Exploring breast cancer stigma among medical students in Egypt: A national multi-center cross- sectional study

Exploring breast cancer stigma among medical students in Egypt: A national multi-center cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring breast cancer stigma among medical students in Egypt: A national multi-center cross- sectional study Mohamed Ahmed Zoromba, Hana Mohamed Deibes, Dareen H. Abdelhady, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6640623/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted 8 You are reading this latest preprint version Abstract Background: Breast cancer (BC) stigma remains an understudied barrier to early detection and quality care, particularly in low- and middle-income countries (LMICs). Yet, there is a lack of studies that assessed BC stigma among medical students worldwide; a critical gap given their future roles as healthcare providers. This study aims to explore BC stigma among medical students in Egypt and identify its associated factors. Methods: A national multi-center cross-sectional study was conducted during the academic year 2024–2025, involving a convenience sample of 2,576 medical students from eight medical faculties across Egypt’s four main regions. Data were collected through an online questionnaire capturing socio-demographic characteristics, educational background, BC-related experiences, and knowledge of BC including students’ primary sources of information on the subject, alongside the BC-adapted Cancer Stigma Scale (CASS) that assessed six domains: Severity, Financial Discrimination, Personal Responsibility, Awkwardness, Avoidance, and Policy Opposition. Median (M) scores were computed, and non-parametric tests and multivariate linear regression were used to identify associated factors. Results: The overall BC stigma score was relatively low, with a median of 2.16 (36% of the total score). However, stigma was highest in Severity and Financial Discrimination (M = 3.0 and 2.67, respectively), and lowest in Avoidance and Policy Opposition (M = 1.00 and 1.33, respectively). Significantly higher stigma scores were observed in males (M = 2.20), those living in Upper Egypt governorates and rural residents (M = 2.30 and 2.24; respectively), and those with less-than-sufficient family income (M = 2.30). The regression analysis revealed significant associations between stigma and various sociodemographic variables, including sex, age, educational year, residence, and family income (p-values < 0.001), and BC-related questions such as history of breast problems and sufficient awareness about BC (both p < 0.001). The primary sources of information about BC for medical students were found to be medical curricula (24.2%), internet/social media (20.0%), and healthcare professionals (16.3%). Conclusion: This study provides an insight into exploring BC stigma among medical students. While the overall stigma was relatively low, significant disparities persist, particularly regarding perceived Severity among male and rural participants. Future interventions should target students with high levels of stigma through curricular reforms that incorporate anti-stigma training. Trial Registration Not applicable. Breast cancer stigma Medical students Egypt Cancer stigma scale Low- and middle-income countries Figures Figure 1 Introduction Globally, breast cancer (BC) is the second most diagnosed cancer and the leading cause of cancer-related deaths in women [ 1 ]. In Egypt, according to the latest Global Cancer Observatory (GLOBOCAN) report (2022), BC is the most common cancer among females, accounting for 34.9% of all cancer cases [ 2 ]. BC can be successfully treated if diagnosed early. However, this is not often the case in Egypt, where most cases present as either locally advanced or metastatic [ 3 ]. This reflects a broader pattern, common in low- and middle-income countries (LMICs), where limited healthcare resources and a predominant focus on curative rather than preventive care impede timely detection [ 4 ]. To reduce BC’s rising mortality, the Egyptian government launched Egypt's first national screening program, "Women Health Outreach Program" (WHOP) in 2007, and “Egyptian Women’s Health Initiative" (EWHI) in 2019 [ 5 , 6 ]. Despite these efforts, women continue to face significant barriers in utilizing these initiatives, undermining their full potential. Reducing the number of late-stage BC cases in Egypt remains a critical public health priority, one that requires an in-depth understanding of the factors contributing to these delayed presentations. Existing research classifies these factors into three main categories: personal, economic, and healthcare system-related barriers. They include: a general tendency to delay health consultation (often due to financial constraints or fear of diagnosis), limited access to healthcare, lack of awareness, and – notably in Arab communities like Egypt – disease-related stigma [ 7 – 9 ]. Among these barriers, disease-related stigma stands out. Goffman, a foundational theorist in this area, first defined stigma as an attribute that associates a person with an unfavorable stereotype [ 10 ]. He claimed that in the eyes of others, the stigmatized individual is reduced from a whole and normal person to one who is shamed or disregarded [ 10 ]. "Disease-related stigma" is a term that refers to individuals facing discrimination, isolation, rejection, and/or criticism simply due to having suffered from a certain health condition [ 11 ]. Cancer-related stigma, in particular, exists due to a combination of certain myths, lack of understanding, and sociocultural beliefs, especially pronounced in Arab societies [ 9 ]. Among BC patients, stigma often arises from widespread misconceptions, such as fears that the disease is contagious or beliefs that it is a divine punishment from God for past sins. These perceptions can lead others to distance themselves from those with BC, prompting many women to blame themselves for their illness and conceal their symptoms to escape potential social isolation by others [ 9 ]. Such predicaments can dissuade women from seeking medical assistance, thereby delaying their diagnosis and treatment, and reducing their chances of survival [ 12 ]. On top of that, at a time when they are at their most vulnerable, patients still face stigma even in healthcare facilities [ 13 – 15 ]. They can be subjected to outright refusal of care, inadequate treatment, long waiting hours, verbal and physical abuse, or having their care assigned to less experienced personnel [ 15 ]. Patients place significant trust in healthcare providers and often rely on doctors to guide them through the proper clinical process, so much so that, in cases of BC, some may forgo screening unless explicitly advised by a doctor [ 7 ]. This highlights the critical role healthcare staff play in encouraging positive health-seeking behaviors and countering harmful attitudes. Therefore, not only is it essential that physicians convey accurate facts to both the public and patients, but also being more empathetic and impartial themselves can help shape an ideal patient experience, and encourage compliance, improving both the physical and mental health of patients [ 16 , 17 ]. Addressing stigma towards BC patients early, particularly during medical school, is critical, as future doctors’ perceptions will directly influence patient care. While numerous studies assessed medical and non-medical students' knowledge, awareness, and attitudes toward BC, both internationally and in Egypt [ 18 – 20 ], those examining attitudes mostly focused on students’ perception of BC screening effectiveness and their willingness to undergo testing. However, no studies specifically investigated medical students’ stigma towards BC patients, leaving a critical gap that hinders the development of effective educational interventions to improve patients’ outcomes. This study aims to explore the key dimensions of BC–related stigma among medical students in Egypt and identify its associated factors, to inform future curriculum reforms and public health strategies to reduce stigma and improve outcomes in Egypt and beyond. Methodology Study Design and Setting A national multi-center cross-sectional study with analytical and correlational components was conducted from January 2025 to May 2025. This study took place at the medical faculties of public universities across Egypt's four main geographical regions: Urban region (Alexandria University and Ain Shams University), Upper Egypt (Minia University and Fayoum University), Lower Egypt (Mansoura University and Zagazig University), and the Frontier region (Arish University and New Valley University). Public universities were selected to ensure representation of Egypt’s cultural diversity and to include a broader student demographic, while also accounting for the availability of local data collaborators. Study Population and Sampling Technique This study targeted undergraduate medical students from the first to the fifth year and interns from the universities mentioned above. Participants not affiliated with the target universities or who did not provide consent to complete the questionnaire were excluded. Participants were proportionally allocated across each region based on the number of registered students in the medical faculties of the public universities. Convenience sampling was used due to logistical constraints, particularly the inability to contact all medical students for random sampling. To reduce the potential bias, we ensured geographical diversity and proportional representation across regions and educational years. Sample Size Calculation A pilot study was conducted on 31 students from different educational years. It revealed that the mean score of the Cancer Stigma Scale (CASS) was 1.74 ± 0.75 Standard deviation (SD). Using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium), a minimum required sample size of 2188 medical students was calculated at a 95% confidence level, a 5% margin of error, and a design effect of four to compensate for the convenience sampling. However, 2,576 medical students completed the questionnaire and were included in the analysis. Study Tool The English questionnaire consisted of two sections. The first included socio-demographic, educational data, and knowledge-related questions, including age, gender, university, educational year, residence, family income, the student’s personal experience with BC (including their personal and family history of BC), whether they encountered someone with BC, the main sources from which they obtained information about BC—using a multiple-response checkbox (which allow participants to select more than one option), whether they studied BC in their curriculum, and whether they believe there is sufficient awareness about BC in their community. The second section included the adapted CASS, which was developed and validated by Marlow et al. in 2014 for the non-cancer patient population [ 21 ]. The CASS consists of 25 items measuring six stigma domains: 1- Severity (perceptions of cancer's impact), 2- Financial Discrimination (support for restricting patients' rights), 3- Personal Responsibility (blame attribution), 4- Awkwardness (discomfort interacting with patients), 5- Avoidance (distancing behaviors), and 6- Policy Opposition (resistance to support systems). Responses were rated using a six-point Likert scale (1 = strongly disagree, 6 = strongly agree) and reverse-scored for 5 items, so all scores were from 1 to 6; higher scores indicated higher levels of stigma. We calculated mean scores of each domain (sum of the domain items' scores divided by their number), and a total mean score for all items of the CASS. After a public health expert reviewed the questionnaire, a pilot study was conducted at Mansoura University on 31 students to ensure content validity, clarity, and completion time. The reliability of the CASS was assessed using Cronbach’s alpha test, which measures the internal consistency of the items. The CASS score showed good internal validity (Cronbach’s alpha = 0.94), and its domain values ranged from 0.72 to 0.97. To adapt the CASS for BC stigma, the word “cancer” was replaced by “breast cancer” in each item, and the “not sure” option was removed, following a previous adaptation [ 22 ]. The pilot data were excluded from the analysis. Data Collection Data were collected using a Google Forms questionnaire. Collaborators distributed the questionnaire via the students’ social media groups (e.g., Facebook, WhatsApp, and Telegram groups) across the selected universities. The form included the study’s goals and objectives, anonymity assurance, and informed consent. To avoid duplicate responses, Google Forms settings were adjusted to accept one response per email (without collecting emails to ensure anonymity). Participants who did not provide consent were excluded. Statistical Analysis The data were analyzed using IBM Statistical Package for Social Science (SPSS) software version 29 (IBM Corp., Armonk, NY, USA). Categorical variables were summarized as frequencies and percentages (%). Continuous variables (CASS scores) were tested for normality and found to be non-parametric in distribution. Therefore, they were summarized by median (min-max). Inferential tests: Mann-Whitney U test and Kruskal-Wallis test were used to compare group medians. Following a significant result from the Kruskal-Wallis test, Dunn’s pairwise comparison was used to adjust for multiple comparisons. Spearman’s correlation coefficient (r) was used to assess bivariate correlations. Multiple linear regression analysis was performed to identify factors associated with BC stigma scores. Before correlation and regression analysis, the CASS score was log-transformed to meet the normality assumption required for linear regression results. A p-value of ≤ 0.05 was considered statistically significant. Results Descriptive statistics of the 25-item CASS The total score was relatively low (with a mean of 2.37 ± 0.83) and a median = 2.16 (36% of the total possible score of 6), with notable variation observed across different stigma domains. Stigma was highest in Severity (M = 3.00) and Financial Discrimination (M = 2.67) domains. Specifically, 58.8% agreed that cancer devastates the lives of those it touches, and 49.1% supported policy reconsideration for patients. In contrast, the Avoidance domain (M = 1.00) was the lowest, with only 14.3% of participants indicating they would avoid a person with cancer. Similarly, the Policy Opposition statements received endorsement by only 2.8–5% of the participants (M = 1.33) (Table 1 ). Table 1 Descriptive statistics of the 25 items of the Cancer Stigma Scale (CASS) and total score Agree 1 n(%) Disagree 2 n(%) Median (Min-Max) Awkwardness 2.40 (1.00–6.00) ®I would feel at ease around someone with cancer 2183 (84.7%) 393 (15.3%) ®I would feel comfortable around someone with cancer 2179 (84.6%) 397 (15.4%) I would find it difficult being around someone with cancer 834 (32.4%) 1742 (67.6%) I would find it hard to talk to someone with cancer 677 (26.3%) 1899 (73.7%) I would feel embarrassed discussing cancer with someone who had it 1216 (47.2%) 1360 (52.8%) Severity 3.00 (1.0–6.00) Once you’ve had cancer, you can never be ‘normal’ again 945 (36.7%) 1631 (63.3%) Having cancer usually ruins a person’s career 1164 (45.2%) 1412 (54.8%) Getting cancer means having to mentally prepare oneself for death 720 (28.0%) 1856 (72.0%) Cancer usually ruins close personal relationships 1093 (42.4%) 1483 (57.6%) Cancer devastates the lives of those it touches 1514 (58.8%) 1062 (41.2%) Avoidance 1.00 (1.00–6.00) If a colleague had cancer, I would try to avoid them 392 (15.2%) 2184 (84.8%) I would distance myself physically from someone with cancer 424 (16.5%) 2152 (83.5%) I would feel irritated by someone with cancer 421 (16.3%) 2155 (83.7%) I would try to avoid a person with cancer 368 (14.3%) 2208 (85.7%) I would feel angered by someone with cancer 379 (14.7%) 2197 (85.3%) Policy Opposition 1.33 (1.00–6.00) ®More government funding should be spent on the care and treatment of those with cancer 2477 (96.2%) 99 (3.8%) ®The needs of people with cancer should be given top priority 2448 (95.0%) 128 (5.0%) ®We have a responsibility to provide the best possible care for people with cancer 2503 (97.2%) 73 (2.8%) Responsibility 2.50 (1.00–6.00) A person with cancer is liable for their condition 1465 (56.9%) 1111 (43.1%) A person with cancer is accountable for their condition 1087 (42.2%) 1489 (57.8%) If a person has cancer, it’s probably their fault 533 (20.7%) 2043 (79.3%) A person with cancer is to blame for their condition 479 (18.6%) 2097 (81.4%) Discrimination 2.67 (1.00–6.00) It is acceptable for banks to refuse to make loans to people with cancer 516 (20.0%) 2060 (80.0%) Banks should be allowed to refuse mortgage applications for cancer-related reasons 656 (25.5%) 1920 (74.5%) It is acceptable for insurance companies to reconsider a policy if someone has cancer 1264 (49.1%) 1312 (50.9%) Total CASS Score 2.16 (1.00-5.80) Note. 1 Agree included: slightly agree, moderately agree, and strongly agree. 