{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:39:36Z","timestamp":1790033976623,"version":"4.0.1"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjonc"],"accepted":{"date-parts":[[2025,12,9]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Globally, breast cancer is the most common cancer among women. In 2022, it was estimated to have resulted in 670\u2009000 deaths and 2.3\u2009million new cases and represented 6.9% of all cancer-related deaths and 11.6% of the global cancer burden. In Middle East and North Africa (MENA) countries, screening and early detection continue to lag despite global initiatives like the WHO\u2019s Global Breast Cancer Initiative that has pledged to reduce mortality by 2.5% annually. Despite it being a low-cost and easy-to-access screening method, breast self-examination (BSE) is far from prevalent across the region. The objective of this research is to investigate awareness about breast cancer and the practice of BSE among women in MENA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method and analysis<\/jats:title>\n                    <jats:p>An observational cross-sectional study was conducted across multiple MENA countries from March to August 2024. Convenience sampling was employed, and participants completed an online, self-administered questionnaire in Arabic or English. All analyses were conducted using R V.4.4.1. Descriptive statistics were used to summarise participant characteristics, and multivariable logistic regression models were fitted to identify factors associated with breast cancer awareness and BSE awareness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 5435\u2009women participated in this study. Overall, most participants demonstrated poor awareness of breast cancer (60.8%), and BSE awareness was similarly suboptimal (56.95% poor). In this adjusted model, higher awareness clustered among women with mid-life age, higher education, high income and greater personal\/clinical exposure (benign injury, knowing someone affected), and among those informed by healthcare professionals. Lower awareness was linked to suburban residence, married\/divorced status and reliance on mass-media channels. These patterns suggest prioritising outreach to suburban communities and women with lower educational attainment or non-clinical information sources, while integrating health-professional-led education into public campaigns.<\/jats:p>\n                    <jats:p>Good BSE awareness concentrates among the youngest women and those using broadcast\/social media and is lower with older age, average\/high income, manual work, prior benign injury and personal acquaintance with a case; residence shows no significant association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall awareness was suboptimal, with most participants below the \u2018good\u2019 threshold. Drivers of awareness differed between general breast cancer knowledge and BSE, highlighting the need for age-tailored and education-tailored, channel-specific interventions codelivered with healthcare professionals and reinforced through targeted digital outreach. Given the cross-sectional design, these associations are non-causal and warrant confirmation in longitudinal studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjonc-2025-000869","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T09:55:22Z","timestamp":1766656522000},"page":"e000869","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Breast cancer awareness and breast self-examination among females in the Middle East and North Africa: a multinational cross-sectional study"],"prefix":"10.1136","volume":"4","author":[{"given":"Israa Ahmed","family":"Qutob","sequence":"first","affiliation":[{"name":"Alexandria University Faculty of Medicine, Alexandria, Alexandria Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa","family":"Soliman","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Zagazig university, Sharqia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda","family":"Aufy","sequence":"additional","affiliation":[{"name":"Children\u2019s cancer hospital-CCHE-57357, Cario, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Salah","family":"Elgahamy","sequence":"additional","affiliation":[{"name":"Faculty of Science, Al-Azhar University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayhana","family":"Trabelsi","sequence":"additional","affiliation":[{"name":"National Fund of Social Insurance of Salaried Employees, Touggourt, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah Tarek","family":"Shaalan","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Baheya Foundation for Early Detection & Treatment of Breast Cancer, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-430X","authenticated-orcid":false,"given":"Majid","family":"Omari","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology and Research in Health Sciences, Sidi Mohamed Ben Abdellah University Faculty of Medicine and Pharmacy, Fes, Morocco"},{"name":"National School of Public Health (ENSP), Ministry of Health and Social Protection, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Shehab","sequence":"additional","affiliation":[{"name":"Salmaniya Medical Complex, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullrahman","family":"Elgarawany","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Galala University, Galala, Suez, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Abdelaziz","family":"Eldaly","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally Muhamed","family":"Seliem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rola Nail","family":"Marie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baraa