Cultural Beliefs and Perceptions of Breast Cancer among Adolescent Girls in Semi-Urban Bangladesh: A School-Based Study

Cultural Beliefs and Perceptions of Breast Cancer among Adolescent Girls in Semi-Urban Bangladesh: A School-Based 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 Cultural Beliefs and Perceptions of Breast Cancer among Adolescent Girls in Semi-Urban Bangladesh: A School-Based Study Ryadul Alam, Sadia Akter, Tanaa Mohammad, Rowshanara Rini, Mst Mariyam, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8628237/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Breast cancer is the most common cancer among women and poses a growing public health burden in developing countries, including Bangladesh. Cultural stigma, limited awareness, and delayed recognition contribute to late diagnosis, particularly among younger females. This study examines cultural beliefs and perceptions of breast cancer among adolescent girls in semi-urban Bangladesh. Method A school-based cross-sectional study was conducted among adolescent girls in semi-urban Savar, Dhaka, Bangladesh, from January to May 2025. Four schools were randomly selected and 384 participants were recruited using stratified random sampling. Cultural beliefs about breast cancer were assessed using a modified 13-item Ferrans Cultural Beliefs Scale, translated into Bangla using a committee-based approach. Data were analyzed using SPSS version 26 with descriptive statistics, t-tests, one-way ANOVA, and multiple linear regression. Result Cultural belief score is 7.38 ± 2.08, rooted misconceptions among participants. Multiple linear regression analysis showed that higher class of study was positively associated with cultural belief scores (β = 0.236, p = 0.037), while having a family history of breast cancer was strongly associated with lower cultural belief scores (β = −1.979, p < 0.001). Reliance on friends as a source of information significantly increased cultural belief scores (β = 1.358, p 0.05). Conclusion Cultural beliefs about breast cancer are common among adolescent girls in semi-urban Bangladesh that underscoring the need for early, culturally sensitive school-based education. Cultural Belief Breast Cancer Adolescent Girls Bangladesh Introduction Cancer is a major public health problem globally, with an estimated 20 million new cases and 9.7 million deaths globally [ 1 ]. While lung cancer is the most common cancer in men (12.4% of all new cases), breast cancer is by far the most common cancer amongst women, accounting for 11.6% of all new cancer cases [ 1 ]. More than half of the Breast Cancer deaths occur in the economically developing countries [ 2 ]. The South Asian countries are experiencing an epidemic of breast cancer in secrecy. The rate of breast cancer is on the rise and is alarming. About 588 million women above the age of 15 are dealing with a growing breast cancer epidemic [ 2 ]. In South Asia, information on epidemiology, genetic and other environmental backgrounds of breast cancer is very limited. Breast cancer in Pakistan affects one out of every nine women, and the mortality rate of breast cancer is 26.% [ 3 , 4 ]. In India, the percentage of breast cancer incidence presents 27% and the mortality rate presents 21.5% [ 5 ]. Following the current trend, breast cancer accounts for 45% of all cancer in females aged 25–49 years age group in the United Kingdom [ 6 ]. The incidence in the age group between 15–24 is 3.1 per million of population in the UK [ 6 ]. As a rule, in comparison with older women and women above 50, this illness is more popular among younger women below 50, and nowadays, due to the increased number of people in this population, the absolute numbers of women who are too young and diagnosed with breast cancer are rising. In Bangladesh, breast cancer represents a growing public health concern and ranks second only to cervical cancer among women. Together, these two cancers account for nearly 38% of all female cancers nationwide. The incidence rate of breast cancer in Bangladesh is estimated at 22.5 per 100,000 women, with a mean age of diagnosis of 41.8 years, indicating a substantial burden among premenopausal women [ 7 , 8 ]. Despite this, awareness and timely recognition of breast cancer remain low, particularly among younger females [ 9 ]. Cultural taboos surrounding the female body, modesty norms, fear of social judgment, and reluctance to discuss breast-related health issues contribute significantly to delayed health-seeking behavior [ 10 ]. Most of the breast cancer cases diagnosed at advanced stages in Bangladesh [ 11 ]. This pattern is closely linked to sociocultural barriers, including misconceptions about cancer, stigma associated with the disease, fear of discrimination, and limited open communication within families and communities. In semi-urban areas, these challenges are further compounded by inadequate health education, limited access to accurate information, and persistent traditional beliefs that frame cancer as a fatal or shameful condition rather than a treatable disease [ 12 , 13 ]. Distance to healthcare facilities, lack of time, inconvenient service hours, and lack of health insurance or awareness about screening centers are significant obstacles [ 14 ]. Adolescence is a critical developmental period during which health beliefs, attitudes, and perceptions are formed [ 15 ]. Cultural beliefs acquired during this stage often shape lifelong health behaviors and influence future decision-making related to disease prevention and healthcare utilization. Cultural beliefs, stigma, and lack of family or community support can discourage screening, especially in more conservative or close-knit communities [ 16 ]. The most consistently reported barrier is insufficient knowledge about breast cancer and available screening methods. Many young women are unaware of the importance of screening, how to perform self-exams, or where to access services [ 17 – 19 ]. Fear of pain, fear of a cancer diagnosis, embarrassment, and anxiety about the screening procedure or results deter many young women from participating [ 16 , 19 ]. However, in Bangladesh, adolescent girls—particularly those attending high schools in semi-urban settings—remain an understudied population in breast cancer research. Existing studies have largely focused on adult women or university students, overlooking the early formation of beliefs, misconceptions, and stigma among school-aged girls. Understanding cultural beliefs about breast cancer among adolescent girls is especially important in semi-urban contexts, where traditional values coexist with increasing exposure to modern education and media. These settings represent a transitional space in which cultural norms, gender expectations, and health knowledge interact in complex ways. Without targeted, culturally sensitive interventions at the school level, misconceptions and stigma surrounding breast cancer may persist into adulthood, perpetuating delays in recognition and care-seeking. Therefore, this study aims to explore knowledge, perception and predictors of cultural belief related to breast cancer among female high school students in semi-urban areas of Bangladesh. By focusing on adolescent girls within a school-based setting, this research seeks to address a critical gap