2 Disagree included: slightly disagree, moderately disagree, and strongly disagree. ® Reversed items. Variation of CASS scores by Socio-Demographics Of the 2,576 participants, ages ranged from 17 to 31 years with a mean of 21.33 ± 2.18 SD. Female accounted for 56.5%, 53.5% were aged 21 or younger, and participants were distributed evenly across the educational years. Most resided in urban areas (73.6%), and 71.0% reported having sufficient financial income. Only 2.3% of the participants were from the Frontier governorates (Table 2 ). Table 2 Variation of total CASS score and its domains with socio-demographic characteristics of study participants (N = 2576) Characteristic Total n(%) Total CASS score median(min- max) Awkwardness median(min-max) Severity median(min-max) Avoidance median(min-max) Policy Opposition median(min-max) Responsibility median(min-max) Discrimination median(min- max) Sex Male 1456 (56.5%) 2.20 (1.00-4.94) 2.20 (1.00-5.60) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.67 (1.00–6.00) 2.50 (1.00–6.00) 2.33 (1.00–6.00) Female 1120 (43.5%) 2.12 (1.00-5.80) 2.40 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.67 (1.00–6.00) p-value x < 0.001 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.575 Age group 21 and younger 1379 (53.5%) 2.12 (1.00-5.16) 2.40 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) 22 and older 1197 (46.5%) 2.20 (1.00-5.80) 2.40 (1.00–6.00) 3.20 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) p-value x 0.001 0.155 < 0.001 0.163 0.553 0.019 0.751 Region Frontiers Governorates 60 (2.3%) 2.24 (1.20–4.48) 2.50 (1.00-4.60) 2.60 (1.00-5.20) 1.00 (1.00-5.20) 1.33 (1.00-4.33) 3.00 (1.00-5.50) 3.00 (1.00-5.67) Lower Egypt Governorates 821 (31.9%) 2.20 (1.00-5.08) a,b 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Upper Egypt Governorates 466 (18.1%) 2.30 (1.00-4.64) b,c 2.70 (1.00-5.20) 3.00 a (1.00-5.60) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.75 (1.00-5.50) 2.67 (1.00–6.00) Urban Governorates 1229 (47.7%) 2.08 (1.00-5.80) a,c 2.20 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.33 (1.00–6.00) p-value * < 0.001 < 0.001 0.110 0.001 < 0.001 < 0.001 < 0.001 Educational year 1st year 387 (15%) 2.16 (1.04–5.16) e,f 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) 2nd year 423 (16.4%) 2.12 (1.00-4.68) a 2.20 (1.00-5.60) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00-5.33) 2.25 (1.00–6.00) 2.67 (1.00–6.00) 3rd year 451 (17.5%) 2.12 (1.00-4.96) b 2.40 (1.00–6.00) 2.60 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) 4th year 456 (17.7%) 2.16 (1.08–5.80) c,g 2.20 (1.00–6.00) 3.20 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) 5th year 413 (16.0%) 2.28(1.08–4.80) a,b,d,f,g 2.60 (1.00-5.60) 3.20 (1.00-5.80) 1.00 (1.00-5.60) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Intern 446 (17.3%) 2.12 (1.00-4.92) c,d,e 2.40 (1.00-5.20) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00-5.67) 2.25 (1.00–6.00) 2.17 (1.00–6.00) p-value * < 0.001 0.182 < 0.001 0.005 0.053 < 0.001 < 0.001 Residence Rural 680 (26.4%) 2.24 (1.00-5.80) 2.60 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Urban 1896 (73.6%) 2.12 (1.00-5.16) 2.20 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) p-value x < 0.001 < 0.001 0.003 < 0.001 0.127 0.003 < 0.001 Family income Less than or barely sufficient 421 (16.3%) 2.28 (1.16–5.80) a,b 2.40 (1.00–6.00) 3.20 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.75 (1.00–6.00) 2.67 (1.00–6.00) Sufficient 1828 (71.0%) 2.16 (1.00-5.16) a,c 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) More than sufficient 327 (12.7%) 2.00 (1.00-4.68) b,c 2.20 (1.00-5.60) 2.60 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.00 (1.00-5.75) 2.33 (1.00–6.00) p-value * < 0.001 < 0.001 < 0.001 < 0.001 0.053 < 0.001 < 0.001 Note. *= p-value was calculated using KW test (Kruskal-Wallis H test ) , x = p-value was calculated using Mann-Whitney U test a,b,c,d,e,f,g = are significant (P-value < 0.05) between the corresponding groups using Dunn’s pairwise comparison by Post-Hoc analysis, significant p-values (< 0.05) are bold. Male students had significantly higher total stigma scores than females (2.20 vs. 2.12; p < 0.001), particularly in Severity, Policy Opposition, Personal Responsibility, and Avoidance (all p ≤ 0.001), despite identical median values in some cases. Conversely, females reported significantly higher Awkwardness (median = 2.40 vs. 2.20; p = 0.001). Students aged 22 or older had higher total stigma scores (2.20 vs. 2.12; p = 0.001), especially in the Severity domain (3.20 vs. 2.80; p < 0.001). Students from Upper Egypt exhibited the highest stigma score (2.30; p < 0.001), with significant differences across all domains. Fifth-year students exhibited higher stigma levels (2.28; p < 0.001), with notable variation in Severity, Avoidance, Personal Responsibility, and Financial Discrimination. Rural students also had higher stigma scores (2.24 vs 2.12; p < 0.001), particularly in Awkwardness, Severity, and Financial Discrimination (all p ≤ 0.003). Participants from families with less than sufficient income had the highest score (2.28; p < 0.001), especially in Severity and Personal Responsibility (both p < 0.001). Variation of CASS by Academic, Clinical History, and Knowledge-Related Variables In Table 3 , students with a personal history of breast problems reported higher stigma scores (2.40 vs. 2.16; p < 0.001 ) , significantly higher across all major domains, including Awkwardness, Severity, Avoidance, Personal Responsibility, and Financial Discrimination. Interestingly, those who believed there was sufficient community awareness about BC reported a higher total stigma score (2.28 vs. 2.12; p < 0.001). Significant differences were found in Awkwardness, Severity, Financial Discrimination, and Personal Responsibility (Table 3 ). Table 3 Variation of total CASS score and its domains with academic, clinical history, knowledge-related characteristics of study participants (N = 2576) Characteristic Total n (%) Total CASS score median (min – max ) Awkwardness median(min-max) Severity median(min-max) Avoidance median(min-max) Policy Opposition median(min-max) Responsibility median(min-max) Discrimination median(min- max) Contact with breast cancer patient No 1451 (56.3%) 2.16 (1.00-5.16) 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Yes 1125 (43.7%) 2.12 (1.00-5.80) 2.20 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.33 (1.00–6.00) p-value x 0.219 0.002 < 0.001 0.008 < 0.001 0.040 0.012 Breast cancer in close friends/family members No 1825 (70.8%) 2.16 (1.00-5.16) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Yes 751 (29.2%) 2.12 (1.04–5.80) 2.40 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.67 (1.00–6.00) p-value x 0.176 0.082 0.395 0.035 < 0.001 0.065 0.536 History of breast problems No 2374 (92.2%) 2.16 (1.00-5.16) 2.40 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Yes 202 (7.8%) 2.40 (1.00-5.80) 3.00 (1.00–6.00) 3.20 (1.00–6.00) 1.20 (1.00–6.00) 1.33 (1.00–6.00) 2.75 (1.00–6.00) 3.00 (1.00–6.00) p-value x < 0.001 < 0.001 < 0.001 < 0.001 0.831 0.011 < 0.001 Family history of breast cancer No 2205 (85.6%) 2.16 (1.00-5.16) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Yes 371 (14.4%) 2.12 (1.04–5.80) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.67 (1.00–6.00) p-value x 0.290 0.132 0.959 0.001 0.007 0.078 0.504 Studied breast cancer in your curriculum No 794 (30.8%) 2.12 (1.00-4.96) 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) Yes 1782 (69.2%) 2.16 (1.00-5.80) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) p-value x 0.473 0.831 0.444 0.050 0.690 0.268 0.720 Believe there is sufficient awareness about breast cancer in your community No 1842 (71.5%) 2.12 (1.00-5.80) 2.20 (1.00–6.00) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.33 (1.00–6.00) Yes 734 (28.5%) 2.28 (1.00-5.16) 2.40 (1.00-5.60) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.75 (1.00–6.00) 2.67 (1.00–6.00) p-value x < 0.001 0.009 0.025 < 0.001 0.311 < 0.001 < 0.001 Breast cancer is the most common cancer in women I don’t know 385 (14.9%) 2.20 (1.12–4.96) 2.40 (1.00-5.60) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.67 (1.00-5.33) 2.50 (1.00–6.00) 2.67 (1.00–6.00) No 124 (4.8%) 2.16 (1.04–4.72) 2.40 (1.00-5.20) 2.80 (1.00-5.80) 1.00 (1.00-5.40) 1.33 (1.00–6.00) 2.50 (1.00-5.75) 2.67 (1.00–6.00) Yes 2067 (80.2%) 2.16 (1.00-5.80) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) p-value* 0.655 0.039 0.677 0.282 0.004 0.977 0.329 Believe that a person's lifestyle can be a cause of breast cancer No 524 (20.3%) 2.12 (1.00-5.16) 2.40 (1.00-5.60) 2.80 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.25 (1.00–6.00) 2.67 (1.00–6.00) Yes 2052 (79.7%) 2.16 (1.00-5.80) 2.40 (1.00–6.00) 3.00 (1.00–6.00) 1.00 (1.00–6.00) 1.33 (1.00–6.00) 2.50 (1.00–6.00) 2.67 (1.00–6.00) p-value x 0.553 0.025 0.674 0.942 0.503 0.004 0.846 Note. *= p-value was calculated using KW test (Kruskal-Wallis H test) , x = p-value was calculated using Mann-Whitney U test a,b,c = are significant (P-value < 0.05) between the corresponding groups using Dunn’s pairwise comparison by Post-Hoc analysis, significant p-values (< 0.05) are bold. Correlation and linear regression Table 4 presents the correlation and linear regression analyses between the log-total CASS score and associated factors. A significant negative correlation was observed with sex (r =-0.1, p < 0.001), region (r =-0.1, p < 0.001), family income (r =-0.11, p < 0.001), history of breast problems ( r =-0.08, p < 0.001), and sufficient awareness about BC (r =-0.1, p < 0.001). In contrast, a significant positive correlation was observed in residence (r = 0.09, p = 0.001) and age (r = 0.04, p = 0.03). Table 4 Correlation and linear regression analysis of Cancer Stigma Scores Log total CASS score Correlation Linear regression r P β t P Sex -0.1 < 0.001 -0.02 4.2 < 0.001 Age 0.04 0.03 0.01 4.2 < 0.001 Region -0.1 < 0.001 -0.02 5.2 < 0.001 Educational year -0.002 0.9 -0.01 3.7 < 0.001 Residence 0.09 0.001 0.02 3.2 < 0.001 Family income -0.11 < 0.001 -0.025 4.8 < 0.001 Contact with breast cancer patient 0.02 0.22 0.006 1.0 0.3 Breast cancer in close friends/family members 0.03 0.2 0.003 0.4 0.7 Family history of breast cancer 0.02 0.3 0.003 0.3 0.7 History of breast problems -0.08 < 0.001 -0.05 5.1 < 0.001 Studied breast cancer in the curriculum -0.01 0.47 0.002 0.3 0.7 Sufficient awareness about breast cancer -0.1 < 0.001 -0.04 6.3 < 0.001 Constant Model ANOVA R 2 0.44 F = 14.3; P < 0.001 0.06 Note. r = Spearman coefficient, β = unstandardized coefficient. Categorical variables were included in the correlation and linear regression: sex coded as male = 1, female = 2. Regions were categorized as upper Egypt = 1, lower Egypt = 2, urban = 3, frontiers = 4. Residence classified as urban = 1, rural = 2. Family income is classified as less than sufficient = 1, sufficient = 2, and more than sufficient = 3. The academic, experimental, and knowledge-related questions as yes = 1 and no = 2. Several variables were significantly associated with the log-transformed CASS score in the multiple linear regression model. These included sex (β =-0.02, p < 0.001), age (β = 0.01, p < 0.001), region (β =-0.02, p < 0.001), educational year (β =-0.01, p < 0.001), residence (β = 0.02, p < 0.001), family income (β =-0.025, p = 0.001), personal history of breast problems (β =-0.05, p < 0.001), and perception of sufficient community awareness about BC (β =-0.04, p < 0.001) (Table 4 ). Main sources of information about breast cancer Figure 1 shows the main sources of information about BC among participants. Medical curricula were reported as the primary source of their information (24.2%), followed by internet/social media (20.0%) and healthcare professionals (16.3%). In contrast, workshops/seminars (6.7%) and family or friends (7.0%) were the least dependent sources of information (Fig. 1 ). Discussion As key figures within healthcare settings, physicians must be especially empathetic and aware of the impact of stigma, as the perceptions of these healthcare professionals directly influence clinical care and patients' health [ 17 ]. However, even though BC is widely regarded as a stigmatized topic given its close association with female identity and socially sensitive nature, both locally and globally [ 23 – 25 ], stigma among medical students, who represent future healthcare providers, has yet to be explored in existing research. Recognizing this gap, we used an adapted version of the CASS tool to evaluate the extent of medical students' stigma towards BC and identify its associated factors. To the best of our knowledge, this was the first study in Egypt and the world to employ the CASS among medical students, which could serve as a stepping-stone for evaluating BC stigma in the general population. We aimed to use our findings to pinpoint adjustments needed to the current medical education system, with the ultimate goal of supporting broader public health initiatives. The observed low median CASS score (below 50% of the maximum 6 points) likely reflected medical students' robust oncology education, consistent with studies from Egypt [ 26 ], Saudi Arabia [ 27 ], and South India [ 28 ] that demonstrated superior cancer knowledge among medical trainees. However, even minimal stigma levels warrant clinical attention, as evidence confirms these can manifest through microaggressions or implicit biases that compromise care quality [ 29 ]. This highlights the need for early, structured training that goes beyond medical knowledge to include communication without judgment, active listening, and self-awareness. Supporting future healthcare professionals in developing these skills helps create a care environment where patients feel truly heard, respected, and safe — and that can make all the difference. Yet, some domains of stigma were more pronounced than others. Higher stigma levels were found in the Severity domain, followed by Financial Discrimination and Personal Responsibility. Meanwhile, respondents were less stigmatizing of the parts on Policy Opposition and Avoidance. Having Severity as the domain with the highest score and Avoidance with the lowest was precisely in line with the results of two extensive general population studies conducted in Saudi Arabia [ 30 ] and England [ 22 ], as well as a study involving university students in Malaysia [ 31 ]. Participants' elevated Severity domain scores reflected both legitimate concerns about breast cancer outcomes in Egypt and potential misinformation exposure. Egypt's documented breast cancer mortality rate of 53.5% significantly exceeded global averages due to frequent late-stage diagnosis (71% of cases) and limited screening access (14% coverage) [ 32 ], objectively justifying heightened severity perceptions. Among the 20.0% of students relying primarily on social media for health information in our study, Chung et al. demonstrated that this exposure can directly increase cancer fatalism odds ratio (OR) = 2.3, 95% confidence interval (CI):1.8–3.1 through disproportionate representation of poor outcomes and minimal survivorship narratives [ 33 ]. Medical curricula should counter this by: incorporating critical evaluation of online health content, featuring survivor testimonials, and contextualizing Egyptian outcomes alongside global survival data to demonstrate treatability. These educational reforms should accompany the expansion of the national screening program to align perceived and actual disease trajectories [ 32 , 34 ]. Achieving this also required equipping both the public and future healthcare providers with clear, evidence-based information about cancer outcomes and proactively addressing fatalistic beliefs through structured education and communication. In contrast, medical students in our sample demonstrated the least stigmatizing attitudes in Avoidance, when compared to the rest of the domains. Physical changes brought on by cancer treatment, such as alopecia and surgical scars, were thought to have an impact on cancer patients' relationships and social interactions, making them feel rejected and excluded [ 35 ]. Particularly in BC, where mastectomies are one of its core lines of treatment, some cultures regard them as mutilating [ 36 ]. In Middle Eastern societies, misconceptions that BC is contagious further contribute to social avoidance of those affected [ 9 ]. However, through their education in cancer biology, etiology, and treatment, medical students have come to understand the fact that cancer can only be transmitted genetically, and is therefore non-contagious in nature. Their familiarity with BC treatments and their outcomes also meant they are less likely to view interventions such as mastectomy as disfiguring or mutilating. As a result, medical students were less inclined to avoid those with BC and came to see them as 'normal' in contrast to the general population. Knowledge, however, can sometimes be a double-edged sword. Research has indicated that an awareness of the modifiable risk factors for cancer, such as smoking, obesity, poor eating habits, and physical inactivity, is associated with higher personal responsibility scores [ 37 ]. For medical students who had studied the pathophysiology and potential etiologies of various cancers, including BC, this is an evident fact. This was supported by our findings, since almost 80% of our sample of medical students reported that they believed a person’s lifestyle could be a cause of BC, with the bivariate analysis revealing a significant increase in their Personal Responsibility domain compared to those who do not hold the same belief. While it is important to raise awareness about the causes of cancer, it may unintentionally perpetuate the notion that cancer is self-inflicted and increase stigma towards patients. Special attention should be paid to medical curricula and online platforms, as these served as the primary sources of BC information for nearly half of the students in our sample. Therefore, medical curricula must strategically convey information in a manner that promotes awareness of risk factors whilst minimizing the potential for stigmatization [ 22 ]. For instance, it must be emphasized that cancer is a complex, multifactorial disease with a combination of genetic, environmental, and lifestyle elements collectively influencing its pathogenesis [ 38 ]. Medical curricula should frame discussions of modifiable risk factors by emphasizing their probabilistic nature rather than deterministic outcomes, while acknowledging that many patients face unavoidable risks as prior radiation therapy or genetic predisposition. Training should focus on teaching students to communicate risk information empathetically without implying blame, using techniques like patient-centered counseling that highlight structural barriers to healthy behaviors. Regular competency assessments through clinical simulations can help ensure graduates can discuss risk factors in ways that promote awareness without fostering stigma, ultimately improving patient trust and outcomes. Meanwhile, medical students also demonstrated very low values of Policy Opposition towards BC. This could be explained by their awareness of the lengthy and costly nature of cancer treatment, making them more empathetic and supportive of resource allocation towards cancer care [ 39 ]. In addition, their sense of responsibility as future healthcare providers to act in the best interest of the patient and their commitment to improving health outcomes could have played a role. This, in turn, accentuates the importance of medical students’ involvement as policy advocates and even future policy-makers. Their engagement can help push for policies that address critical issues like BC treatment [ 40 ], aligning with the broader goals of the World Health Organization (WHO) Global Breast Cancer Initiative [ 41 ], as well as the United Nations (UN) 2030 Agenda for Sustainable Development [ 42 ]. A prominent example of organizations that encourage medical student advocacy and participation in health-related decision-making is the International Federation of Medical Students’ Associations (IFMSA). As one of the oldest and largest global bodies representing medical students, IFMSA provides a platform for students to contribute to policy development aimed at reducing health inequities and enhancing patient care worldwide [ 43 ]. In light of our data, men had higher stigma levels than women. This could be potentially due to women’s reported higher empathy levels [ 44 ] and greater involvement in cancer awareness campaigns, which often highlight topics like women's health and BC screening [ 45 , 46 ]. This is consistent with the results of numerous studies, including ones conducted among university students in Malaysia [ 31 ], as well as the general population in England [ 22 ], Saudi Arabia [ 30 ], and Oman [ 47 ]. In contrast, one study amongst the general population in China found no association between gender and stigma levels [ 48 ]. However, this might have been due to their small sample size, as well as gender imbalance with an overrepresentation of female participants. Interestingly, when it came to age, our findings showed that as individuals got older, their stigma levels got higher, especially within the severity domain. This closely matches the results of a Saudi Arabian study where increasing age was associated with greater stigma [ 30 ]. One possible explanation is that older students may have had past life experiences witnessing family or community members suffer or