M","family":"Ayesh","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Al-Quds university, Jerusalem, Palestine, State of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel Khaled","family":"Albaoni","sequence":"additional","affiliation":[{"name":"Faculty of pharmacy, Jordan University of Science and technology, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed I S","family":"Alnatsha","sequence":"additional","affiliation":[{"name":"College of Medicine, Hebron University, Hebron, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiela Ennaji","family":"Almansouri","sequence":"additional","affiliation":[{"name":"Department of Genetic Engineering, Libyan Biotechnology Research Center, Tripoli, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima Adel","family":"Abdulla","sequence":"additional","affiliation":[{"name":"Salmaniya Medical Complex, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abrar","family":"Kadhem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Alhoori","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenan","family":"Shabani","sequence":"additional","affiliation":[{"name":"Salmaniya Medical Complex, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Matrook","sequence":"additional","affiliation":[{"name":"Salmaniya Medical Complex, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Fuad","sequence":"additional","affiliation":[{"name":"Paediatrics department, Tawam hospital, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumia","family":"Cheriet","sequence":"additional","affiliation":[{"name":"university hospital center, Mostaganem, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya Ahmed","family":"Abdou","sequence":"additional","affiliation":[{"name":"Children\u2019s cancer hospital-CCHE-57357, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esraa","family":"Awad","sequence":"additional","affiliation":[{"name":"Internal medicine department, Zagazig University, Sharqia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha Osman","family":"Frere","sequence":"additional","affiliation":[{"name":"Family Medicine Department, Zagazig university, Sharqia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2025122501550898000_4.1.e000869.1","doi-asserted-by":"publisher","DOI":"10.1002\/cac2.12207"},{"key":"2025122501550898000_4.1.e000869.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03502-3"},{"key":"2025122501550898000_4.1.e000869.3","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1002\/ijc.35325","article-title":"Current and future burden of female breast cancer in the Middle East and North Africa region using 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Cultural barriers to breast cancer screening in arab women. In: Laher I , ed. Handbook of Healthcare in the Arab World. Cham: Springer International Publishing, 2021: 177\u2013205. Available: https:\/\/link.springer.com\/10.1007\/978-3-030-36811-1_160","DOI":"10.1007\/978-3-030-36811-1_160"},{"key":"2025122501550898000_4.1.e000869.8","doi-asserted-by":"crossref","DOI":"10.1016\/j.apjon.2023.100293","article-title":"The stigma in patients with breast cancer: A concept analysis","volume":"10","author":"Wu","year":"2023","journal-title":"Asia Pac J Oncol Nurs"},{"key":"2025122501550898000_4.1.e000869.9","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4103\/nmj.NMJ_84_19","article-title":"Awareness and practice of breast self examination among women in different African countries: A 10-year review of literature","volume":"60","author":"Johnson","year":"2019","journal-title":"Niger Med J"},{"key":"2025122501550898000_4.1.e000869.10","unstructured":"Pippin MM , Boyd R . Breast self-examination. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK565846\/"},{"key":"2025122501550898000_4.1.e000869.11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/MS9.0000000000000211","article-title":"Validation of cost-effective model for breast self-examination","volume":"85","author":"Idrees","year":"2023","journal-title":"Annals of Medicine & Surgery"},{"key":"2025122501550898000_4.1.e000869.12","doi-asserted-by":"crossref","first-page":"132","DOI":"10.21608\/msnj.2021.107542.1014","article-title":"Effect Of Breast Self Examination Programme On Women\u2019s Awareness For Early Detection Of Breast Cancer","volume":"010","author":"Abd-Elaziz","year":"2021","journal-title":"Minia Scientific Nursing Journal"},{"key":"2025122501550898000_4.1.e000869.13","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2025.e42167","article-title":"Exploring barriers to early breast examination and screening among Arab women in the MENA region: A KAP study","volume":"11","author":"Qtaishat","year":"2025","journal-title":"Heliyon"},{"key":"2025122501550898000_4.1.e000869.14","unstructured":"World Bank . 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Around Breast Cancer and Mammography Screening Among Jordanian Women","volume":"12","author":"Al-Mousa","year":"2020","journal-title":"Breast Cancer Dove Med Press"},{"key":"2025122501550898000_4.1.e000869.22","doi-asserted-by":"crossref","first-page":"385","DOI":"10.3390\/epidemiologia5030028","article-title":"Awareness about breast cancer and breast self-examination among undergraduate female students at the University of Agadir, Morocco: a cross-sectional descriptive study","volume":"5","author":"Ben El-Fakir","year":"2024","journal-title":"Epidemiologia (Basel)"},{"key":"2025122501550898000_4.1.e000869.23","doi-asserted-by":"crossref","first-page":"8843","DOI":"10.1007\/s00432-023-04786-z","article-title":"Breast cancer knowledge and practices amongst women in Algeria","volume":"149","author":"Lounis","year":"2023","journal-title":"J Cancer Res Clin 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