in the literature and generate evidence to inform culturally appropriate awareness programs and early preventive strategies tailored to this vulnerable population. Method Study Design and Participants and Sampling This school-based cross-sectional study was conducted among adolescent girls in a semi-urban area of Dhaka, Bangladesh. The study was carried out over a five-month period, from January 2025 to May 2025, across four that are selected randomly from the selected semi urban area, Savar. The sample size was determined using Yamane’s simplified sampling formula, which estimated a minimum required sample of 384 participants. A proportionate stratified random sampling technique was used, with each school considered a stratum. The number of participants selected from each school was proportional to the total number of eligible students enrolled, ensuring balanced representation across the study population. Inclusion criteria were: (i) female students who enrolled in the selected schools, and (ii) willingness to participate in the survey. Exclusion criteria for those who provided incomplete responses. Study Instruments A modified version of the Cultural Beliefs Scale that was first created by Ferrans was used to evaluate cultural beliefs about breast cancer. This scale was formulated to assess the degree to which beliefs that are culturally based serve to act as impediment to early breast cancer diagnosis, and that it may also be a contributor to the late diagnosis. The initial scale has 17 questions divided into four conceptual areas that are beliefs about breast lumps (4 items), self-help techniques (4 items), faith-based beliefs (4 items), and perceived futility of treatment (5 items). The question is rated in a dichotomous format of response (true or false). To exclude the items of mammography in the current study, mammography services are not regularly available and applicable in the study setting and target population. Upon the removal of these items, the resulting version of the scale had 13 items, whose total scores were to fall between 0 and 13 [ 20 ]. The higher the scores, the more the cultural beliefs being endorsed which might serve as the hindrance to early recognition and care seeking of breast cancer and the lower the scores, the lower the number of beliefs. The translation into Bangali was done using a committee-based translation strategy so as to have linguistic correctness and cultural appropriateness. First, a questionnaire was translated into Bangali by three bilingual experts on their own. These translators were scholars who had knowledge on public health and were conversant with the Bangladeshi cultures besides being good in the English language. A consensus meeting to address inconsistencies and sharpen language was carried out to review and discuss the translated versions. The initial Bangali version was then used by the main investigator, oncologist and another local authority to revise it further to increase the clarity and cultural suitability to adolescent respondents. Data analysis SPSS version 26 was used to analyze the data. Descriptive statistics including frequencies. and percentages were calculated with respect to categorical variables; means and standard were calculated with respect to categorical variables. continuous variables had deviations. Certain one-way analyses (i.e. t-tests and one-way ANOVA) were calculated to determine the relationship between independent and dependent variables. Multiple linear regression is done to determine the factors associated with cultural belief. Ethical considerations The study protocol was reviewed and approved by the Biosafety, Biosecurity, and Ethical Clearance Committee, BBEC, JU/M 2025/01(175), Jahangirnagar University, Savar, Dhaka-1342, Bangladesh. In accordance with the Declaration of Helsinki, before starting data collection, participants were informed about the objectives, methodology and the approximate time to complete the survey. Then written informed consent was obtained from each participant. Likewise, participants were also assured that all information related to them will be kept confidential and anonymous. Result Out of 384 adolescent girls, the majority were between the age of 13–15 years (65.4%), then 16–17 years (29.2%), and 17–19 years (5.5). Class 9 was 42.7% and Class 10 was 34.9 and Class 11–12 was 22.4. Most of them were single (98.2%) and had the religion of Islam (97.1%). In terms of household income, 62.5% of the respondents gave the monthly income of the family above 30,000 BDT on average, and 37.5% ranked below 30,000. The level of education among fathers was as follows; 5.2% primary education, 26.0% secondary, 39.1% higher secondary, 26.3% graduate level and 3.4% had no education. In the case of education of mothers, 12.0% were primary educated, 32.3% secondary, 31.0% were higher secondary, 23.2% graduate level and 1.6 percent were not educated at all. Cultural belief scores did not differ significantly by marital status (t = 0.968, p = 0.334). Cultural belief scores were significantly higher among participants from lower-income households compared to those from higher-income households (F = 3.50, p = 0.001). Father’s educational level showed no significant association with cultural belief scores (F = 0.723, p = 0.576). However, mothers’ educational level was significantly associated with cultural beliefs (F = 4.290, p = 0.002), with higher mean scores observed among participants whose mothers had primary or higher secondary education compared to those whose mothers were graduates. There is no significant differences in cultural belief scores that were observed across religious groups (F = 0.159, p = 0.853). Participants with a family history of breast cancer (8.1%) had significantly higher cultural belief scores compared to those without such a history (t = 7.982, p < 0.001). Among participants reporting a family history of breast cancer, no significant differences in cultural belief scores were observed based on the relationship with the affected family member (F = 0.377, p = 0.825). Knowledge about breast self-examination (BSE) was reported by 29.9% of participants; however, cultural belief scores did not differ significantly between those who had knowledge of BSE and those who did not (t = 0.127, p = 0.889). Sources of information related to breast health were also examined. No significant differences in cultural belief scores were observed for information obtained from television, radio, books, the internet, or healthcare professionals (p > 0.05). However, participants who reported receiving information from family members or friends had significantly lower cultural belief scores compared to those who did not (t = − 7.861, p < 0.001) ( Table 1 ). Table 1 Differences in Cultural Beliefs by General Characteristics (N = 384) Characteristics N (%) Cultural Belief M ± SD F / t P values Age 13–15 years old 251 (65.4) 7.15 (2.03) 1.780 0.170 16–17 years old 112 (29.2) 7.57 (2.07) 17–19 years old 21 (5.5) 7.46 (2.24) Class of Study Class 9 (Secondary Level) 164 (42.7) 6.93 (1.90) 6.865 0.001** Class 10 (Secondary Level) 134 (34.9) 7.72 (2.06) Class 11 & 12 (Intermediate Level) 86 (22.4) 7.72 (2.28) Section Science 154 (40.1) 7.61 (2.17) 1.673 0.189 Business Study 117 (30.5) 7.15 (1.74) Humanities Marital