die from BC, thus causing them to retain a stronger emotional association of cancer with fatality or suffering, even after learning the clinical facts. At the same time, stigma varied across educational years, with fifth-year students exhibiting the highest levels of stigmatizing attitudes, specifically when it came to awkwardness and severity, while interns managed to rank among the lowest. The reason for heightened severity among fifth-years could be more rooted in their personal traditional views or cultural beliefs, reinforcing negative stereotypes. Furthermore, some students may have felt ill-prepared to sensitively engage with the social and emotional aspects of BC stigma, leading to increased feelings of uncertainty and awkwardness—particularly if they have not yet received adequate training in areas such as psycho-oncology or the psychological impact of stigma, which many medical programs do not dive into until later years [ 49 ]. Similarly, first-year students also demonstrated relatively high levels of stigma. The disparity between first-year students and interns likely stemmed from the intensive training and consecutive increased awareness and knowledge that interns receive in their final years, in contrast to first-year students, who naturally have limited experience and patient exposure, as they have only recently begun their medical journey [ 50 ]. These results underscored the pivotal role of advanced medical education and experiential learning in mitigating negative attitudes toward individuals with BC. Our study on students indicated that those residing in rural regions, such as Upper Egypt, and those having "less than sufficient" income both exhibited significantly higher levels of BC stigma. This may be because Egypt, like other LMICs, serves as an example for nations facing rural-urban development gaps. According to a 2024 report by the UN's Economic and Social Commission for Western Asia (ESCWA), 28% of rural Egyptians are multidimensionally poor, more than twice the rate in urban areas (11.9%), due to a lack of services, housing, education, and employment opportunities [ 51 ]. Supporting this, the World Bank’s 2019 report, Understanding Poverty and Inequality in Egypt, highlights that most of the poor and vulnerable populations reside in the governorates of Upper Egypt, which are predominantly rural [ 52 ]. Higher levels of stigma observed among individuals with lower income may be associated with the increased financial challenges often faced by low-income households. The already high cost of cancer care could have contributed to BC patients being perceived as an additional economic burden, potentially reinforcing stigmatizing attitudes toward the disease [ 53 , 54 ]. Additionally, localized cultural taboos, gender norms, and other social factors, which are more prominent in rural areas, may have influenced these perceptions [ 7 , 24 , 55 ]. Additionally, localized cultural taboos, gender norms, and other social factors, which are more prominent in rural areas, likely influenced these perceptions [ 7 , 24 , 55 ]. Resolving these issues requires two parallel strategies: first, community-based programs and awareness campaigns should be tailored to address the specific cultural and social dynamics of these regions; second, increased investment in healthcare infrastructure and access is critical, as greater accessibility can help normalize service utilization and reduce associated fear and shame. Together, these interventions can effectively tackle stigma at both the personal and community levels. While contact with BC patients helped reduce feelings of Awkwardness, Personal Responsibility, and Financial Discrimination, our findings showed that it had no discernible impact on other stigma beliefs, such as perceived severity. Likewise, a large-scale Saudi Arabian study also reported persistent stigma despite patient contact [ 30 ]. The persistence of perceptions surrounding BC’s severity and life-threatening nature may stem from deeply ingrained cultural beliefs, exposure to inaccurate media portrayals, or personal experiences with advanced or fatal cases. Such beliefs may remain unchanged even after direct patient contact, particularly if the interactions are brief, emotionally distant, or involve visibly unwell patients. Initial or surface-level contact may not provide enough depth or emotional engagement to challenge internalized assumptions about the disease's severity meaningfully. This suggests that clinical exposure alone may not be enough to tackle all facets of stigma. However, a study at the Egyptian University of Port Said addressed this challenge by demonstrating that combining exposure with structured education led to more positive attitude changes [ 56 ], highlighting the potential value of integrating educational interventions to strengthen the effect of clinical contact. Similarly, our results also showed that having close friends or relatives with BC did not significantly alter perceptions of the disease's severity or personal responsibility. Given that medical students represent future healthcare providers, their attitudes are particularly important, as patients are likely to expect empathy and support, rather than stigma, from those in clinical roles. Contrary to expectations, students with a personal history of breast-related conditions had higher stigma scores, particularly in terms of Awkwardness, Severity, and Financial Discrimination. While one might anticipate that personal experience would foster greater empathy and reduce stigma [ 57 ], the opposite was found. Individuals who have experienced breast health issues may have faced stigma themselves. This could have led them to internalize negative perceptions, which in turn affected their attitudes toward others with similar conditions [ 58 ]. This shows the importance of addressing emotional responses as part of increasing awareness within medical education. Strengths and limitations Our study has several strengths and limitations. While the cross-sectional design offers valuable insights, it does not establish a definitive cause-and-effect relationship between stigma and its potential contributing factors. Longitudinal studies are encouraged to uncover these dynamics. Convenience sampling was adopted due to logistical constraints, including the reliance on available local collaborators across the multicenter universities. This method may have introduced a potential for selection bias, as participants were self-selected or recruited based on accessibility. However, to improve representativeness, the sample was proportionally allocated among medical students from different educational years across Egypt’s four main regions. Future studies should aim to include non-medical students and expand across multiple countries to gain broader insight into BC stigma. Furthermore, this study employed a self-administered online questionnaire, which inevitably introduced the possibility of response bias, where participants may have misinterpreted the questions, leading to inaccurate answers. While stigma is generally perceived as socially undesirable, potentially influencing participants to respond more favorably, the anonymity of online questionnaires should likely minimize the impact of social desirability bias. Regarding our regression model, it explained 6% of the variation in the cancer stigma score, suggesting that additional unmeasured factors may contribute. Variables such as personal demographics (marital status, race, and religion), healthcare access, and media exposure patterns may play a role in shaping BC stigma. This limits the predictive utility of our identified variables, warranting further research to explore their effect. Additionally, while log transformation was necessary to address non-normality in our data, it is important to recognize that such transformations can alter the interpretation of effect sizes and potentially distort original data relationships. These analytical decisions should be considered when interpreting the regression results. Despite these limitations, this study provides initial evidence that BC stigma exists among future healthcare leaders, laying the groundwork for incorporating anti-stigma training into medical education and guiding public health initiatives to address existing gaps. Conclusion BC stigma among medical students was relatively low, though some aspects were more prominent than others. The extent of BC stigma was associated with participants’ sociodemographic characteristics such as sex, age, educational year, residence, and income, as well as other factors like contact with BC patients and personal history of breast problems. Given their future roles as healthcare providers, medical students should be equipped with both the empathy and knowledge necessary to combat stigma within healthcare settings. Targeted interventions should involve curriculum reforms that integrate anti-stigma training, taking into account high-risk groups such as males and rural residents. Future research should expand to include non-medical student populations and adopt longitudinal designs to evaluate the effectiveness of stigma-reduction strategies. Broader cross-cultural comparisons may also reveal how different educational and healthcare systems mediate stigma, offering more globalized solutions to address this critical public health concern in LMICs. Abbreviations BC Breast Cancer CASS Cancer Stigma Scale CI Confidence interval EWHI Egyptian Women’s Health Initiative ESCWA Economic and Social Commission for Western Asia GLOBOCAN Global Cancer Observatory IFMSA International Federation of Medical Students’ Associations LMICs Low- and middle-income countries OR Odds ratio SD Standard deviation UN United Nations WHO World Health Organization WHOP Women’s Health Outreach Program Declarations Acknowledgments The authors extend their sincere gratitude to the support provided by the Mansoura Students’ Scientific Association’s (MSSA-Mansoura) Research Support Division (RSD), as this study was conducted under the auspices of the RSD’s 2023-2024 research club. Special thanks to Mr. Yusof M. Omar (director of the RSD 2023-2024) and Ms. Basma Kamel (research club coordinator 2023-2024) for their mentorship, guidance, and encouragement through the research process. Author contributions AAA: Proposed the idea. DHA, HMD, WMM, MAZ, and AE: Planned the study and made substantial contributions to the conception and design. MAZ, AMK, FAJ, AAA, AME, ME, ANE, and SG: Major contributors to data acquisition. HMD and AE: data analysis and interpretation. FAJ, HMD: drafted and prepared the figure and tables. WMM, MAZ, DHA, HMD, AME, and AMK: Drafted and wrote the manuscript. MAZ and AE rigorously revised the manuscript for crucial intellectual content. All authors read and approved the final manuscript. Funding No funding or sponsorship was received from companies, groups, individuals, organizations, or other entities. Data Availability The data of this study are available from the corresponding author upon reasonable request. Conflict of interest The authors declare that they have no conflict of interest. Ethical considerations Ethical approval was obtained from the Institutional Research Board (IRB) at Mansoura University’s Faculty of Medicine (approval code: R.24.20.2854). Participation was voluntary, and anonymity was ensured. Before proceeding with the study, informed consent was obtained from all participants at the beginning of the questionnaire. No minors (individuals under 16 years) were included, and parental/guardian consent was not required. No identifiable data were collected; data were accessible only to the research team and used solely for research purposes. The study followed the Declaration of Helsinki regulations. Consent for publication Not applicable. BCS team of collaborators Sameh Waheed, Haneena, Mariam Mohamed Mansour, Malak S Zidan, Salma Hamed, AbdelRahman Esmail, Selwan Emam, Habiba W. Hamed, Jana A.Merzban, NourAlhoda Mansour, Basel Tarabeh, Jana Samir, Dina Elatal, Nourelhoda Massoud, Ahmed B.Habib, Sohaila Khaled Yousef, Nada Shabaan Mohamed, Maryam Elshehawi, Salma T.Abdelrahman, Hazem Khaled, Radwa Yassin, Ahmed E.Elbanhawy, Mohamed Abdelhamed, Sohaila Faisal, Mohammed Kamal, Rageed K. Al Refa'I, Mahmoud Shehata, Mariam El-orabi, Ali M. Kamal, Basmala Mohamed, Icen Abdullah, Asma Mohammed, Aseel Abbas, Sohaila Mohammed, Saad Saber, and Ibrahim Mohamed. ORCID IDs: Mohamed Ahmed Zoromba: https://orcid.org/0009-0004-1973-1898 Hana Mohamed Deibes: https://orcid.org/0009-0009-6096-7890 Mazen Essam: https://orcid.org/0009-0000-7829-2750 References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229–63. 10.3322/CAAC.21834 . Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today [Internet]. Lyon: International Agency for Research on Cancer; 2024. Available from: https://gco.iarc.fr/today Azim HA, Elghazawy H, Ghazy RM, Abdelaziz AH, Abdelsalam M, Elzorkany A, et al. Clinicopathologic Features of Breast Cancer in Egypt—Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol. 2023. 10.1200/GO.22.00387 . Rivera-Franco MM, Leon-Rodriguez E. Delays in breast cancer detection and treatment in developing countries. Breast Cancer (Auckl). 2018;12. 10.1177/1178223417752677 . Ibrahim AH, Shash E. General oncology care in Egypt. Cancer Arab World. 2022;41–61. 10.1007/978-981-16-7945-2_4 . Salem DS, Kamal RM, Helal MH, Hamed ST, Abdelrazek NA, Said NH, et al. Women health outreach program: A new experience for all Egyptian women. J Egypt Natl Canc Inst. 2008;20(4):313–22. Mamdouh H, El-Mansy H, Kharboush I, Ismail H, Tawfik M, El-Baky M, et al. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med. 2014;21:119–24. 10.4103/2230-8229.134771 . McEwan J, Underwood C, Corbex M. Injustice! That is the cause: A qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt. Cancer Nurs. 2014;37:468–75. 10.1097/NCC.0000000000000118 . Fearon D, Hughes S, Brearley SG. Experiences of breast cancer in Arab countries: A thematic synthesis. Qual Life Res. 2020;29:313–24. 10.1007/S11136-019-02328-0 . Andersen MM, Varga S, Folker AP. On the definition of stigma. J Eval Clin Pract. 2022;28:847–53. 10.1111/JEP.13684 . Stangl AL, Earnshaw VA, Logie CH, Van Brakel W, Simbayi LC, Barré I, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17:1–13. 10.1186/S12916-019-1271-3 . Melhem SJ, Nabhani-Gebara S, Kayyali R. Latency of breast cancer stigma during survivorship and its influencing factors: A qualitative study. Front Oncol. 2023;13:1075298. 10.3389/FONC.2023.1075298 . Aziz MM, Abdelrheem SS, Mohammed HM. Stigma and discrimination against people living with HIV by health care providers in Egypt. BMC Health Serv Res. 2023;23:1–9. 10.1186/S12913-023-09676-1 . Saad S, Bshawri JA, Alsaedi SM, Radi RE, Ghonim RM, Nasraldain HM, et al. Social stigma among health-care providers toward patients with schizophrenia and obsessive-compulsive disorders at tertiary hospital in Makkah, Saudi Arabia. Mental Health Rev J. 2022;27:281–94. 10.1108/MHRJ-11-2021-0078 . Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Med. 2019;17:1–15. 10.1186/S12916-019-1256-2 . Hing JJX, Lee WP, Chua YNS, Tan PT, Mok CW, Sudhakar SS, et al. Impact of health talks on knowledge, attitudes and perception of breast cancer screening and treatment amongst healthcare staff by a breast surgical unit in a public healthcare institution: a cross-sectional study. BMC Womens Health. 2021;21:1–12. 10.1186/S12905-021-01424-Z . Yang N, Cao Y, Li X, Li S, Yan H, Geng Q. Mediating Effects of Patients’ Stigma and Self-Efficacy on Relationships Between Doctors’ Empathy Abilities and Patients’ Cellular Immunity in Male Breast Cancer Patients. Med Sci Monit. 2018;24:3978–86. 10.12659/MSM.910794 . Anwar MM, Khalil DM. Breast cancer knowledge, attitude and practice among medical and non-medical university students. J Public Health (Germany). 2021;29:871–8. 10.1007/S10389-020-01197-Z . Alsaraireh A, Darawad MW. Impact of a Breast Cancer Educational Program on Female University Students’ Knowledge, Attitudes, and Practices. J Cancer Educ. 2019;34:315–22. 10.1007/S13187-017-1304-6 . Kinteh B, Kinteh SLS, Jammeh A, Touray E, Barrow A. Breast Cancer Screening: Knowledge, Attitudes, and Practices among Female University Students in The Gambia. Biomed Res Int. 2023;2023:9239431. 10.1155/2023/9239431 . Marlow LAV, Wardle J. Development of a scale to assess cancer stigma in the non-patient population. BMC Cancer. 2014;14:1–12. 10.1186/1471-2407-14-285 . Vrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: A population-based survey in England. BMC Cancer. 2019;19:1–10. 10.1186/S12885-019-5787-X . Sayed S, Ngugi AK, Mahoney MR, Kurji J, Talib ZM, MacFarlane SB, et al. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC Public Health. 2019;19:1–13. 10.1186/S12889-019-6464-3 . Salem H, Daher-Nashif S. Psychosocial aspects of female breast cancer in the middle east and North Africa. Int J Environ Res Public Health. 2020;17:1–16. 10.3390/IJERPH17186802 . Solikhah S, Matahari R, Utami FP, Handayani L, Marwati TA. Breast cancer stigma among Indonesian women: A case study of breast cancer patients. BMC Womens Health. 2020;20:1–5. 10.1186/S12905-020-00983-X . Anwar MM, Khalil DM. Breast cancer knowledge, attitude, and practice among medical and non-medical university students. J Public Health (Germany). 2021;29:871–8. 10.1007/S10389-020-01197-Z . Ramya Ahmad S, Asmaa Ahmad A, Nesreen Abdullah A, Rana Ahmad Bin S, Shaimaa Amer A, Aisha T, et al. Awareness Level, Knowledge and Attitude towards Breast Cancer between Medical and Non-Medical University Students in Makkah Region: A Cross Sectional Study. Int J Cancer Clin Res. 2019;6. 10.23937/2378-3419/1410106 . Sajan AS, Eldhose SR, Kandasamy K, Ramanathan S. Comparing the knowledge and awareness of cervical and breast cancer among medical and nonmedical students of a private institution in South India. J Cancer Res Ther. 2022;18:1776–81. 10.4103/JCRT.JCRT_172_20 . FitzGerald C, Hurst S. Implicit Bias in Healthcare Professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. 10.1186/s12910-017-0179-8 . Albenayyan HA, AlSubaie R, Alarfaj MO, Alshekhmobarak L, Alkhalifah MF, Alsaleem H, et al. Cancer Stigma Among 800 Saudi Citizens: A Cross-Sectional Study and Literature Review. Cureus. 2023. 10.7759/CUREUS.49088 . Justine M, Jafri MS, Joanny A, Akmar AN. Stigmatization toward cancer among university students in Malaysia. J Health Sci. 2021;11:149–53. 10.17532/JHSCI.2021.1322 . Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer Incidence in Egypt: Results of the National Population-Based Cancer Registry Program. J Cancer Epidemiol. 2014;1–18. 10.1155/2014/437971 . Chung JE, Lee CJ. The impact of cancer information online on cancer fatalism: education and eHealth literacy as moderators. Health Educ Res. 2019;34:543–55. 10.1093/HER/CYZ027 . Abdelaziz AH, Shawki MA, Shaaban AM, Albarouki SK, Rachid AM, Alsalhani OM, et al. Breast Cancer Awareness among Egyptian Women and the Impact of Caring for Patients with Breast Cancer on Family Caregivers’ Knowledge and Behaviour. Res Oncol. 2021;17:1–8. 10.21608/RESONCOL.2020.42340.1114 . Ernst J, Mehnert A, Dietz A, Hornemann B, Esser P. Perceived stigmatization and its impact on quality of life - results from a large register-based study including breast, colon, prostate and lung cancer patients. BMC Cancer. 