In our study, the knowledge level of female students studying at a pharmacy faculty in Turkey about breast cancer risk factors and symptoms was evaluated. There were limited studies on this subject among pharmacy students [14, 27]. According to our study, students’ knowledge of breast cancer risk factors was poor, but their knowledge of breast cancer symptoms was acceptable.
Similar to our study, in most of the studies conducted, students had poor and limited knowledge about breast cancer [25, 28,29,30]. It is very important to know the risk factors in the early diagnosis and prevention of breast cancer [31]. Having a history of breast cancer in a first-degree relative is an important risk factor for breast cancer [32]. In a study conducted in Ethiopia [29], 75.3% of students, in a study conducted in Syria [11], 92.4% of students, in a study conducted in Egypt [33], 57% of medical students and 31.5% of non-medical students knew that having a family history of breast cancer was a risk factor. In our study, the correct response rate (62%) was close to the previous studies.
In our study, very few students knew breast cancer risk factors such as menstruation before the age of 12, late menopause, and giving birth for the first time after the age of 30 (19.8%, 26.2%, 21.1% respectively). While the rates of correct answers to these questions were higher in studies conducted in Jordan and Ethiopia [28, 29], the studies conducted in Egypt and Pakistan [25, 33] were similar to our study. In a study conducted among medical faculty students in Pakistan [13], having children at an older age or not having children at all was known as a breast cancer risk factor in 28.9% of preclinical students and 48.6% of clinical students. Early menarche and late menopause were known as breast cancer risk factors by 14.8% and 23.4% of preclinical students and 20.3% and 29.7% of clinical students, respectively. In a study conducted in Egypt [33], medical students and non-medical students knew early menarche and late menopause as breast cancer risk factors at a rate of 34.2% and 21%, respectively. In a study conducted in the Midwestern USA [17], using oral contraceptives, and taking hormone replacement therapy were known as breast cancer risk factors by 14%, and 27% of the students, respectively. In a study conducted on medical faculty students in Turkey [21], the questions of early menarche, late menopause, and family history were answered correctly by 48.7%, 53.5% and 87.9% of the students, respectively. In general, regardless of the country where the research was conducted, medical school students were more likely to know breast cancer risk factors than other university students. The results of our study were similar to studies conducted with university students in other countries.
Modifiable lifestyle risk factors are important to reduce and prevent breast cancer risks [8]. In our study, students knew about lifestyle factors (such as low physical activity, obesity, smoking and alcohol use, and stress) at a higher rate than other risk factors. This may be because students in our study were generally aware of the importance of lifestyle changes that are effective in preventing many chronic diseases [34]. In other studies, lifestyle risk factors were less known as breast cancer risk factors compared to our study [13, 25, 35, 36].
In our study and other studies, students’ knowledge of breast cancer symptoms was higher than the risk of breast cancer [11, 13, 37]. This may be because breast cancer symptoms are seen more frequently on social media [38], or because students expect breast-related changes in breast cancer to occur, so the rate of correct answers may have increased.
In our study, students learned about breast cancer mostly from social media (29.5%) and medical websites (27%). The rate of learning from pharmacists was quite low (5.9%). Pharmacists have an important role in patient counseling and increasing patient awareness about breast cancer. Pharmacists can educate patients about BSE, CBE, mammograms and provide lifestyle advice, and produce educational brochures about breast cancer risk factors and symptoms.They can also inform patients about the side effects of the anticancer drugs they use and possible drug-drug interactions with other medications [23, 39]. In this context, pharmacists need to update their knowledge through in-service training and take a more active role in patient counseling. In studies conducted in various countries, students’ sources of information varied, but social media was more prevalent. In a study in Saudi Arabia [40], students’ sources of information were awareness campaigns (54.1%), internet (38.6%) and television (38.6%). In a study conducted in Egypt [33], social media was the source of information for most students (42.9%). Unlike the study conducted on medical faculty students in Turkey and Syria [11, 21], the students’ source of information was courses (39.2% and 70.4%, respectively). This may be because more emphasis is given to courses related to cancer awareness in medical school or that students are less interested in social media because they have very busy course schedules.
In some studies, it was found that the academic year affected the level of breast cancer knowledge (p < 0.05) [25, 29]. In the study of Ismail et al. [11], it was found that grade point average, maternal education level, smoking, and alcohol use affected the level of breast cancer knowledge (p < 0.05). In our study, no statistical significance was found in any of the variables related to breast cancer risk factors and symptoms (p > 0.05). The reason why there is no significant difference between the academic year and breast cancer knowledge level may be that breast cancer is not mentioned in any of the courses at the faculty. To eliminate educational gaps, it is necessary to include courses on breast cancer awareness in the faculty. It is also clear that different educational interventions such as social media, television, and brochure distribution are needed.
Strengths and limitations of the study
To the best of our knowledge, this is the first study investigating the breast cancer knowledge level of pharmacy students in Turkey. Additionally, the rate of students who were interested in the research was not bad (74.5%).
One of the limitations of our study was that it could not be generalized nationally because it was conducted in a single faculty.
Recommendations
We recommend conducting multicenter, large-scale studies. Additionally, studies can be conducted in the future to investigate the effects of various educational interventions on students’ knowledge levels and to compare the effects of educational interventions. For this purpose, controlled studies or pre-post intervention studies can be conducted. It would also be useful to investigate the long-term effects of these educational interventions.