Status Married Unmarried 113 (29.4) 7 (1.8) 377 (98.2) 7.32 (2.24) 8.14 (0.69) 7.37 (2.09) 0.968 0.334 Average Family Monthly Income < AMFI (AMFI (> 30,000 BDT) 240 (62.5) 7.10 (2.12) Father’s Education Level Primary Level 20 (5.2) 7.35 (1.75) 0.723 0.576 Secondary Level 100 (26.0) 7.16 (2.03) Higher Secondary Level 150 (39.1) 7.56 (2.17) Graduate 101 (26.3) 7.30 (2.12) No education 13 (3.4) 7.76 (1.36) Mother’s Education Level Primary Level 46 (12.0) 7.39 (1.91) 4.290 0.002*** Secondary Level 124 (32.3) 7.49 (2.13) Higher Secondary Level 119 (31.0) 7.83 (1.79) Graduate 89 (23.2) 6.66 (2.33) No education 6 (1.6) 7.16 (0.98) Religion Islam 373 (97.1) 7.37 (2.09) 0.159 0.853 Hindu 10 (2.6) 7.70 (1.49) Others 1 (0.3) 8.00 (0.00) Family History of Breast Cancer Yes 31 (8.1) 9.35 (1.98) 7.982 < 0.001*** No 353 (91.9) 7.33 (1.69) Relationship with the patient Mother 7 (1.8) 7.00 (1.41) 0.377 0.825 Sister 7 (1.8) 7.71 (2.49) Aunt 12 (3.1) 8.00 (1.65) Grandmother 5 (1.3) 7.20 (1.92) Unknown 353 (91.9) 7.37 (2.10) Knowledge about BSE Yes 115 (29.9) 7.40 (1.82) 0.127 0.889 No 269 (70.1) 7.37 (2.18) Source of BSE information Television Yes 23 (6.0) 7.17 (2.12) -0.508 0.612 No 361 (94.0) 7.40 (2.08) Radio Yes 2 (0.5) 5.50 (2.12) -1.287 0.199 No 382 (99.5) 7.39 (2.07) Books Yes 5 (1.3) 7.40 (2.50) 0.013 0.990 No 379 (98.7) 7.38 (2.07) Family/ Friends Yes 55 (14.3) 5.49 (2.59) -7.861 < 0.001*** No 329 (85.7) 7.70 (1.80) Internet Yes 102 (26.6) 7.44 (2.07) 0.301 0.764 No 282 (73.4) 7.36 (2.08) Healthcare workers/ Health professionals Yes 11 (2.9) 7.90 (3.20) 0.842 0.400 No 373 (97.1) 7.37 (2.04) Table 2 presents the distribution of responses to individual items assessing cultural beliefs related to breast cancer among the participants. Beliefs related to breast lump characteristics were common. More than one-third of respondents believed that a breast lump is not cancer if it is not painful (35.2%) or does not increase in size (41.4%). Additionally, 35.9% believed that frequently touching or pressing a breast lump could cause it to develop into breast cancer. Regarding self-help techniques, 45.1% of participants believed that excessive worry about breast cancer increases the likelihood of developing the disease, while 39.6% believed that taking good care of oneself can prevent breast cancer. Furthermore, 37.2% believed that natural remedies could eliminate a breast lump, indicating reliance on non-medical approaches. Faith-based beliefs were also prevalent among the respondents. Approximately one-quarter of participants (26.0%) believed that faith in God could protect them from breast cancer. A higher proportion believed that prayer could cause breast lumps to disappear (61.2%), and 58.0% believed that strong faith in God could eliminate the need for medical treatment. Beliefs reflecting the futility of treatment were evident among a substantial proportion of participants. Half of the respondents (50.3%) believed that breast cancer grows faster if surgically operated on. Additionally, 34.4% believed that poverty prevents cure due to limited access to the best treatment. Although 23.2% correctly recognized that breast cancer can be cured if treated appropriately (reverse-coded item), 26.6% believed that treatment does not alter outcomes because cancer inevitably leads to death. The overall mean cultural belief score was 7.38 ± 2.08, indicating a moderate level of endorsement of culturally rooted misconceptions related to breast cancer among the participants. Table 2 Participants’ Levels of Cultural Beliefs (N = 384) Domain Item Response n(%) Right Wrong 1. Breast lump characteristics 1.If a breast lump is not painful, it is not cancer. 135 (35.2) 249 (68.2) 2. If a breast lump does not get bigger, it is not cancer 159 (41.4) 225 (58.6) 3. If a breast lump is touched/pressed often, it will turn out to be breast cancer 138 (35.9) 246 (64.1) 2. Self-help techniques 5. The more you worry about breast cancer, the more likely you will get it. 173 (45.1) 211 (54.9) 6. If you take good care of yourself, you won’t get breast cancer. 152 (39.6) 232 (60.4) 13. If you have a breast lump, a “natural” remedy can help to get rid of it 143 (37.2) 241 (62.8) 3. Faith-based beliefs 7. Faith in God can protect you from breast cancer 100 (26.0) 284 (74.0) 10. If you pray enough, sometimes breast lumps will disappear. 235 (61.2) 149 (38.8) 14. If a woman has enough faith in God, she won’t need treatment for breast cancer. 195 (58.0) 189 (49.2) 4. Futility of treatment 11. If breast cancer is cut open in surgery, it will grow faster 193 (50.3) 191 (49.7) 15. If a woman is poor, she will not get cured from cancer because she won’t get the best treatment. 132 (34.4) 252 (65.6) *16. If breast cancer is treated correctly, it can be cured. 89 (23.2) 295 (76.8) 17. It doesn’t really matter if you get treated for breast cancer, because if you get cancer, it will kill you sooner or later 102 (26.6) 282 (73.4) Total mean score 7.38 ± 2.08 A multiple linear regression ( R² = 0.355, F = 43.13 ) analysis was conducted to identify predictors of cultural beliefs about breast cancer among adolescent girls. Class of study was a significant positive predictor of cultural belief scores (B = 0.236, SE = 0.113, β = 0.089, t = 2.097, p = 0.037), indicating that students in higher classes were more likely to endorse cultural beliefs related to breast cancer. Family history of breast cancer emerged as a strong negative predictor (B = − 1.979, SE = 0.181, β = −0.466, t = − 10.930, p < 0.001), suggesting that participants with a family history of breast cancer held significantly fewer cultural misconceptions compared to those without such a history. Friends as a source of information was significantly associated with higher cultural belief scores (B = 1.358, SE = 0.258, β = 0.229, t = 5.260, p < 0.001), indicating that reliance on peers for information was linked to greater endorsement of cultural beliefs. In contrast, mother’s education level (B = − 0.059, SE = 0.086, β = −0.028, p = 0.497) and average monthly family income (B = − 0.277, SE = 0.182, β = −0.065, p = 0.128) were not statistically significant predictors of cultural belief scores ( Table 3 ). Table 3 Multiple Linear Regression Analysis for Factors Associated with Cultural Beliefs Predictor B SE β t p 95% CI Class of study 0.236 0.113 0.089 2.097 0.037* [0.015, 0.458] Mother’s education level -0.059 0.086 -0.028 -0.680 0.497 [-0.228, 0.111] Family history of breast cancer -1.979 0.181 -0.466 -10.930 < 0 .001** [-2.335, -1.623] Friends 1.358 0.258 0.229 5.260 < 0.001** [0.851, 1.866] Average monthly income -0.277 0.182 -0.065 -1.525 0.128 [-0.635, 0.080] R² = 0.363, Adjusted R² = 0.355, F = 43.13 Discussion This study provides a insights into knowledge, perception and predictors of cultural belief related to breast cancer among female high school students in semi-urban areas of Bangladesh. The present study found that cultural belief scores increased significantly with higher class of study, indicating that students in advanced grades held stronger culturally rooted beliefs about breast cancer. This finding is partially inconsistent with studies conducted among adult women and university students, where higher educational attainment is associated with greater health and science-related capabilities [ 21 , 