2017;17:1–8. 10.1186/S12885-017-3742-2 . Riley KE, Ulrich MR, Hamann HA, Ostroff JS. Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA J Ethics. 2017;19:475–85. Tetteh DA, Faulkner SL. Sociocultural Factors and Breast Cancer in Sub-Saharan Africa: Implications for Diagnosis and Management. Women’s Health. 2016;12:147. 10.2217/WHE.15.76 . Sun YS, Zhao Z, Yang ZN, Xu F, Lu HJ, Zhu ZY, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13:1387. 10.7150/IJBS.21635 . Barr L, Daniel B. Does following a breast cancer patient for a day enhance medical student empathy? Med Teach. 2024. 10.1080/0142159X.2024.2311864 . AlMubarak SH. Students as policymakers and policy advocates: Role-playing evidence-based health policies. Simul Gaming. 2022;54(1):45–67. 10.1177/10468781221143052 . World Health Organization. Global Breast Cancer Initiative Implementation Framework: Assessing, Strengthening and Scaling Up of Services for the Early Detection and Management of Breast Cancer [Internet]. Geneva: WHO. 2023. Available from: https://www.who.int/publications/i/item/9789240065987 United Nations. Transforming our world: the 2030 Agenda for Sustainable Development [Internet]. United Nations. Available from: https://sdgs.un.org/2030agenda International Federation of Medical Students’ Associations. Policy and advocacy [Internet]. IFMSA. Available from: https://ifmsa.org/policy-and-advocacy/ Santos MA, Grosseman S, Morelli TC, Giuliano ICB, Erdmann TR. Empathy differences by gender and specialty preference in medical students: a study in Brazil. Int J Med Educ. 2016;7:149–53. 10.5116/IJME.572F.115F . Hassan EE, Seedhom AE, Mahfouz EM. Awareness about breast cancer and its screening among rural Egyptian women, Minia District: A population-based study. Asian Pac J Cancer Prev. 2017;18:1623–8. 10.22034/APJCP.2017.18.6.1623 . Manzour AF, Gamal Eldin DA. Awareness about breast cancer and mammogram among women attending outpatient clinics, Ain Shams University Hospitals, Egypt. J Egypt Public Health Assoc. 2019;94:26. 10.1186/S42506-019-0026-5 . Naabi MAL, Zaabi A, Al. Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman. Asian Pac J Cancer Prev. 2024;25:1223–9. 10.31557/APJCP.2024.25.4.1223 . Ye X, Liu HY, Lu SR, Zhai Q, Yu B. Translation and validation of the Chinese version of the Cancer Stigma Scale. J Oncol Pharm Pract. 2019;25:1622–30. 10.1177/1078155218802627 . Grassi L, Watson M. Core-curriculum in psycho‐oncology: Towards the certification of the psycho‐oncologist profession. Psycho-oncology. 2024;33(1). 10.1002/pon.6285 . Sedrak AS, Galal YS, Amin TT. Cancer screening knowledge and attitudes of under- and post-graduate students at Kasr Al Ainy School of Medicine, Cairo University, Egypt. Asian Pac J Cancer Prev. 2016;17(8):3809–16. United Nations Economic and Social Commission for Western Asia. Multidimensional Poverty in Egypt [Internet]. Beirut: UNESCWA. 2017. Available from: https://www.unescwa.org/sites/default/files/pubs/pdf/multidimensional-poverty-egypt-english_0.pdf Understanding Poverty and Inequality in Egypt. Understanding Poverty and Inequality in Egypt. 2019. 10.1596/32812 Ferrell R, Kravitz K. Cancer Care: Supporting Underserved and Financially Burdened Family Caregivers. J Adv Pract Oncol. 2017;8:494. 10.6004/jadpro.2017.8.5.5 . Alzehr A, Hulme C, Spencer A, Morgan-Trimmer S. The economic impact of cancer diagnosis on individuals and their families: a systematic review. Support Care Cancer. 2022;30:6385–404. 10.1007/S00520-022-06913-X . Jaffee K, Cohen M, Azaiza F, Hammad A, Hamade H, Thompson H. Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women. J Immigr Minor Health. 2021;23:95–102. 10.1007/S10903-020-01019-0 . El-Ata BA, A Sabour A, Shehata Ibrahim M. Effect of A Health Education Program about Breast Cancer and Breast Self Examination on the Knowledge and Practices of Females Employees. Egypt J Health Care. 2016;7:182–95. 10.21608/EJHC.2016.197443 . Trusson D, Pilnick A. Between stigma and pink positivity: women’s perceptions of social interactions during and after breast cancer treatment. Sociol Health Illn. 2017;39:458–73. 10.1111/1467-9566.12486 . Amini-Tehrani M, Zamanian H, Daryaafzoon M, Andikolaei S, Mohebbi M, Imani A, et al. Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. J Adv Nurs. 2021;77:3412–23. 10.1111/JAN.14881 . Additional Declarations No competing interests reported. Supplementary Files Breastcancerstigmaquestionnaire11.docx Cite Share Download PDF Status: Published Journal Publication published 27 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Accepted 27 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviews received at journal 30 Jun, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviewers invited by journal 27 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 26 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6640623","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493853866,"identity":"e38f4e08-6e22-11f0-907b-06cc9d20a69f","order_by":0,"name":"Mohamed Ahmed Zoromba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYPCCAwz8QFICxpXAoxShRbKBmVQtBgeI1aLbf/jYh485d+SNz58/eIMxxy5PvoH54G0eBhu7BhxazA4cS545c9szw203kpktGLclFxscYEu25mFIS8ap5WCPMTPvtsOM224ws0kwbmNO3MDAYybNw3A4GZfDzA7zgLXYb+4/DNJSnzi/gf8bUMt/3FqOQbQADU8GaTmc2HCAhw2o5YAdTi1n2JIZgX5JnnEj2dgicdvxxA2H2Ywt5xgkJ+DUcv7wYYaP2+7Y9vcffHjj47bqxPntzQ9vvKmws8elBRWATWYGEQYMiQ3E6UECRNoyCkbBKBgFIwAAAEnOVyweYCCbAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"Ahmed","lastName":"Zoromba","suffix":""},{"id":493853985,"identity":"ecf2e6b6-6e22-11f0-907b-06cc9d20a69f","order_by":1,"name":"Hana Mohamed Deibes","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Hana","middleName":"Mohamed","lastName":"Deibes","suffix":""},{"id":493854023,"identity":"f5753b45-6e22-11f0-907b-06cc9d20a69f","order_by":2,"name":"Dareen H. Abdelhady","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Dareen","middleName":"H.","lastName":"Abdelhady","suffix":""},{"id":493854059,"identity":"fe36b3da-6e22-11f0-907b-06cc9d20a69f","order_by":3,"name":"Walaa Mostafa Mokhtar","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Walaa","middleName":"Mostafa","lastName":"Mokhtar","suffix":""},{"id":493854077,"identity":"06686d73-6e23-11f0-907b-06cc9d20a69f","order_by":4,"name":"Abeer M. Kamal","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Abeer","middleName":"M.","lastName":"Kamal","suffix":""},{"id":493854099,"identity":"0f889fed-6e23-11f0-907b-06cc9d20a69f","order_by":5,"name":"Fatima Alhussein Jumma","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Alhussein","lastName":"Jumma","suffix":""},{"id":493854137,"identity":"19454199-6e23-11f0-907b-06cc9d20a69f","order_by":6,"name":"Aya M. Eltantawy","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Aya","middleName":"M.","lastName":"Eltantawy","suffix":""},{"id":493854165,"identity":"20d52ae8-6e23-11f0-907b-06cc9d20a69f","order_by":7,"name":"Aalaa Abdelwahed Ahmed","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Aalaa","middleName":"Abdelwahed","lastName":"Ahmed","suffix":""},{"id":493854214,"identity":"29b0b31a-6e23-11f0-907b-06cc9d20a69f","order_by":8,"name":"Mazen Essam","email":"","orcid":"","institution":"Faculty of Medicine, Minia University","correspondingAuthor":false,"prefix":"","firstName":"Mazen","middleName":"","lastName":"Essam","suffix":""},{"id":493854217,"identity":"32dd1f8d-6e23-11f0-907b-06cc9d20a69f","order_by":9,"name":"Abdallah N. Alsaaidy","email":"","orcid":"","institution":"Faculty of Medicine, Alexandria Universitiy","correspondingAuthor":false,"prefix":"","firstName":"Abdallah","middleName":"N.","lastName":"Alsaaidy","suffix":""},{"id":493854218,"identity":"3c4c6305-6e23-11f0-907b-06cc9d20a69f","order_by":10,"name":"Salha Gourashi","email":"","orcid":"","institution":"Faculty of Medicine, Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Salha","middleName":"","lastName":"Gourashi","suffix":""},{"id":493854275,"identity":"4714b5a4-6e23-11f0-907b-06cc9d20a69f","order_by":11,"name":"Abdel-Hady El-Gilany","email":"","orcid":"","institution":"Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Abdel-Hady","middleName":"","lastName":"El-Gilany","suffix":""},{"id":493854483,"identity":"528469c1-6e23-11f0-907b-06cc9d20a69f","order_by":12,"name":"BCS Team of collaborators","email":"","orcid":"","institution":"Faculty of Medicine, Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"BCS","middleName":"Team of","lastName":"collaborators","suffix":""}],"badges":[],"createdAt":"2025-05-11 16:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6640623/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6640623/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-24656-2","type":"published","date":"2025-10-27T15:58:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88193094,"identity":"fb9cf31a-caa5-431f-a8c0-64da05c4258d","added_by":"auto","created_at":"2025-08-03 15:09:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36428,"visible":true,"origin":"","legend":"\u003cp\u003eMain sources of information about breast cancer among medical students in Egypt (N=2576). Note: categories are not mutually exclusive.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6640623/v1/bc11b66ab59bae24fda9296b.png"},{"id":95040527,"identity":"2e804544-bdfd-48a4-ae0d-08eded5a7cb9","added_by":"auto","created_at":"2025-11-03 16:09:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2330331,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6640623/v1/70e722fd-5109-42cb-aa07-7864a5249f6e.pdf"},{"id":88193502,"identity":"2fa0da3e-f4ea-43c6-9f8f-0de0f5d86d63","added_by":"auto","created_at":"2025-08-03 15:17:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":200350,"visible":true,"origin":"","legend":"","description":"","filename":"Breastcancerstigmaquestionnaire11.docx","url":"https://assets-eu.researchsquare.com/files/rs-6640623/v1/2e669649751bd57f40b6713a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring breast cancer stigma among medical students in Egypt: A national multi-center cross- sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, breast cancer (BC) is the second most diagnosed cancer and the leading cause of cancer-related deaths in women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Egypt, according to the latest Global Cancer Observatory (GLOBOCAN) report (2022), BC is the most common cancer among females, accounting for 34.9% of all cancer cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBC can be successfully treated if diagnosed early. However, this is not often the case in Egypt, where most cases present as either locally advanced or metastatic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This reflects a broader pattern, common in low- and middle-income countries (LMICs), where limited healthcare resources and a predominant focus on curative rather than preventive care impede timely detection [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To reduce BC\u0026rsquo;s rising mortality, the Egyptian government launched Egypt's first national screening program, \"Women Health Outreach Program\" (WHOP) in 2007, and \u0026ldquo;Egyptian Women\u0026rsquo;s Health Initiative\" (EWHI) in 2019 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite these efforts, women continue to face significant barriers in utilizing these initiatives, undermining their full potential. Reducing the number of late-stage BC cases in Egypt remains a critical public health priority, one that requires an in-depth understanding of the factors contributing to these delayed presentations. Existing research classifies these factors into three main categories: personal, economic, and healthcare system-related barriers. They include: a general tendency to delay health consultation (often due to financial constraints or fear of diagnosis), limited access to healthcare, lack of awareness, and \u0026ndash; notably in Arab communities like Egypt \u0026ndash; disease-related stigma [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong these barriers, disease-related stigma stands out. Goffman, a foundational theorist in this area, first defined stigma as an attribute that associates a person with an unfavorable stereotype [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. He claimed that in the eyes of others, the stigmatized individual is reduced from a whole and normal person to one who is shamed or disregarded [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. \"Disease-related stigma\" is a term that refers to individuals facing discrimination, isolation, rejection, and/or criticism simply due to having suffered from a certain health condition [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Cancer-related stigma, in particular, exists due to a combination of certain myths, lack of understanding, and sociocultural beliefs, especially pronounced in Arab societies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Among BC patients, stigma often arises from widespread misconceptions, such as fears that the disease is contagious or beliefs that it is a divine punishment from God for past sins. These perceptions can lead others to distance themselves from those with BC, prompting many women to blame themselves for their illness and conceal their symptoms to escape potential social isolation by others [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such predicaments can dissuade women from seeking medical assistance, thereby delaying their diagnosis and treatment, and reducing their chances of survival [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn top of that, at a time when they are at their most vulnerable, patients still face stigma even in healthcare facilities [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. They can be subjected to outright refusal of care, inadequate treatment, long waiting hours, verbal and physical abuse, or having their care assigned to less experienced personnel [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Patients place significant trust in healthcare providers and often rely on doctors to guide them through the proper clinical process, so much so that, in cases of BC, some may forgo screening unless explicitly advised by a doctor [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This highlights the critical role healthcare staff play in encouraging positive health-seeking behaviors and countering harmful attitudes. Therefore, not only is it essential that physicians convey accurate facts to both the public and patients, but also being more empathetic and impartial themselves can help shape an ideal patient experience, and encourage compliance, improving both the physical and mental health of patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAddressing stigma towards BC patients early, particularly during medical school, is critical, as future doctors\u0026rsquo; perceptions will directly influence patient care. While numerous studies assessed medical and non-medical students' knowledge, awareness, and attitudes toward BC, both internationally and in Egypt [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], those examining attitudes mostly focused on students\u0026rsquo; perception of BC screening effectiveness and their willingness to undergo testing. However, no studies specifically investigated medical students\u0026rsquo; stigma towards BC patients, leaving a critical gap that hinders the development of effective educational interventions to improve patients\u0026rsquo; outcomes. This study aims to explore the key dimensions of BC\u0026ndash;related stigma among medical students in Egypt and identify its associated factors, to inform future curriculum reforms and public health strategies to reduce stigma and improve outcomes in Egypt and beyond.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eA national multi-center cross-sectional study with analytical and correlational components was conducted from January 2025 to May 2025. This study took place at the medical faculties of public universities across Egypt's four main geographical regions: Urban region (Alexandria University and Ain Shams University), Upper Egypt (Minia University and Fayoum University), Lower Egypt (Mansoura University and Zagazig University), and the Frontier region (Arish University and New Valley University). Public universities were selected to ensure representation of Egypt\u0026rsquo;s cultural diversity and to include a broader student demographic, while also accounting for the availability of local data collaborators.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling Technique\u003c/h3\u003e\n\u003cp\u003eThis study targeted undergraduate medical students from the first to the fifth year and interns from the universities mentioned above. Participants not affiliated with the target universities or who did not provide consent to complete the questionnaire were excluded. Participants were proportionally allocated across each region based on the number of registered students in the medical faculties of the public universities. Convenience sampling was used due to logistical constraints, particularly the inability to contact all medical students for random sampling. To reduce the potential bias, we ensured geographical diversity and proportional representation across regions and educational years.\u003c/p\u003e\n\u003ch3\u003eSample Size Calculation\u003c/h3\u003e\n\u003cp\u003eA pilot study was conducted on 31 students from different educational years. It revealed that the mean score of the Cancer Stigma Scale (CASS) was 1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75 Standard deviation (SD). Using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium), a minimum required sample size of 2188 medical students was calculated at a 95% confidence level, a 5% margin of error, and a design effect of four to compensate for the convenience sampling. However, 2,576 medical students completed the questionnaire and were included in the analysis.\u003c/p\u003e\n\u003ch3\u003eStudy Tool\u003c/h3\u003e\n\u003cp\u003eThe English questionnaire consisted of two sections. The first included socio-demographic, educational data, and knowledge-related questions, including age, gender, university, educational year, residence, family income, the student\u0026rsquo;s personal experience with BC (including their personal and family history of BC), whether they encountered someone with BC, the main sources from which they obtained information about BC\u0026mdash;using a multiple-response checkbox (which allow participants to select more than one option), whether they studied BC in their curriculum, and whether they believe there is sufficient awareness about BC in their community.\u003c/p\u003e\u003cp\u003eThe second section included the adapted CASS, which was developed and validated by Marlow et al. in 2014 for the non-cancer patient population [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The CASS consists of 25 items measuring six stigma domains: 1- Severity (perceptions of cancer's impact), 2- Financial Discrimination (support for restricting patients' rights), 3- Personal Responsibility (blame attribution), 4- Awkwardness (discomfort interacting with patients), 5- Avoidance (distancing behaviors), and 6- Policy Opposition (resistance to support systems). Responses were rated using a six-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 6\u0026thinsp;=\u0026thinsp;strongly agree) and reverse-scored for 5 items, so all scores were from 1 to 6; higher scores indicated higher levels of stigma. We calculated mean scores of each domain (sum of the domain items' scores divided by their number), and a total mean score for all items of the CASS.