosis, underscoring the need for improved awareness and early detection measures in this
population.

Several risk factors contribute to the development of breast cancer in younger women, many of which
differ from those in older women. Key factors include genetic predisposition, family history of breast or
ovarian cancer, and specific gene mutations such as BRCA1 and BRCA2 (Metcalfe & Lynch, 2020).
Hormonal factors, such as early menarche, nulliparity, and oral contraceptive use, have also been
associated with an increased risk of breast cancer in this age group (Collaborative Group on Hormonal
Factors in Breast Cancer, 2019).

Lifestyle factors, including smoking, alcohol consumption, obesity, and physical inactivity, further
compound the risk. Environmental exposures, particularly during critical periods of breast development,
may also play a role in carcinogenesis among younger women (Hiatt et al., 2014)

Awareness and knowledge about breast cancer among women aged 20 to 40 years are often limited,
particularly in LMICs. Misconceptions about the risk of breast cancer in younger women lead to delays in
seeking medical attention. A study conducted in sub-Saharan Africa revealed that only 30% of women in
this age group were aware of the importance of early detection, and fewer than 15% performed regular
breast self-examinations (Okobia et al., 2006).

Even in high-income countries, young women often underestimate their vulnerability to breast cancer.
Campaigns and screening guidelines typically target older women, inadvertently excluding younger
populations and perpetuating gaps in awareness (Siegel et al., 2022).
The attitudes of young women toward breast cancer screening are influenced by cultural, social, and
economic factors. Fear of a cancer diagnosis, stigma, and lack of trust in healthcare systems are common
barriers. Economic challenges, including the high cost of diagnostic procedures, further limit access to
screening services. For instance, mammography, the gold standard for breast cancer screening, is often
not recommended for women under 40 unless they are at high risk, leaving breast self-examinations
(BSE) and clinical breast examinations (CBE) as the primary early detection methods (American Cancer
Society, 2023).

Studies have shown that the adoption of early detection practices is suboptimal among young women.
The prevalence of BSE, for instance, is as low as 10% in certain regions, reflecting inadequate education
and training on this simple yet effective practice (Ravichandran et al., 2010). Similarly, access to CBE and
diagnostic imaging remains limited in LMICs, further reducing the likelihood of early diagnosis.

Healthcare providers play a pivotal role in influencing these practices. However, research highlights a
lack of targeted communication between healthcare providers and younger women, contributing to the
low uptake of early detection measures (Kohler et al., 2017).

Early detection of breast cancer dramatically improves survival outcomes. While breast cancer in young
women tends to be more aggressive, timely diagnosis can enable access to more effective treatments,
including surgery, chemotherapy, radiation, and targeted therapies (Paluch-Shimon et al., 2020). For
younger women, early detection is particularly important as it preserves fertility options, improves
quality of life, and minimizes the long-term psychosocial impact of the disease.

Given the unique challenges faced by women aged 20 to 40 years, there is a pressing need for targeted
interventions to address gaps in knowledge, attitudes, awareness, and practices. Public health
campaigns should emphasize the importance of breast health among younger women and dispel myths
about their risk. Healthcare systems should prioritize accessible and affordable early detection services,
particularly in resource-limited settings. Finally, research focusing on the specific needs of this age group
is crucial to developing evidence-based policies and programs.

1. Problem Statement

Breast cancer remains a significant global health challenge, with a high prevalence and mortality rate
among women. While traditionally associated with older age groups, recent studies highlight its growing
incidence among younger women aged 20–40 years, who often present with more aggressive forms of
the disease (Azim et al., 2022). Early detection is critical to improving prognosis and survival rates.
However, awareness and practices related to early detection, such as breast self-examination (BSE),
clinical breast examination (CBE), and timely medical consultation, remain suboptimal in this
demographic, particularly in low- and middle-income countries (WHO, 2023).

Women in this age group face unique barriers to early detection. These include limited knowledge about
breast cancer risk factors, misconceptions about susceptibility, lack of awareness regarding early
symptoms, and cultural or socioeconomic barriers that deter proactive health-seeking behaviors (Bray et
al., 2021). Furthermore, healthcare systems in many regions fail to target young women adequately in
breast cancer awareness and screening programs, leaving a significant gap in early detection efforts
(Siegel et al., 2023).

Understanding the prevalence of breast cancer, as well as the knowledge, attitudes, awareness, and
practices surrounding its early detection among women aged 20–40 years, is essential. Addressing these
gaps will contribute to the development of tailored interventions that improve early diagnosis and
reduce the burden of the disease in this critical age group.

2. Purpose of the Study

The purpose of this study is to explore the prevalence of breast cancer and evaluate the knowledge,
attitudes, awareness, and practices regarding its early detection among women aged 20–40 years. The
study aims to identify gaps and barriers in early detection efforts and provide evidence-based
recommendations for improving breast cancer awareness and early screening in this demographic.

3. Research Question

What are the prevalence, knowledge, attitudes, awareness levels, and practices regarding early
detection of breast cancer among women aged 20–40 years?

4. Hypothesis

1. Primary Hypothesis: Women aged 20–40 years have limited knowledge and awareness about breast
cancer and its early detection methods, which contributes to suboptimal practices.

2. Secondary Hypothesis: Sociocultural and economic barriers significantly influence attitudes and
behaviors toward early breast cancer detection in this demographic.

5. Objectives

General Objective

To assess the prevalence, knowledge, attitudes, awareness, and practices regarding early detection of
breast cancer among women aged 20–40 years.

Specific Objectives

1. To determine the prevalence of breast cancer among women aged 20–40 years in the study
population.

2. To evaluate the level of knowledge regarding breast cancer risk factors, symptoms, and early
detection methods.
3. To analyze the attitudes and perceptions of women aged 20–40 years toward breast cancer screening
and early diagnosis.

4. To assess the awareness of breast cancer campaigns and their impact on early detection practices.

5. To identify the key barriers that hinder women aged 20–40 years from engaging in early detection
practices such as BSE, CBE, and mammography.

6. Definition of Key Concepts

1. Breast Cancer: A malignant tumor that develops from the cells of the breast. It is the most common
cancer among women worldwide and can occur at any age, with a growing incidence in women aged
20–40 years (Sung et al., 2021).

2. Early Detection: The process of identifying breast cancer at an early stage when treatment is most
effective. Methods include BSE, CBE, and mammography (American Cancer Society, 2023).

3. Knowledge: The level of understanding women have about breast cancer risk factors, symptoms, and
early detection practices.

4. Attitude: The perceptions, beliefs, and emotional responses of women regarding breast cancer and its
early detection methods.

5. Awareness: The extent to which women are informed about breast cancer campaigns, early detection
methods, and available resources.

6. Practices: The actual behaviors or actions taken by women to detect breast cancer early, including
regular BSE, attendance at CBE, and undergoing mammography when indicated.

7. Prevalence: The proportion of cases of breast cancer within a specified population of women aged
20–40 years during a given time frame.

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