22 ]. However, similar patterns have been observed in recent study in China, cancer literacy strongly tracks education level, yet even better-educated groups have weakest literacy in prevention and risk factors [ 23 ]. This discrepancy may be explained by the absence of structured breast health education in secondary & higher secondary school curriculum in Bangladesh [ 24 ]. As adolescents advance academically, both the internet and parents, with friends becoming especially important for sensitive topics (e.g., sexuality) [ 25 ]. In the absence of accurate guidance, these exposures may reinforce cultural myths rather than correct them. Thus, unlike higher education settings, secondary schooling alone may be insufficient to counter deeply ingrained cultural beliefs during adolescence. Adolescents with a family history of breast cancer exhibited significantly lower cultural belief scores. Similar findings have been reported in studies from in the Middle East and North Africa, knowing a family member or friend with breast cancer had a stronger impact on women’s self-care and screening than education or employment [ 26 ]. One of the most important findings is that adolescents who cited friends as a source of information had significantly higher cultural belief scores. A large reviews and meta-analyses, peers show consistent, cross-domain effects on adolescent behavior and attitudes [ 27 ]. However, it contrasts with studies among older youth and university students where peer education showed significant gains in breast cancer knowledge, health responsibility, health beliefs, and breast self-examination practices [ 28 ].The divergence likely reflects differences in informational quality rather than the influence mechanism itself. Among younger adolescents in semi-urban Bangladesh, peer networks may function as echo chambers for misinformation, rumors, and culturally transmitted myths, particularly in environments where adult guidance and formal health education are limited. This contrasts with university environments, where peer discussions are more likely to be informed by academic exposure and access to credible information sources. Contrary to several studies conducted among adult women, this study found no significant association between cultural belief scores and household income or mother’s education level in the multivariable model. Previous research has often reported higher education, income, and health insurance jointly improve breast cancer knowledge, attitudes, and preventive behaviors, whereas low SES and cultural beliefs sustain misinformation and delayed diagnosis [ 29 ]. The high prevalence of faith-based observed in this study is consistent with findings from other South Asian and Muslim-majority contexts, where religious interpretations often coexist with biomedical explanations of disease [ 30 ]. Beliefs that prayer alone can eliminate illness or that cancer is inevitably fatal have been widely documented and are associated with delayed care-seeking in adulthood. This study has several limitations that should be considered when interpreting the findings. First, cross-sectional design prevents causal inferences regarding the relationships between sociodemographic factors and cultural beliefs about breast cancer. Second, the study was conducted among female students from semi-urban schools in a limited geographic area, which may restrict the generalizability of the results to adolescents in rural or urban settings. Third, the reliance on self-reported data may have introduced reporting or social desirability bias, particularly given the sensitive nature of breast health topics in the local cultural context. Finally, the absence of qualitative data limits a deeper exploration of the underlying reasons and contextual meanings behind the observed cultural beliefs. Conclusion This study shows that many adolescent girls in semi-urban Bangladesh hold cultural beliefs and misconceptions about breast cancer that may influence how they understand the disease and respond to it in the future. Such beliefs are influenced by levels of school, family exposure on breast cancer, and friends. Due to the importance of teens as a period during which long-term health attitudes are established, it is essential to inform about misconceptions at an early age. Elementary and culturally sensitive interventions could be undertaken in schools to make the research understandable and lower the pernicious beliefs through the incorporation of peers, families, and trusted community members. Altogether, the results indicate the necessity to educate young girls with proper and correct information to make them build healthier attitudes to breast cancer during their adulthood. Declarations Ethics approval & consent to participate: The study was approved by the Biosafety, Biosecurity & Ethical Committee, Faculty of Biological Sciences, Jahangirnagar University (Approval No. BBEC, JU/M 2025/01(175)). Written informed consent was obtained from all participants and their legal guardians . Consent for publication: Written informed consent for publication of anonymized data was obtained from all participants. Availability of data and materials: The datasets supporting the conclusions of this article are available from the corresponding author upon reasonable request Competing interest statement: All authors declare that there are no conflicts of interest. Funding statement: This research received no external funding. All resources utilized for the study were provided by the authors. Author Contributions Conceptualization: Ryadul Alam, Md. Tajuddin Sikder Data collection and Data entry: Sadia Akter, Tanaa Mohammad, Rowshanara Rini, Mst Mariyam, Afrana Akter Priti, Aishwaria Mitra Ayshee, Md Shahriar Hossen Sayem, Afsana Mohammad Mimi, Formal analysis: Ryadul Alam, Sadia Akter, Zubaida Iftekhar Investigation: Md. Habibullah Talukder, Md. Tajuddin Sikder Methodology: Ryadul Alam, Md. Tajuddin Sikder, Zubaida Iftekhar Supervision: Md. Habibullah Talukder, Md. Tajuddin Sikder Validation: Md. Habibullah Talukder Writing – original draft: Ryadul Alam, Sadia Akter, Tanaa Mohammad, Rowshanara Rini, Mst Mariyam, Afrana Akter Priti, Aishwaria Mitra Ayshee, Md Shahriar Hossen Sayem Writing – review & editing : Md. Habibullah Talukder, Zubaida Iftekhar Acknowledgement: The authors sincerely thank all participants in this study. We also extend our gratitude to the school authorities and teachers for their cooperation and support during data collection. References WHO. Global cancer burden growing, amidst mounting need for services. WHO https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services (2024). Godfrey K, Agatha T, Nankumbi J. Breast Cancer Knowledge and Breast Self-Examination Practices Among Female University Students in Kampala, Uganda: A Descriptive Study. Oman Med J. 2016;31:129–34. Naqvi A, Zehra F, Ahmad R, Ahmad N. Developing a Research Instrument to Document Awareness, Knowledge, and Attitudes Regarding Breast Cancer and Early Detection Techniques for Pakistani Women: The Breast Cancer Inventory (BCI). Diseases. 2016;4:37. Naqvi AA, et al. Awareness, knowledge and attitude towards breast cancer, breast screening and early detection techniques among women in Pakistan. JPMA J Pak Med Assoc. 