\u003c/p\u003e\u003cp\u003eAfter a public health expert reviewed the questionnaire, a pilot study was conducted at Mansoura University on 31 students to ensure content validity, clarity, and completion time. The reliability of the CASS was assessed using Cronbach\u0026rsquo;s alpha test, which measures the internal consistency of the items. The CASS score showed good internal validity (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.94), and its domain values ranged from 0.72 to 0.97. To adapt the CASS for BC stigma, the word \u0026ldquo;cancer\u0026rdquo; was replaced by \u0026ldquo;breast cancer\u0026rdquo; in each item, and the \u0026ldquo;not sure\u0026rdquo; option was removed, following a previous adaptation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The pilot data were excluded from the analysis.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using a Google Forms questionnaire. Collaborators distributed the questionnaire via the students\u0026rsquo; social media groups (e.g., Facebook, WhatsApp, and Telegram groups) across the selected universities. The form included the study\u0026rsquo;s goals and objectives, anonymity assurance, and informed consent. To avoid duplicate responses, Google Forms settings were adjusted to accept one response per email (without collecting emails to ensure anonymity). Participants who did not provide consent were excluded.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using IBM Statistical Package for Social Science (SPSS) software version 29 (IBM Corp., Armonk, NY, USA). Categorical variables were summarized as frequencies and percentages (%). Continuous variables (CASS scores) were tested for normality and found to be non-parametric in distribution. Therefore, they were summarized by median (min-max). Inferential tests: Mann-Whitney U test and Kruskal-Wallis test were used to compare group medians. Following a significant result from the Kruskal-Wallis test, Dunn\u0026rsquo;s pairwise comparison was used to adjust for multiple comparisons. Spearman\u0026rsquo;s correlation coefficient (r) was used to assess bivariate correlations. Multiple linear regression analysis was performed to identify factors associated with BC stigma scores. Before correlation and regression analysis, the CASS score was log-transformed to meet the normality assumption required for linear regression results. A p-value of \u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive statistics of the 25-item CASS\u003c/h2\u003e\u003cp\u003eThe total score was relatively low (with a mean of 2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83) and a median\u0026thinsp;=\u0026thinsp;2.16 (36% of the total possible score of 6), with notable variation observed across different stigma domains. Stigma was highest in Severity (M\u0026thinsp;=\u0026thinsp;3.00) and Financial Discrimination (M\u0026thinsp;=\u0026thinsp;2.67) domains. Specifically, 58.8% agreed that cancer devastates the lives of those it touches, and 49.1% supported policy reconsideration for patients.\u003c/p\u003e\u003cp\u003eIn contrast, the Avoidance domain (M\u0026thinsp;=\u0026thinsp;1.00) was the lowest, with only 14.3% of participants indicating they would avoid a person with cancer. Similarly, the Policy Opposition statements received endorsement by only 2.8\u0026ndash;5% of the participants (M\u0026thinsp;=\u0026thinsp;1.33) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eDescriptive statistics of the 25 items of the Cancer Stigma Scale (CASS) and total score\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAgree\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003en(%)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eDisagree\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003en(%)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e(Min-Max)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAwkwardness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026reg;I would feel at ease around someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2183 (84.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e393 (15.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026reg;I would feel comfortable around someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2179 (84.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e397 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would find it difficult being around someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e834 (32.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1742 (67.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would find it hard to talk to someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e677 (26.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1899 (73.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would feel embarrassed discussing cancer with someone who had it\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1216 (47.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1360 (52.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeverity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.00 (1.0\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce you\u0026rsquo;ve had cancer, you can never be \u0026lsquo;normal\u0026rsquo; again\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e945 (36.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1631 (63.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHaving cancer usually ruins a person\u0026rsquo;s career\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1164 (45.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1412 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGetting cancer means having to mentally prepare oneself for death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e720 (28.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1856 (72.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer usually ruins close personal relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1093 (42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1483 (57.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer devastates the lives of those it touches\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1514 (58.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1062 (41.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvoidance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf a colleague had cancer, I would try to avoid them\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e392 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2184 (84.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would distance myself physically from someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e424 (16.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2152 (83.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would feel irritated by someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e421 (16.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2155 (83.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would try to avoid a person with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e368 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2208 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI would feel angered by someone with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e379 (14.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2197 (85.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolicy Opposition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026reg;More government funding should be spent on the care and treatment of\u003c/p\u003e\u003cp\u003ethose with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2477 (96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026reg;The needs of people with cancer should be given top priority\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2448 (95.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026reg;We have a responsibility to provide the best possible care for people with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2503 (97.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResponsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA person with cancer is liable for their condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1465 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1111 (43.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA person with cancer is accountable for their condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1087 (42.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1489 (57.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf a person has cancer, it\u0026rsquo;s probably their fault\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e533 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2043 (79.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA person with cancer is to blame for their condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e479 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2097 (81.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiscrimination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt is acceptable for banks to refuse to make loans to people with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e516 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2060 (80.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBanks should be allowed to refuse mortgage applications for cancer-related reasons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e656 (25.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1920 (74.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt is acceptable for insurance companies to reconsider a policy if someone\u003c/p\u003e\u003cp\u003ehas cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1264 (49.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1312 (50.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal CASS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote.\u003c/em\u003e \u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003cem\u003eAgree included: slightly agree, moderately agree, and strongly agree.\u003c/em\u003e \u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cem\u003eDisagree included: slightly disagree, moderately disagree, and strongly disagree.\u003c/em\u003e \u003cb\u003e\u0026reg;\u003c/b\u003e \u003cem\u003eReversed items.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eVariation of CASS scores by Socio-Demographics\u003c/h2\u003e\u003cp\u003eOf the 2,576 participants, ages ranged from 17 to 31 years with a mean of 21.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 SD. Female accounted for 56.5%, 53.5% were aged 21 or younger, and participants were distributed evenly across the educational years. Most resided in urban areas (73.6%), and 71.0% reported having sufficient financial income. Only 2.3% of the participants were from the Frontier governorates (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eVariation of total CASS score and its domains with socio-demographic characteristics of study participants (N\u0026thinsp;=\u0026thinsp;2576)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eTotal CASS score median(min- max)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAwkwardness\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSeverity\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAvoidance\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePolicy Opposition\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eResponsibility\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eDiscrimination\u003c/p\u003e\u003cp\u003emedian(min- max)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1456 (56.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.20 (1.00-4.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1120 (43.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value \u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.575\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 and younger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1379 (53.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 and older\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1197 (46.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.20 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value \u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.751\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrontiers Governorates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (2.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.24 (1.20\u0026ndash;4.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003cp\u003e(1.00-4.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.60 (1.00-5.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003cp\u003e(1.00-5.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00-4.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e3.00 (1.00-5.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003cp\u003e(1.00-5.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLower Egypt Governorates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e821 (31.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.20 (1.00-5.08) \u003csup\u003e\u003cb\u003ea,b\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUpper Egypt Governorates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e466 (18.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.30 (1.00-4.64) \u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.70\u003c/p\u003e\u003cp\u003e(1.00-5.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.75 (1.00-5.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban Governorates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1229 (47.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08 (1.00-5.80) \u003csup\u003e\u003cb\u003ea,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1st year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e387 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.04\u0026ndash;5.16)\u003csup\u003e\u003cb\u003ee,f\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e423 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-4.68) \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00-5.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e451 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-4.96) \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.60 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e456 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.08\u0026ndash;5.80) \u003csup\u003e\u003cb\u003ec,g\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e413 (16.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.28(1.08\u0026ndash;4.80)\u003csup\u003e\u003cb\u003ea,b,d,f,g\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.60\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.20\u003c/p\u003e\u003cp\u003e(1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e446 (17.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-4.92) \u003csup\u003e\u003cb\u003ec,d,e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00-5.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00-5.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.17\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e680 (26.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.24 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.60 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1896 (73.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value \u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than or barely sufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e421 (16.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.28 (1.16\u0026ndash;5.80)\u003csup\u003e\u003cb\u003ea,b\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.75 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1828 (71.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.16) \u003csup\u003e\u003cb\u003ea,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than sufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e327 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.00 (1.00-4.68)\u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.60 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e2.00 (1.00-5.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote. *= p-value was calculated using KW test (Kruskal-Wallis H test )\u003c/em\u003e, \u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e \u003cem\u003e= p-value was calculated using Mann-Whitney U test\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003e\u003cb\u003ea,b,c,d,e,f,g\u003c/b\u003e\u003c/sup\u003e\u003cem\u003e= are significant (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the corresponding groups using Dunn\u0026rsquo;s pairwise comparison by Post-Hoc analysis, significant p-values (\u0026lt;\u0026thinsp;0.05) are bold.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMale students had significantly higher total stigma scores than females (2.20 vs. 2.12; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), particularly in Severity, Policy Opposition, Personal Responsibility, and Avoidance (all p\u0026thinsp;\u0026le;\u0026thinsp;0.001), despite identical median values in some cases. Conversely, females reported significantly higher Awkwardness (median\u0026thinsp;=\u0026thinsp;2.40 vs. 2.20; p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eStudents aged 22 or older had higher total stigma scores (2.20 vs. 2.12; p\u0026thinsp;=\u0026thinsp;0.001), especially in the Severity domain (3.20 vs. 2.80; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Students from Upper Egypt exhibited the highest stigma score (2.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with significant differences across all domains. Fifth-year students exhibited higher stigma levels (2.28; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with notable variation in Severity, Avoidance, Personal Responsibility, and Financial Discrimination.\u003c/p\u003e\u003cp\u003eRural students also had higher stigma scores (2.24 vs 2.12; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), particularly in Awkwardness, Severity, and Financial Discrimination (all p\u0026thinsp;\u0026le;\u0026thinsp;0.003). Participants from families with less than sufficient income had the highest score (2.28; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), especially in Severity and Personal Responsibility (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eVariation of CASS by Academic, Clinical History, and Knowledge-Related Variables\u003c/h2\u003e\u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, students with a personal history of breast problems reported higher stigma scores (2.40 vs. 2.16; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cb\u003e)\u003c/b\u003e, significantly higher across all major domains, including Awkwardness, Severity, Avoidance, Personal Responsibility, and Financial Discrimination. Interestingly, those who believed there was sufficient community awareness about BC reported a higher total stigma score (2.28 vs. 2.12; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Significant differences were found in Awkwardness, Severity, Financial Discrimination, and Personal Responsibility (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eVariation of total CASS score and its domains with academic, clinical history, knowledge-related characteristics of study participants (N\u0026thinsp;=\u0026thinsp;2576)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal CASS score median \u003cem\u003e(min \u0026ndash; max\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAwkwardness\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSeverity\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAvoidance\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePolicy Opposition\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eResponsibility\u003c/p\u003e\u003cp\u003emedian(min-max)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eDiscrimination\u003c/p\u003e\u003cp\u003emedian(min- max)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eContact with breast cancer patient\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1451 (56.