2018;68:576–86. Jadhav CR, Srinivasamurthy BC, Sb KP, Agrawal V, Kv B. Breast tumors and college students: a study of their knowledge, attitude and practice. Indian J Pathol Oncol (2017). Cancer Research UK. Breast cancer incidence (invasive) statistics. Cancer Res UK https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive (2015). Begum SA, et al. Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study. Mymensingh Med J MMJ. 2019;28:96–104. Hossain MS, Ferdous S, Karim-Kos HE. Breast cancer in South Asia: A Bangladeshi perspective. Cancer Epidemiol. 2014;38:465–70. Dhaka Tribune. Social taboo leading cause for unchecked breast cancer in Bangladesh. Dhaka Tribune https://www.dhakatribune.com/bangladesh/event/159421/social-taboo-leading-cause-for-unchecked-breast (2018). Rajaram N, et al. Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis. BMC Health Serv Res. 2023;23:206. Alam NE, et al. Evaluation of knowledge, awareness and attitudes towards breast cancer risk factors and early detection among females in Bangladesh: A hospital based cross-sectional study. PLoS ONE. 2021;16:e0257271. Li M, Ni P, Zuo T, Liu Y, Zhu B. Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China. Front Public Health. 2024;12:1367947. O’Callaghan C, et al. Enhancing equitable access to cancer information for culturally and linguistically diverse (CALD) communities to complement beliefs about cancer prognosis and treatment. Support Care Cancer. 2021;29:5957–65. Joho AA, Mdoe MB, Masoi TJ, Yahaya JJ. Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study. Sci Rep. 2024;14:12291. Mastorci F, Lazzeri MFL, Vassalle C, Pingitore A. The Transition from Childhood to Adolescence: Between Health and Vulnerability. Children 11, 989 (2024). Mahalakshmi S, Suresh S. Barriers to Cancer Screening Uptake in Women: A Qualitative Study from Tamil Nadu, India. Asian Pac J Cancer Prev. 2020;21:1081–7. Alkarak S et al. Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study. Cureus https://doi.org/10.7759/cureus.58324 (2024) doi:10.7759/cureus.58324. Ngan TT, Jenkins C, Minh HV, Donnelly M, O’Neill C. Breast cancer screening practices among Vietnamese women and factors associated with clinical breast examination uptake. PLoS ONE. 2022;17:e0269228. Poon PKM, et al. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front Oncol. 2023;12:1053698. Kim JG, Hong HC, Lee H, Ferrans CE, Kim E-M. Cultural beliefs about breast cancer in Vietnamese women. BMC Womens Health. 2019;19:74. Xue X, Cheng M, Zhang W. DOES EDUCATION REALLY IMPROVE HEALTH? A META-ANALYSIS. J Econ Surv. 2021;35:71–105. Zajacova A, Lawrence EM. The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach. Annu Rev Public Health. 2018;39:273–89. Li M, Ni P, Zuo T, Liu Y, Zhu B. Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China. Front Public Health. 2024;12:1367947. Hamid F, Roy T. Unveiling Sociocultural Barriers to Breast Cancer Awareness Among the South Asian Population: Case Study of Bangladesh and West Bengal, India. JMIR Hum Factors. 2025;12:e53969. Saraipour F, Panahi S, Nemati-Anaraki L, Shahraki-Mohammadi A. Adolescents’ Health Information–Seeking Behavior: A Scoping Review. J Adolesc Health. 2025;77:592–601. 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;17:6802. Laursen B, Veenstra R. Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research. J Res Adolesc. 2021;31:889–907. Coskun S, Alibekiroğlu N, Gençyürek G. Effect of Peer Education on Early Breast Cancer Detection, Health Responsibility, Health Beliefs, Knowledge, and Practices Among University Students. Public Health Nurs. 2025;42:1694–706. Karmakar R, Nagisetti Y, Mukundan A, Wang H-C. Impact of the family and socioeconomic factors as a tool of prevention of breast cancer. World J Clin Oncol 16, (2025). Arabiat D, et al. Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families. J Multidiscip Healthc. 2021;14:1755–68. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-8628237","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590559606,"identity":"ef6152fc-581d-4f4b-870d-50761ac99ea7","order_by":0,"name":"Ryadul Alam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYJACCYYCBhkGBsaGAx8qbIB8xsYDhLUYMPAwMDA3PpxxJo0BrJdILezNxrwth8EieLWYz0h+eJvHwI6Hf9rBNsmZDeft1rYfBtpSYxONS4vMjTRjax6DZB6J24ltEh933E7ediYRqOVYWm4DLkdJJJhJ8xgw8zAAtUjOPHM72ewAUAtjw2E8WtK/AbXU88gDtUjztp1LNjv/kJCWHJAth3kMbicCvd92wM7sBiFbeN4UW84xOM5jeDsRFMjJCWY3gLYk4PMLe/rGG28qquXkbqc/AEalnb3Z+fSHDz7U2ODUwiCQgMpPBKtMwFCHBPgPoPLt8SkeBaNgFIyCkQkAEP9lFOs6iTEAAAAASUVORK5CYII=","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":true,"prefix":"","firstName":"Ryadul","middleName":"","lastName":"Alam","suffix":""},{"id":590559607,"identity":"5d42ff27-cf9e-441a-a844-7ef219c3ff24","order_by":1,"name":"Sadia Akter","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Sadia","middleName":"","lastName":"Akter","suffix":""},{"id":590559608,"identity":"cc11864a-3fd3-484c-9159-73af70ea854b","order_by":2,"name":"Tanaa Mohammad","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Tanaa","middleName":"","lastName":"Mohammad","suffix":""},{"id":590559612,"identity":"8e60c556-be91-4772-8226-b2946923abc3","order_by":3,"name":"Rowshanara Rini","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Rowshanara","middleName":"","lastName":"Rini","suffix":""},{"id":590559615,"identity":"f52f8fc9-29f3-47a2-a3b1-a284512a30f3","order_by":4,"name":"Mst Mariyam","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Mst","middleName":"","lastName":"Mariyam","suffix":""},{"id":590559620,"identity":"4712a3ac-17a3-423f-b616-5f3f70718018","order_by":5,"name":"Afrana Akter Priti","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Afrana","middleName":"Akter","lastName":"Priti","suffix":""},{"id":590559622,"identity":"bac0ae20-bf3c-4551-bef3-a7a80668b592","order_by":6,"name":"Aishwaria Mitra Ayshee","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Aishwaria","middleName":"Mitra","lastName":"Ayshee","suffix":""},{"id":590559626,"identity":"81000882-8880-4511-926f-c6e25b17731e","order_by":7,"name":"Md Shahriar Hossen Sayem","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Md","middleName":"Shahriar Hossen","lastName":"Sayem","suffix":""},{"id":590559628,"identity":"f1de82ce-c5d1-45ad-82fc-506ed1266def","order_by":8,"name":"Afsana Mohammad Mimi","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Afsana","middleName":"Mohammad","lastName":"Mimi","suffix":""},{"id":590559630,"identity":"29801d38-61f5-4b19-9e5b-e2e7e594e784","order_by":9,"name":"Zubaida Iftekhar","email":"","orcid":"","institution":"St Francis College","correspondingAuthor":false,"prefix":"","firstName":"Zubaida","middleName":"","lastName":"Iftekhar","suffix":""},{"id":590559631,"identity":"3517e422-1b72-4be9-86bf-6e6215ebeb90","order_by":10,"name":"Md. Habibullah Talukder","email":"","orcid":"","institution":"National Institute of Cancer Research \u0026 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Habibullah","lastName":"Talukder","suffix":""},{"id":590559639,"identity":"e7e4c30c-87b1-44b2-8281-1132dd594920","order_by":11,"name":"Md. Tajuddin Sikder","email":"","orcid":"","institution":"Jahangirnagar University","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Tajuddin","lastName":"Sikder","suffix":""}],"badges":[],"createdAt":"2026-01-17 21:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8628237/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8628237/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107882874,"identity":"6e86b834-c5f9-4fd2-8c04-d40d8a022d26","added_by":"auto","created_at":"2026-04-27 08:58:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":444796,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8628237/v1/49b47fe2-89ba-46f2-92ce-f5e0729b3594.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cultural Beliefs and Perceptions of Breast Cancer among Adolescent Girls in Semi-Urban Bangladesh: A School-Based Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a major public health problem globally, with an estimated 20\u0026nbsp;million new cases and 9.7\u0026nbsp;million deaths globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While lung cancer is the most common cancer in men (12.4% of all new cases), breast cancer is by far the most common cancer amongst women, accounting for 11.6% of all new cancer cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. More than half of the Breast Cancer deaths occur in the economically developing countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The South Asian countries are experiencing an epidemic of breast cancer in secrecy. The rate of breast cancer is on the rise and is alarming. About 588\u0026nbsp;million women above the age of 15 are dealing with a growing breast cancer epidemic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn South Asia, information on epidemiology, genetic and other environmental backgrounds of breast cancer is very limited. Breast cancer in Pakistan affects one out of every nine women, and the mortality rate of breast cancer is 26.% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In India, the percentage of breast cancer incidence presents 27% and the mortality rate presents 21.5% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Following the current trend, breast cancer accounts for 45% of all cancer in females aged 25\u0026ndash;49 years age group in the United Kingdom [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The incidence in the age group between 15\u0026ndash;24 is 3.1 per million of population in the UK [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As a rule, in comparison with older women and women above 50, this illness is more popular among younger women below 50, and nowadays, due to the increased number of people in this population, the absolute numbers of women who are too young and diagnosed with breast cancer are rising.\u003c/p\u003e \u003cp\u003eIn Bangladesh, breast cancer represents a growing public health concern and ranks second only to cervical cancer among women. Together, these two cancers account for nearly 38% of all female cancers nationwide. The incidence rate of breast cancer in Bangladesh is estimated at 22.5 per 100,000 women, with a mean age of diagnosis of 41.8 years, indicating a substantial burden among premenopausal women [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite this, awareness and timely recognition of breast cancer remain low, particularly among younger females [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cultural taboos surrounding the female body, modesty norms, fear of social judgment, and reluctance to discuss breast-related health issues contribute significantly to delayed health-seeking behavior [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost of the breast cancer cases diagnosed at advanced stages in Bangladesh [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This pattern is closely linked to sociocultural barriers, including misconceptions about cancer, stigma associated with the disease, fear of discrimination, and limited open communication within families and communities. In semi-urban areas, these challenges are further compounded by inadequate health education, limited access to accurate information, and persistent traditional beliefs that frame cancer as a fatal or shameful condition rather than a treatable disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Distance to healthcare facilities, lack of time, inconvenient service hours, and lack of health insurance or awareness about screening centers are significant obstacles [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdolescence is a critical developmental period during which health beliefs, attitudes, and perceptions are formed [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Cultural beliefs acquired during this stage often shape lifelong health behaviors and influence future decision-making related to disease prevention and healthcare utilization. Cultural beliefs, stigma, and lack of family or community support can discourage screening, especially in more conservative or close-knit communities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The most consistently reported barrier is insufficient knowledge about breast cancer and available screening methods. Many young women are unaware of the importance of screening, how to perform self-exams, or where to access services [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Fear of pain, fear of a cancer diagnosis, embarrassment, and anxiety about the screening procedure or results deter many young women from participating [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, in Bangladesh, adolescent girls\u0026mdash;particularly those attending high schools in semi-urban settings\u0026mdash;remain an understudied population in breast cancer research. Existing studies have largely focused on adult women or university students, overlooking the early formation of beliefs, misconceptions, and stigma among school-aged girls.\u003c/p\u003e \u003cp\u003eUnderstanding cultural beliefs about breast cancer among adolescent girls is especially important in semi-urban contexts, where traditional values coexist with increasing exposure to modern education and media. These settings represent a transitional space in which cultural norms, gender expectations, and health knowledge interact in complex ways. Without targeted, culturally sensitive interventions at the school level, misconceptions and stigma surrounding breast cancer may persist into adulthood, perpetuating delays in recognition and care-seeking.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to explore knowledge, perception and predictors of cultural belief related to breast cancer among female high school students in semi-urban areas of Bangladesh. By focusing on adolescent girls within a school-based setting, this research seeks to address a critical gap in the literature and generate evidence to inform culturally appropriate awareness programs and early preventive strategies tailored to this vulnerable population.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants and Sampling\u003c/h2\u003e \u003cp\u003eThis school-based cross-sectional study was conducted among adolescent girls in a semi-urban area of Dhaka, Bangladesh. The study was carried out over a five-month period, from January 2025 to May 2025, across four that are selected randomly from the selected semi urban area, Savar.