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1125 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreast cancer in close friends/family members\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1825 (70.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e751 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.04\u0026ndash;5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of breast problems\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2374 (92.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.40 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.75 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history of breast cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2205 (85.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e371 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.04\u0026ndash;5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudied breast cancer in your curriculum\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e794 (30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-4.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1782 (69.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.050\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.720\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBelieve there is sufficient awareness about breast cancer in your community\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1842 (71.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e734 (28.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.28 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.75 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreast cancer is the most common cancer in women\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e385 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.20 (1.12\u0026ndash;4.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.67 (1.00-5.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.04\u0026ndash;4.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00-5.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00-5.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2067 (80.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBelieve that a person's lifestyle can be a cause of breast cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e524 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.00-5.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00-5.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.80 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.25 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2052 (79.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16 (1.00-5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.40 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.33 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.50 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.67 (1.00\u0026ndash;6.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.846\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote. *= p-value was calculated using KW test (Kruskal-Wallis H test)\u003c/em\u003e, \u003csup\u003e\u003cb\u003ex\u003c/b\u003e\u003c/sup\u003e \u003cem\u003e= p-value was calculated using Mann-Whitney U test\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003e\u003cb\u003ea,b,c\u003c/b\u003e\u003c/sup\u003e\u003cem\u003e= are significant (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the corresponding groups using Dunn\u0026rsquo;s pairwise comparison by Post-Hoc analysis, significant p-values (\u0026lt;\u0026thinsp;0.05) are bold.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation and linear regression\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the correlation and linear regression analyses between the log-total CASS score and associated factors. A significant negative correlation was observed with sex (r =-0.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), region (r =-0.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), family income (r =-0.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of breast problems ( r =-0.08, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sufficient awareness about BC (r =-0.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, a significant positive correlation was observed in residence (r\u0026thinsp;=\u0026thinsp;0.09, p\u0026thinsp;=\u0026thinsp;0.001) and age (r\u0026thinsp;=\u0026thinsp;0.04, p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eCorrelation and linear regression analysis of Cancer Stigma Scores\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eLog total CASS score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eLinear regression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContact with breast cancer patient\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreast cancer in close friends/family members\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history of breast cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of breast problems\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudied breast cancer in the curriculum\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSufficient awareness about breast cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstant\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eModel ANOVA\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;14.3; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote. r\u0026thinsp;=\u0026thinsp;Spearman coefficient, β\u0026thinsp;=\u0026thinsp;unstandardized coefficient. Categorical\u003c/em\u003e variables were included in the correlation and linear regression: sex coded as male\u0026thinsp;=\u0026thinsp;1, female\u0026thinsp;=\u0026thinsp;2. Regions were categorized as upper Egypt\u0026thinsp;=\u0026thinsp;1, lower Egypt\u0026thinsp;=\u0026thinsp;2, urban\u0026thinsp;=\u0026thinsp;3, frontiers\u0026thinsp;=\u0026thinsp;4. Residence classified as urban\u0026thinsp;=\u0026thinsp;1, rural\u0026thinsp;=\u0026thinsp;2. Family income is classified as less than sufficient\u0026thinsp;=\u0026thinsp;1, sufficient\u0026thinsp;=\u0026thinsp;2, and more than sufficient\u0026thinsp;=\u0026thinsp;3. The academic, experimental, and knowledge-related questions as yes\u0026thinsp;=\u0026thinsp;1 and no\u0026thinsp;=\u0026thinsp;2.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSeveral variables were significantly associated with the log-transformed CASS score in the multiple linear regression model. These included sex (β =-0.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), age (β\u0026thinsp;=\u0026thinsp;0.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), region (β =-0.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), educational year (β =-0.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), residence (β\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), family income (β =-0.025, p\u0026thinsp;=\u0026thinsp;0.001), personal history of breast problems (β =-0.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and perception of sufficient community awareness about BC (β =-0.04, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMain sources of information about breast cancer\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the main sources of information about BC among participants. Medical curricula were reported as the primary source of their information (24.2%), followed by internet/social media (20.0%) and healthcare professionals (16.3%). In contrast, workshops/seminars (6.7%) and family or friends (7.0%) were the least dependent sources of information (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs key figures within healthcare settings, physicians must be especially empathetic and aware of the impact of stigma, as the perceptions of these healthcare professionals directly influence clinical care and patients' health [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, even though BC is widely regarded as a stigmatized topic given its close association with female identity and socially sensitive nature, both locally and globally [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], stigma among medical students, who represent future healthcare providers, has yet to be explored in existing research. Recognizing this gap, we used an adapted version of the CASS tool to evaluate the extent of medical students' stigma towards BC and identify its associated factors. To the best of our knowledge, this was the first study in Egypt and the world to employ the CASS among medical students, which could serve as a stepping-stone for evaluating BC stigma in the general population. We aimed to use our findings to pinpoint adjustments needed to the current medical education system, with the ultimate goal of supporting broader public health initiatives.\u003c/p\u003e\u003cp\u003eThe observed low median CASS score (below 50% of the maximum 6 points) likely reflected medical students' robust oncology education, consistent with studies from Egypt [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Saudi Arabia [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and South India [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] that demonstrated superior cancer knowledge among medical trainees. However, even minimal stigma levels warrant clinical attention, as evidence confirms these can manifest through microaggressions or implicit biases that compromise care quality [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This highlights the need for early, structured training that goes beyond medical knowledge to include communication without judgment, active listening, and self-awareness. Supporting future healthcare professionals in developing these skills helps create a care environment where patients feel truly heard, respected, and safe \u0026mdash; and that can make all the difference. Yet, some domains of stigma were more pronounced than others. Higher stigma levels were found in the Severity domain, followed by Financial Discrimination and Personal Responsibility. Meanwhile, respondents were less stigmatizing of the parts on Policy Opposition and Avoidance. Having Severity as the domain with the highest score and Avoidance with the lowest was precisely in line with the results of two extensive general population studies conducted in Saudi Arabia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and England [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], as well as a study involving university students in Malaysia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Participants' elevated Severity domain scores reflected both legitimate concerns about breast cancer outcomes in Egypt and potential misinformation exposure. Egypt's documented breast cancer mortality rate of 53.5% significantly exceeded global averages due to frequent late-stage diagnosis (71% of cases) and limited screening access (14% coverage) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], objectively justifying heightened severity perceptions. Among the 20.0% of students relying primarily on social media for health information in our study, Chung et al. demonstrated that this exposure can directly increase cancer fatalism odds ratio (OR)\u0026thinsp;=\u0026thinsp;2.3, 95% confidence interval (CI):1.8\u0026ndash;3.1 through disproportionate representation of poor outcomes and minimal survivorship narratives [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Medical curricula should counter this by: incorporating critical evaluation of online health content, featuring survivor testimonials, and contextualizing Egyptian outcomes alongside global survival data to demonstrate treatability. These educational reforms should accompany the expansion of the national screening program to align perceived and actual disease trajectories [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Achieving this also required equipping both the public and future healthcare providers with clear, evidence-based information about cancer outcomes and proactively addressing fatalistic beliefs through structured education and communication.\u003c/p\u003e\u003cp\u003eIn contrast, medical students in our sample demonstrated the least stigmatizing attitudes in Avoidance, when compared to the rest of the domains. Physical changes brought on by cancer treatment, such as alopecia and surgical scars, were thought to have an impact on cancer patients' relationships and social interactions, making them feel rejected and excluded [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Particularly in BC, where mastectomies are one of its core lines of treatment, some cultures regard them as mutilating [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In Middle Eastern societies, misconceptions that BC is contagious further contribute to social avoidance of those affected [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, through their education in cancer biology, etiology, and treatment, medical students have come to understand the fact that cancer can only be transmitted genetically, and is therefore non-contagious in nature. Their familiarity with BC treatments and their outcomes also meant they are less likely to view interventions such as mastectomy as disfiguring or mutilating. As a result, medical students were less inclined to avoid those with BC and came to see them as 'normal' in contrast to the general population. Knowledge, however, can sometimes be a double-edged sword. Research has indicated that an awareness of the modifiable risk factors for cancer, such as smoking, obesity, poor eating habits, and physical inactivity, is associated with higher personal responsibility scores [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For medical students who had studied the pathophysiology and potential etiologies of various cancers, including BC, this is an evident fact. This was supported by our findings, since almost 80% of our sample of medical students reported that they believed a person\u0026rsquo;s lifestyle could be a cause of BC, with the bivariate analysis revealing a significant increase in their Personal Responsibility domain compared to those who do not hold the same belief. While it is important to raise awareness about the causes of cancer, it may unintentionally perpetuate the notion that cancer is self-inflicted and increase stigma towards patients. Special attention should be paid to medical curricula and online platforms, as these served as the primary sources of BC information for nearly half of the students in our sample. Therefore, medical curricula must strategically convey information in a manner that promotes awareness of risk factors whilst minimizing the potential for stigmatization [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. For instance, it must be emphasized that cancer is a complex, multifactorial disease with a combination of genetic, environmental, and lifestyle elements collectively influencing its pathogenesis [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Medical curricula should frame discussions of modifiable risk factors by emphasizing their probabilistic nature rather than deterministic outcomes, while acknowledging that many patients face unavoidable risks as prior radiation therapy or genetic predisposition. Training should focus on teaching students to communicate risk information empathetically without implying blame, using techniques like patient-centered counseling that highlight structural barriers to healthy behaviors. Regular competency assessments through clinical simulations can help ensure graduates can discuss risk factors in ways that promote awareness without fostering stigma, ultimately improving patient trust and outcomes.\u003c/p\u003e\u003cp\u003eMeanwhile, medical students also demonstrated very low values of Policy Opposition towards BC. This could be explained by their awareness of the lengthy and costly nature of cancer treatment, making them more empathetic and supportive of resource allocation towards cancer care [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, their sense of responsibility as future healthcare providers to act in the best interest of the patient and their commitment to improving health outcomes could have played a role. This, in turn, accentuates the importance of medical students\u0026rsquo; involvement as policy advocates and even future policy-makers. Their engagement can help push for policies that address critical issues like BC treatment [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], aligning with the broader goals of the World Health Organization (WHO) Global Breast Cancer Initiative [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], as well as the United Nations (UN) 2030 Agenda for Sustainable Development [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. A prominent example of organizations that encourage medical student advocacy and participation in health-related decision-making is the International Federation of Medical Students\u0026rsquo; Associations (IFMSA). As one of the oldest and largest global bodies representing medical students, IFMSA provides a platform for students to contribute to policy development aimed at reducing health inequities and enhancing patient care worldwide [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn light of our data, men had higher stigma levels than women. This could be potentially due to women\u0026rsquo;s reported higher empathy levels [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] and greater involvement in cancer awareness campaigns, which often highlight topics like women's health and BC screening [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This is consistent with the results of numerous studies, including ones conducted among university students in Malaysia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], as well as the general population in England [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Saudi Arabia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Oman [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In contrast, one study amongst the general population in China found no association between gender and stigma levels [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. However, this might have been due to their small sample size, as well as gender imbalance with an overrepresentation of female participants.\u003c/p\u003e\u003cp\u003eInterestingly, when it came to age, our findings showed that as individuals got older, their stigma levels got higher, especially within the severity domain. This closely matches the results of a Saudi Arabian study where increasing age was associated with greater stigma [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. One possible explanation is that older students may have had past life experiences witnessing family or community members suffer or die from BC, thus causing them to retain a stronger emotional association of cancer with fatality or suffering, even after learning the clinical facts. At the same time, stigma varied across educational years, with fifth-year students exhibiting the highest levels of stigmatizing attitudes, specifically when it came to awkwardness and severity, while interns managed to rank among the lowest. The reason for heightened severity among fifth-years could be more rooted in their personal traditional views or cultural beliefs, reinforcing negative stereotypes. Furthermore, some students may have felt ill-prepared to sensitively engage with the social and emotional aspects of BC stigma, leading to increased feelings of uncertainty and awkwardness\u0026mdash;particularly if they have not yet received adequate training in areas such as psycho-oncology or the psychological impact of stigma, which many medical programs do not dive into until later years [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Similarly, first-year students also demonstrated relatively high levels of stigma. The disparity between first-year students and interns likely stemmed from the intensive training and consecutive increased awareness and knowledge that interns receive in their final years, in contrast to first-year students, who naturally have limited experience and patient exposure, as they have only recently begun their medical journey [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These results underscored the pivotal role of advanced medical education and experiential learning in mitigating negative attitudes toward individuals with BC.\u003c/p\u003e\u003cp\u003eOur study on students indicated that those residing in rural regions, such as Upper Egypt, and those having \"less than sufficient\" income both exhibited significantly higher levels of BC stigma. This may be because Egypt, like other LMICs, serves as an example for nations facing rural-urban development gaps. According to a 2024 report by the UN's Economic and Social Commission for Western Asia (ESCWA), 28% of rural Egyptians are multidimensionally poor, more than twice the rate in urban areas (11.9%), due to a lack of services, housing, education, and employment opportunities [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Supporting this, the World Bank\u0026rsquo;s 2019 report, Understanding Poverty and Inequality in Egypt, highlights that most of the poor and vulnerable populations reside in the governorates of Upper Egypt, which are predominantly rural [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Higher levels of stigma observed among individuals with lower income may be associated with the increased financial challenges often faced by low-income households. The already high cost of cancer care could have contributed to BC patients being perceived as an additional economic burden, potentially reinforcing stigmatizing attitudes toward the disease [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Additionally, localized cultural taboos, gender norms, and other social factors, which are more prominent in rural areas, may have influenced these perceptions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Additionally, localized cultural taboos, gender norms, and other social factors, which are more prominent in rural areas, likely influenced these perceptions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Resolving these issues requires two parallel strategies: first, community-based programs and awareness campaigns should be tailored to address the specific cultural and social dynamics of these regions; second, increased investment in healthcare infrastructure and access is critical, as greater accessibility can help normalize service utilization and reduce associated fear and shame. Together, these interventions can effectively tackle stigma at both the personal and community levels.\u003c/p\u003e\u003cp\u003eWhile contact with BC patients helped reduce feelings of Awkwardness, Personal Responsibility, and Financial Discrimination, our findings showed that it had no discernible impact on other stigma beliefs, such as perceived severity. Likewise, a large-scale Saudi Arabian study also reported persistent stigma despite patient contact [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The persistence of perceptions surrounding BC\u0026rsquo;s severity and life-threatening nature may stem from deeply ingrained cultural beliefs, exposure to inaccurate media portrayals, or personal experiences with advanced or fatal cases. Such beliefs may remain unchanged even after direct patient contact, particularly if the interactions are brief, emotionally distant, or involve visibly unwell patients. Initial or surface-level contact may not provide enough depth or emotional engagement to challenge internalized assumptions about the disease's severity meaningfully. This suggests that clinical exposure alone may not be enough to tackle all facets of stigma. However, a study at the Egyptian University of Port Said addressed this challenge by demonstrating that combining exposure with structured education led to more positive attitude changes [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], highlighting the potential value of integrating educational interventions to strengthen the effect of clinical contact. Similarly, our results also showed that having close friends or relatives with BC did not significantly alter perceptions of the disease's severity or personal responsibility. Given that medical students represent future healthcare providers, their attitudes are particularly important, as patients are likely to expect empathy and support, rather than stigma, from those in clinical roles.\u003c/p\u003e\u003cp\u003eContrary to expectations, students with a personal history of breast-related conditions had higher stigma scores, particularly in terms of Awkwardness, Severity, and Financial Discrimination. While one might anticipate that personal experience would foster greater empathy and reduce stigma [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], the opposite was found. Individuals who have experienced breast health issues may have faced stigma themselves. This could have led them to internalize negative perceptions, which in turn affected their attitudes toward others with similar conditions [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. This shows the importance of addressing emotional responses as part of increasing awareness within medical education.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eOur study has several strengths and limitations. While the cross-sectional design offers valuable insights, it does not establish a definitive cause-and-effect relationship between stigma and its potential contributing factors. Longitudinal studies are encouraged to uncover these dynamics. Convenience sampling was adopted due to logistical constraints, including the reliance on available local collaborators across the multicenter universities. This method may have introduced a potential for selection bias, as participants were self-selected or recruited based on accessibility. However, to improve representativeness, the sample was proportionally allocated among medical students from different educational years across Egypt\u0026rsquo;s four main regions. Future studies should aim to include non-medical students and expand across multiple countries to gain broader insight into BC stigma.\u003c/p\u003e\u003cp\u003eFurthermore, this study employed a self-administered online questionnaire, which inevitably introduced the possibility of response bias, where participants may have misinterpreted the questions, leading to inaccurate answers. While stigma is generally perceived as socially undesirable, potentially influencing participants to respond more favorably, the anonymity of online questionnaires should likely minimize the impact of social desirability bias. Regarding our regression model, it explained 6% of the variation in the cancer stigma score, suggesting that additional unmeasured factors may contribute. Variables such as personal demographics (marital status, race, and religion), healthcare access, and media exposure patterns may play a role in shaping BC stigma. This limits the predictive utility of our identified variables, warranting further research to explore their effect. Additionally, while log transformation was necessary to address non-normality in our data, it is important to recognize that such transformations can alter the interpretation of effect sizes and potentially distort original data relationships. These analytical decisions should be considered when interpreting the regression results. Despite these limitations, this study provides initial evidence that BC stigma exists among future healthcare leaders, laying the groundwork for incorporating anti-stigma training into medical education and guiding public health initiatives to address existing gaps.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBC stigma among medical students was relatively low, though some aspects were more prominent than others. The extent of BC stigma was associated with participants\u0026rsquo; sociodemographic characteristics such as sex, age, educational year, residence, and income, as well as other factors like contact with BC patients and personal history of breast problems. Given their future roles as healthcare providers, medical students should be equipped with both the empathy and knowledge necessary to combat stigma within healthcare settings. Targeted interventions should involve curriculum reforms that integrate anti-stigma training, taking into account high-risk groups such as males and rural residents. Future research should expand to include non-medical student populations and adopt longitudinal designs to evaluate the effectiveness of stigma-reduction strategies. Broader cross-cultural comparisons may also reveal how different educational and healthcare systems mediate stigma, offering more globalized solutions to address this critical public health concern in LMICs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBreast Cancer\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCASS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCancer Stigma Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEWHI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEgyptian Women\u0026rsquo;s Health Initiative\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESCWA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEconomic and Social Commission for Western Asia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGLOBOCAN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlobal Cancer Observatory\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIFMSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Federation of Medical Students\u0026rsquo; Associations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow- and middle-income countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Nations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHOP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWomen\u0026rsquo;s Health Outreach Program\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to the support provided by the Mansoura Students\u0026rsquo; Scientific Association\u0026rsquo;s (MSSA-Mansoura) Research Support Division (RSD), as this study was conducted under the auspices of the RSD\u0026rsquo;s 2023-2024 research club. Special thanks to Mr. Yusof M. Omar (director of the RSD 2023-2024) and Ms. Basma Kamel (research club coordinator 2023-2024) for their mentorship, guidance, and encouragement through the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAAA: Proposed the idea. DHA, HMD, WMM, MAZ, and AE: Planned the study and made substantial contributions to the conception and design. MAZ, AMK, FAJ, AAA, AME, ME, ANE, and SG: Major contributors to data acquisition. HMD and AE: data analysis and interpretation. FAJ, HMD: drafted and prepared the figure and tables. WMM, MAZ, DHA, HMD, AME, and AMK: Drafted and wrote the manuscript. MAZ and AE rigorously revised the manuscript for crucial intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or sponsorship was received from companies, groups, individuals, organizations, or other entities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Research Board (IRB) at Mansoura University\u0026rsquo;s Faculty of Medicine (approval code: R.24.20.2854). Participation was voluntary, and anonymity was ensured. Before proceeding with the study, informed consent was obtained from all participants at the beginning of the questionnaire. No minors (individuals under 16 years) were included, and parental/guardian consent was not required. No identifiable data were collected; data were accessible only to the research team and used solely for research purposes. The study followed the Declaration of Helsinki regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBCS team of collaborators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSameh Waheed, Haneena, Mariam Mohamed Mansour, Malak S Zidan, Salma Hamed, AbdelRahman Esmail, Selwan Emam, Habiba W. Hamed, Jana A.Merzban, NourAlhoda Mansour, Basel Tarabeh, Jana Samir, Dina Elatal, Nourelhoda Massoud, Ahmed B.Habib, Sohaila Khaled Yousef, Nada Shabaan Mohamed, Maryam Elshehawi, Salma T.Abdelrahman, Hazem Khaled, Radwa Yassin, Ahmed E.Elbanhawy, Mohamed Abdelhamed, Sohaila Faisal, Mohammed Kamal, Rageed K. Al Refa\u0026apos;I, Mahmoud Shehata, Mariam El-orabi, Ali M. Kamal, Basmala Mohamed, Icen Abdullah, Asma Mohammed, Aseel Abbas, Sohaila Mohammed, Saad Saber, and Ibrahim Mohamed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID IDs:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eMohamed Ahmed Zoromba: https://orcid.org/0009-0004-1973-1898\u003c/li\u003e\n \u003cli\u003eHana Mohamed Deibes: https://orcid.org/0009-0009-6096-7890\u003c/li\u003e\n \u003cli\u003eMazen Essam: https://orcid.org/0009-0000-7829-2750\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/CAAC.21834\u003c/span\u003e\u003cspan address=\"10.3322/CAAC.21834\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Pi\u0026ntilde;eros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today [Internet]. Lyon: International Agency for Research on Cancer; 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gco.iarc.fr/today\u003c/span\u003e\u003cspan address=\"https://gco.iarc.fr/today\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAzim HA, Elghazawy H, Ghazy RM, Abdelaziz AH, Abdelsalam M, Elzorkany A, et al. Clinicopathologic Features of Breast Cancer in Egypt\u0026mdash;Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1200/GO.22.00387\u003c/span\u003e\u003cspan address=\"10.1200/GO.22.00387\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRivera-Franco MM, Leon-Rodriguez E. Delays in breast cancer detection and treatment in developing countries. Breast Cancer (Auckl). 2018;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1178223417752677\u003c/span\u003e\u003cspan address=\"10.1177/1178223417752677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIbrahim AH, Shash E. General oncology care in Egypt. Cancer Arab World. 2022;41\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-981-16-7945-2_4\u003c/span\u003e\u003cspan address=\"10.1007/978-981-16-7945-2_4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalem DS, Kamal RM, Helal MH, Hamed ST, Abdelrazek NA, Said NH, et al. Women health outreach program: A new experience for all Egyptian women. J Egypt Natl Canc Inst. 2008;20(4):313\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMamdouh H, El-Mansy H, Kharboush I, Ismail H, Tawfik M, El-Baky M, et al. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med. 2014;21:119\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2230-8229.134771\u003c/span\u003e\u003cspan address=\"10.4103/2230-8229.134771\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcEwan J, Underwood C, Corbex M. Injustice! That is the cause: A qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt. Cancer Nurs. 2014;37:468\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/NCC.0000000000000118\u003c/span\u003e\u003cspan address=\"10.1097/NCC.0000000000000118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFearon D, Hughes S, Brearley SG. Experiences of breast cancer in Arab countries: A thematic synthesis. Qual Life Res. 2020;29:313\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S11136-019-02328-0\u003c/span\u003e\u003cspan address=\"10.1007/S11136-019-02328-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAndersen MM, Varga S, Folker AP. On the definition of stigma. J Eval Clin Pract. 2022;28:847\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/JEP.13684\u003c/span\u003e\u003cspan address=\"10.1111/JEP.13684\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStangl AL, Earnshaw VA, Logie CH, Van Brakel W, Simbayi LC, Barr\u0026eacute; I, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12916-019-1271-3\u003c/span\u003e\u003cspan address=\"10.1186/S12916-019-1271-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMelhem SJ, Nabhani-Gebara S, Kayyali R. Latency of breast cancer stigma during survivorship and its influencing factors: A qualitative study. Front Oncol. 2023;13:1075298. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/FONC.2023.1075298\u003c/span\u003e\u003cspan address=\"10.3389/FONC.2023.1075298\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAziz MM, Abdelrheem SS, Mohammed HM. Stigma and discrimination against people living with HIV by health care providers in Egypt. BMC Health Serv Res. 2023;23:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12913-023-09676-1\u003c/span\u003e\u003cspan address=\"10.1186/S12913-023-09676-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaad S, Bshawri JA, Alsaedi SM, Radi RE, Ghonim RM, Nasraldain HM, et al. Social stigma among health-care providers toward patients with schizophrenia and obsessive-compulsive disorders at tertiary hospital in Makkah, Saudi Arabia. Mental Health Rev J. 2022;27:281\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1108/MHRJ-11-2021-0078\u003c/span\u003e\u003cspan address=\"10.1108/MHRJ-11-2021-0078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Med. 2019;17:1\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12916-019-1256-2\u003c/span\u003e\u003cspan address=\"10.1186/S12916-019-1256-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHing JJX, Lee WP, Chua YNS, Tan PT, Mok CW, Sudhakar SS, et al. Impact of health talks on knowledge, attitudes and perception of breast cancer screening and treatment amongst healthcare staff by a breast surgical unit in a public healthcare institution: a cross-sectional study. BMC Womens Health. 