\u003c/p\u003e \u003cp\u003eThe sample size was determined using Yamane\u0026rsquo;s simplified sampling formula, which estimated a minimum required sample of 384 participants. A proportionate stratified random sampling technique was used, with each school considered a stratum. The number of participants selected from each school was proportional to the total number of eligible students enrolled, ensuring balanced representation across the study population.\u003c/p\u003e \u003cp\u003eInclusion criteria were: (i) female students who enrolled in the selected schools, and (ii) willingness to participate in the survey.\u003c/p\u003e \u003cp\u003eExclusion criteria for those who provided incomplete responses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Instruments\u003c/h3\u003e\n\u003cp\u003eA modified version of the Cultural Beliefs Scale that was first created by Ferrans was used to evaluate cultural beliefs about breast cancer. This scale was formulated to assess the degree to which beliefs that are culturally based serve to act as impediment to early breast cancer diagnosis, and that it may also be a contributor to the late diagnosis.\u003c/p\u003e \u003cp\u003eThe initial scale has 17 questions divided into four conceptual areas that are beliefs about breast lumps (4 items), self-help techniques (4 items), faith-based beliefs (4 items), and perceived futility of treatment (5 items). The question is rated in a dichotomous format of response (true or false). To exclude the items of mammography in the current study, mammography services are not regularly available and applicable in the study setting and target population. Upon the removal of these items, the resulting version of the scale had 13 items, whose total scores were to fall between 0 and 13 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The higher the scores, the more the cultural beliefs being endorsed which might serve as the hindrance to early recognition and care seeking of breast cancer and the lower the scores, the lower the number of beliefs.\u003c/p\u003e \u003cp\u003eThe translation into Bangali was done using a committee-based translation strategy so as to have linguistic correctness and cultural appropriateness. First, a questionnaire was translated into Bangali by three bilingual experts on their own. These translators were scholars who had knowledge on public health and were conversant with the Bangladeshi cultures besides being good in the English language. A consensus meeting to address inconsistencies and sharpen language was carried out to review and discuss the translated versions.\u003c/p\u003e \u003cp\u003eThe initial Bangali version was then used by the main investigator, oncologist and another local authority to revise it further to increase the clarity and cultural suitability to adolescent respondents.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eSPSS version 26 was used to analyze the data. Descriptive statistics including frequencies. and percentages were calculated with respect to categorical variables; means and standard were calculated with respect to categorical variables. continuous variables had deviations. Certain one-way analyses (i.e. t-tests and one-way ANOVA) were calculated to determine the relationship between independent and dependent variables. Multiple linear regression is done to determine the factors associated with cultural belief.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The study protocol was reviewed and approved by the Biosafety, Biosecurity, and Ethical Clearance Committee, BBEC, JU/M 2025/01(175), Jahangirnagar University, Savar, Dhaka-1342, Bangladesh. In accordance with the Declaration of Helsinki, before starting data collection, participants were informed about the objectives, methodology and the approximate time to complete the survey. Then written informed consent was obtained from each participant. Likewise, participants were also assured that all information related to them will be kept confidential and anonymous.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eOut of 384 adolescent girls, the majority were between the age of 13\u0026ndash;15 years (65.4%), then 16\u0026ndash;17 years (29.2%), and 17\u0026ndash;19 years (5.5). Class 9 was 42.7% and Class 10 was 34.9 and Class 11\u0026ndash;12 was 22.4. Most of them were single (98.2%) and had the religion of Islam (97.1%). In terms of household income, 62.5% of the respondents gave the monthly income of the family above 30,000 BDT on average, and 37.5% ranked below 30,000. The level of education among fathers was as follows; 5.2% primary education, 26.0% secondary, 39.1% higher secondary, 26.3% graduate level and 3.4% had no education. In the case of education of mothers, 12.0% were primary educated, 32.3% secondary, 31.0% were higher secondary, 23.2% graduate level and 1.6 percent were not educated at all.\u003c/p\u003e \u003cp\u003eCultural belief scores did not differ significantly by marital status (t\u0026thinsp;=\u0026thinsp;0.968, p\u0026thinsp;=\u0026thinsp;0.334). Cultural belief scores were significantly higher among participants from lower-income households compared to those from higher-income households (F\u0026thinsp;=\u0026thinsp;3.50, p\u0026thinsp;=\u0026thinsp;0.001). Father\u0026rsquo;s educational level showed no significant association with cultural belief scores (F\u0026thinsp;=\u0026thinsp;0.723, p\u0026thinsp;=\u0026thinsp;0.576). However, mothers\u0026rsquo; educational level was significantly associated with cultural beliefs (F\u0026thinsp;=\u0026thinsp;4.290, p\u0026thinsp;=\u0026thinsp;0.002), with higher mean scores observed among participants whose mothers had primary or higher secondary education compared to those whose mothers were graduates. There is no significant differences in cultural belief scores that were observed across religious groups (F\u0026thinsp;=\u0026thinsp;0.159, p\u0026thinsp;=\u0026thinsp;0.853). Participants with a family history of breast cancer (8.1%) had significantly higher cultural belief scores compared to those without such a history (t\u0026thinsp;=\u0026thinsp;7.982, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAmong participants reporting a family history of breast cancer, no significant differences in cultural belief scores were observed based on the relationship with the affected family member (F\u0026thinsp;=\u0026thinsp;0.377, p\u0026thinsp;=\u0026thinsp;0.825). Knowledge about breast self-examination (BSE) was reported by 29.9% of participants; however, cultural belief scores did not differ significantly between those who had knowledge of BSE and those who did not (t\u0026thinsp;=\u0026thinsp;0.127, p\u0026thinsp;=\u0026thinsp;0.889). Sources of information related to breast health were also examined. No significant differences in cultural belief scores were observed for information obtained from television, radio, books, the internet, or healthcare professionals (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, participants who reported receiving information from family members or friends had significantly lower cultural belief scores compared to those who did not (t\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;7.861, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eDifferences in Cultural Beliefs by General Characteristics (N\u0026thinsp;=\u0026thinsp;384)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCultural Belief\u003c/span\u003e\u003c/p\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF / t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.15 (2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;17 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.57 (2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u0026ndash;19 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46 (2.