2021;21:1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12905-021-01424-Z\u003c/span\u003e\u003cspan address=\"10.1186/S12905-021-01424-Z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang N, Cao Y, Li X, Li S, Yan H, Geng Q. Mediating Effects of Patients\u0026rsquo; Stigma and Self-Efficacy on Relationships Between Doctors\u0026rsquo; Empathy Abilities and Patients\u0026rsquo; Cellular Immunity in Male Breast Cancer Patients. Med Sci Monit. 2018;24:3978\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12659/MSM.910794\u003c/span\u003e\u003cspan address=\"10.12659/MSM.910794\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnwar MM, Khalil DM. Breast cancer knowledge, attitude and practice among medical and non-medical university students. J Public Health (Germany). 2021;29:871\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S10389-020-01197-Z\u003c/span\u003e\u003cspan address=\"10.1007/S10389-020-01197-Z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsaraireh A, Darawad MW. Impact of a Breast Cancer Educational Program on Female University Students\u0026rsquo; Knowledge, Attitudes, and Practices. J Cancer Educ. 2019;34:315\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S13187-017-1304-6\u003c/span\u003e\u003cspan address=\"10.1007/S13187-017-1304-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKinteh B, Kinteh SLS, Jammeh A, Touray E, Barrow A. Breast Cancer Screening: Knowledge, Attitudes, and Practices among Female University Students in The Gambia. Biomed Res Int. 2023;2023:9239431. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2023/9239431\u003c/span\u003e\u003cspan address=\"10.1155/2023/9239431\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarlow LAV, Wardle J. Development of a scale to assess cancer stigma in the non-patient population. BMC Cancer. 2014;14:1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2407-14-285\u003c/span\u003e\u003cspan address=\"10.1186/1471-2407-14-285\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: A population-based survey in England. BMC Cancer. 2019;19:1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12885-019-5787-X\u003c/span\u003e\u003cspan address=\"10.1186/S12885-019-5787-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSayed S, Ngugi AK, Mahoney MR, Kurji J, Talib ZM, MacFarlane SB, et al. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC Public Health. 2019;19:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12889-019-6464-3\u003c/span\u003e\u003cspan address=\"10.1186/S12889-019-6464-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalem H, Daher-Nashif S. Psychosocial aspects of female breast cancer in the middle east and North Africa. Int J Environ Res Public Health. 2020;17:1\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/IJERPH17186802\u003c/span\u003e\u003cspan address=\"10.3390/IJERPH17186802\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSolikhah S, Matahari R, Utami FP, Handayani L, Marwati TA. Breast cancer stigma among Indonesian women: A case study of breast cancer patients. BMC Womens Health. 2020;20:1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12905-020-00983-X\u003c/span\u003e\u003cspan address=\"10.1186/S12905-020-00983-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnwar MM, Khalil DM. Breast cancer knowledge, attitude, and practice among medical and non-medical university students. J Public Health (Germany). 2021;29:871\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S10389-020-01197-Z\u003c/span\u003e\u003cspan address=\"10.1007/S10389-020-01197-Z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamya Ahmad S, Asmaa Ahmad A, Nesreen Abdullah A, Rana Ahmad Bin S, Shaimaa Amer A, Aisha T, et al. Awareness Level, Knowledge and Attitude towards Breast Cancer between Medical and Non-Medical University Students in Makkah Region: A Cross Sectional Study. Int J Cancer Clin Res. 2019;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23937/2378-3419/1410106\u003c/span\u003e\u003cspan address=\"10.23937/2378-3419/1410106\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSajan AS, Eldhose SR, Kandasamy K, Ramanathan S. Comparing the knowledge and awareness of cervical and breast cancer among medical and nonmedical students of a private institution in South India. J Cancer Res Ther. 2022;18:1776\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/JCRT.JCRT_172_20\u003c/span\u003e\u003cspan address=\"10.4103/JCRT.JCRT_172_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFitzGerald C, Hurst S. Implicit Bias in Healthcare Professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12910-017-0179-8\u003c/span\u003e\u003cspan address=\"10.1186/s12910-017-0179-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlbenayyan HA, AlSubaie R, Alarfaj MO, Alshekhmobarak L, Alkhalifah MF, Alsaleem H, et al. Cancer Stigma Among 800 Saudi Citizens: A Cross-Sectional Study and Literature Review. Cureus. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/CUREUS.49088\u003c/span\u003e\u003cspan address=\"10.7759/CUREUS.49088\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJustine M, Jafri MS, Joanny A, Akmar AN. Stigmatization toward cancer among university students in Malaysia. J Health Sci. 2021;11:149\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17532/JHSCI.2021.1322\u003c/span\u003e\u003cspan address=\"10.17532/JHSCI.2021.1322\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIbrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer Incidence in Egypt: Results of the National Population-Based Cancer Registry Program. J Cancer Epidemiol. 2014;1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2014/437971\u003c/span\u003e\u003cspan address=\"10.1155/2014/437971\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung JE, Lee CJ. The impact of cancer information online on cancer fatalism: education and eHealth literacy as moderators. Health Educ Res. 2019;34:543\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/HER/CYZ027\u003c/span\u003e\u003cspan address=\"10.1093/HER/CYZ027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdelaziz AH, Shawki MA, Shaaban AM, Albarouki SK, Rachid AM, Alsalhani OM, et al. Breast Cancer Awareness among Egyptian Women and the Impact of Caring for Patients with Breast Cancer on Family Caregivers\u0026rsquo; Knowledge and Behaviour. Res Oncol. 2021;17:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21608/RESONCOL.2020.42340.1114\u003c/span\u003e\u003cspan address=\"10.21608/RESONCOL.2020.42340.1114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErnst J, Mehnert A, Dietz A, Hornemann B, Esser P. Perceived stigmatization and its impact on quality of life - results from a large register-based study including breast, colon, prostate and lung cancer patients. BMC Cancer. 2017;17:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12885-017-3742-2\u003c/span\u003e\u003cspan address=\"10.1186/S12885-017-3742-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRiley KE, Ulrich MR, Hamann HA, Ostroff JS. Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA J Ethics. 2017;19:475\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTetteh DA, Faulkner SL. Sociocultural Factors and Breast Cancer in Sub-Saharan Africa: Implications for Diagnosis and Management. Women\u0026rsquo;s Health. 2016;12:147. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2217/WHE.15.76\u003c/span\u003e\u003cspan address=\"10.2217/WHE.15.76\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun YS, Zhao Z, Yang ZN, Xu F, Lu HJ, Zhu ZY, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13:1387. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7150/IJBS.21635\u003c/span\u003e\u003cspan address=\"10.7150/IJBS.21635\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarr L, Daniel B. Does following a breast cancer patient for a day enhance medical student empathy? Med Teach. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/0142159X.2024.2311864\u003c/span\u003e\u003cspan address=\"10.1080/0142159X.2024.2311864\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlMubarak SH. Students as policymakers and policy advocates: Role-playing evidence-based health policies. Simul Gaming. 2022;54(1):45\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/10468781221143052\u003c/span\u003e\u003cspan address=\"10.1177/10468781221143052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Global Breast Cancer Initiative Implementation Framework: Assessing, Strengthening and Scaling Up of Services for the Early Detection and Management of Breast Cancer [Internet]. Geneva: WHO. 2023. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240065987\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240065987\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations. Transforming our world: the 2030 Agenda for Sustainable Development [Internet]. United Nations. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sdgs.un.org/2030agenda\u003c/span\u003e\u003cspan address=\"https://sdgs.un.org/2030agenda\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInternational Federation of Medical Students\u0026rsquo; Associations. Policy and advocacy [Internet]. IFMSA. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ifmsa.org/policy-and-advocacy/\u003c/span\u003e\u003cspan address=\"https://ifmsa.org/policy-and-advocacy/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantos MA, Grosseman S, Morelli TC, Giuliano ICB, Erdmann TR. Empathy differences by gender and specialty preference in medical students: a study in Brazil. Int J Med Educ. 2016;7:149\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5116/IJME.572F.115F\u003c/span\u003e\u003cspan address=\"10.5116/IJME.572F.115F\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassan EE, Seedhom AE, Mahfouz EM. Awareness about breast cancer and its screening among rural Egyptian women, Minia District: A population-based study. Asian Pac J Cancer Prev. 2017;18:1623\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22034/APJCP.2017.18.6.1623\u003c/span\u003e\u003cspan address=\"10.22034/APJCP.2017.18.6.1623\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManzour AF, Gamal Eldin DA. Awareness about breast cancer and mammogram among women attending outpatient clinics, Ain Shams University Hospitals, Egypt. J Egypt Public Health Assoc. 2019;94:26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S42506-019-0026-5\u003c/span\u003e\u003cspan address=\"10.1186/S42506-019-0026-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaabi MAL, Zaabi A, Al. Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman. Asian Pac J Cancer Prev. 2024;25:1223\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31557/APJCP.2024.25.4.1223\u003c/span\u003e\u003cspan address=\"10.31557/APJCP.2024.25.4.1223\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYe X, Liu HY, Lu SR, Zhai Q, Yu B. Translation and validation of the Chinese version of the Cancer Stigma Scale. J Oncol Pharm Pract. 2019;25:1622\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1078155218802627\u003c/span\u003e\u003cspan address=\"10.1177/1078155218802627\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrassi L, Watson M. Core-curriculum in psycho‐oncology: Towards the certification of the psycho‐oncologist profession. Psycho-oncology. 2024;33(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pon.6285\u003c/span\u003e\u003cspan address=\"10.1002/pon.6285\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSedrak AS, Galal YS, Amin TT. Cancer screening knowledge and attitudes of under- and post-graduate students at Kasr Al Ainy School of Medicine, Cairo University, Egypt. Asian Pac J Cancer Prev. 2016;17(8):3809\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations Economic and Social Commission for Western Asia. Multidimensional Poverty in Egypt [Internet]. Beirut: UNESCWA. 2017. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unescwa.org/sites/default/files/pubs/pdf/multidimensional-poverty-egypt-english_0.pdf\u003c/span\u003e\u003cspan address=\"https://www.unescwa.org/sites/default/files/pubs/pdf/multidimensional-poverty-egypt-english_0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnderstanding Poverty and Inequality in Egypt. Understanding Poverty and Inequality in Egypt. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1596/32812\u003c/span\u003e\u003cspan address=\"10.1596/32812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerrell R, Kravitz K. Cancer Care: Supporting Underserved and Financially Burdened Family Caregivers. J Adv Pract Oncol. 2017;8:494. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.6004/jadpro.2017.8.5.5\u003c/span\u003e\u003cspan address=\"10.6004/jadpro.2017.8.5.5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlzehr A, Hulme C, Spencer A, Morgan-Trimmer S. The economic impact of cancer diagnosis on individuals and their families: a systematic review. Support Care Cancer. 2022;30:6385\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S00520-022-06913-X\u003c/span\u003e\u003cspan address=\"10.1007/S00520-022-06913-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaffee K, Cohen M, Azaiza F, Hammad A, Hamade H, Thompson H. Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women. J Immigr Minor Health. 2021;23:95\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S10903-020-01019-0\u003c/span\u003e\u003cspan address=\"10.1007/S10903-020-01019-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Ata BA, A Sabour A, Shehata Ibrahim M. Effect of A Health Education Program about Breast Cancer and Breast Self Examination on the Knowledge and Practices of Females Employees. Egypt J Health Care. 2016;7:182\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21608/EJHC.2016.197443\u003c/span\u003e\u003cspan address=\"10.21608/EJHC.2016.197443\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTrusson D, Pilnick A. Between stigma and pink positivity: women\u0026rsquo;s perceptions of social interactions during and after breast cancer treatment. Sociol Health Illn. 2017;39:458\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1467-9566.12486\u003c/span\u003e\u003cspan address=\"10.1111/1467-9566.12486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmini-Tehrani M, Zamanian H, Daryaafzoon M, Andikolaei S, Mohebbi M, Imani A, et al. Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. J Adv Nurs. 2021;77:3412\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/JAN.14881\u003c/span\u003e\u003cspan address=\"10.1111/JAN.14881\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer stigma, Medical students, Egypt, Cancer stigma scale, Low- and middle-income countries","lastPublishedDoi":"10.21203/rs.3.rs-6640623/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6640623/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eBreast cancer (BC) stigma remains an understudied barrier to early detection and quality care, particularly in low- and middle-income countries (LMICs). Yet, there is a lack of studies that assessed BC stigma among medical students worldwide; a critical gap given their future roles as healthcare providers. This study aims to explore BC stigma among medical students in Egypt and identify its associated factors.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA national multi-center cross-sectional study was conducted during the academic year 2024\u0026ndash;2025, involving a convenience sample of 2,576 medical students from eight medical faculties across Egypt\u0026rsquo;s four main regions. Data were collected through an online questionnaire capturing socio-demographic characteristics, educational background, BC-related experiences, and knowledge of BC including students\u0026rsquo; primary sources of information on the subject, alongside the BC-adapted Cancer Stigma Scale (CASS) that assessed six domains: Severity, Financial Discrimination, Personal Responsibility, Awkwardness, Avoidance, and Policy Opposition. Median (M) scores were computed, and non-parametric tests and multivariate linear regression were used to identify associated factors.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe overall BC stigma score was relatively low, with a median of 2.16 (36% of the total score). However, stigma was highest in Severity and Financial Discrimination (M\u0026thinsp;=\u0026thinsp;3.0 and 2.67, respectively), and lowest in Avoidance and Policy Opposition (M\u0026thinsp;=\u0026thinsp;1.00 and 1.33, respectively). Significantly higher stigma scores were observed in males (M\u0026thinsp;=\u0026thinsp;2.20), those living in Upper Egypt governorates and rural residents (M\u0026thinsp;=\u0026thinsp;2.30 and 2.24; respectively), and those with less-than-sufficient family income (M\u0026thinsp;=\u0026thinsp;2.30). The regression analysis revealed significant associations between stigma and various sociodemographic variables, including sex, age, educational year, residence, and family income (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and BC-related questions such as history of breast problems and sufficient awareness about BC (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The primary sources of information about BC for medical students were found to be medical curricula (24.2%), internet/social media (20.0%), and healthcare professionals (16.3%).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eThis study provides an insight into exploring BC stigma among medical students. While the overall stigma was relatively low, significant disparities persist, particularly regarding perceived Severity among male and rural participants. Future interventions should target students with high levels of stigma through curricular reforms that incorporate anti-stigma training.\u003c/p\u003e\u003ch2\u003eTrial Registration\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Exploring breast cancer stigma among medical students in Egypt: A national multi-center cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-03 15:09:29","doi":"10.21203/rs.3.rs-6640623/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-08-27T06:35:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T06:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41736025634085146057430435361963259435","date":"2025-07-03T10:34:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T11:10:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27433933811500379199120364477397611465","date":"2025-06-30T09:53:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-27T15:34:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T07:46:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-26T17:43:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f1064d9-80b7-4b98-953b-7ff1428de9b4","owner":[],"postedDate":"August 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:05:26+00:00","versionOfRecord":{"articleIdentity":"rs-6640623","link":"https://doi.org/10.1186/s12889-025-24656-2","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-10-27 15:58:25","publishedOnDateReadable":"October 27th, 2025"},"versionCreatedAt":"2025-08-03 15:09:29","video":"","vorDoi":"10.1186/s12889-025-24656-2","vorDoiUrl":"https://doi.org/10.1186/s12889-025-24656-2","workflowStages":[]},"version":"v1","identity":"rs-6640623","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6640623","identity":"rs-6640623","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}