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass of Study\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 9 (Secondary Level)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.93 (1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 10 (Secondary Level)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.72 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 11 \u0026amp; 12 (Intermediate Level)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.72 (2.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSection\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.61 (2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.15 (1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHumanities\u003c/p\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113 (29.4)\u003c/p\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003cp\u003e377 (98.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.32 (2.24)\u003c/p\u003e \u003cp\u003e8.14 (0.69)\u003c/p\u003e \u003cp\u003e7.37 (2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage Family Monthly Income\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; AMFI (\u0026lt;\u0026thinsp;30,000 BDT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.86 (1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;AMFI (\u0026gt;\u0026thinsp;30,000 BDT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e240 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.10 (2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s Education Level\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.35 (1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.16 (2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Secondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.56 (2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.30 (2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.76 (1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s Education Level\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.39 (1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.49 (2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Secondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.83 (1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.66 (2.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.16 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e373 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.37 (2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.70 (1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u0026nbsp;\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.35 (1.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\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\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e353 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.33 (1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with the patient\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.00 (1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSister\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.71 (2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAunt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00 (1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrandmother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.20 (1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e353 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.37 (2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge about BSE\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.40 (1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e269 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.37 (2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of BSE information\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTelevision\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.17 (2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e361 (94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.40 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadio\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.50 (2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e382 (99.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.39 (2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBooks\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.40 (2.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e379 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.38 (2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily/ Friends\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.49 (2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\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\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e329 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.70 (1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInternet\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.44 (2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e282 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.36 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers/ Health professionals\u003c/b\u003e\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.90 (3.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e373 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.37 (2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the distribution of responses to individual items assessing cultural beliefs related to breast cancer among the participants. Beliefs related to breast lump characteristics were common. More than one-third of respondents believed that a breast lump is not cancer if it is not painful (35.2%) or does not increase in size (41.4%). Additionally, 35.9% believed that frequently touching or pressing a breast lump could cause it to develop into breast cancer.\u003c/p\u003e \u003cp\u003eRegarding self-help techniques, 45.1% of participants believed that excessive worry about breast cancer increases the likelihood of developing the disease, while 39.6% believed that taking good care of oneself can prevent breast cancer. Furthermore, 37.2% believed that natural remedies could eliminate a breast lump, indicating reliance on non-medical approaches. Faith-based beliefs were also prevalent among the respondents. Approximately one-quarter of participants (26.0%) believed that faith in God could protect them from breast cancer. A higher proportion believed that prayer could cause breast lumps to disappear (61.2%), and 58.0% believed that strong faith in God could eliminate the need for medical treatment. Beliefs reflecting the futility of treatment were evident among a substantial proportion of participants. Half of the respondents (50.3%) believed that breast cancer grows faster if surgically operated on. Additionally, 34.4% believed that poverty prevents cure due to limited access to the best treatment. Although 23.2% correctly recognized that breast cancer can be cured if treated appropriately (reverse-coded item), 26.6% believed that treatment does not alter outcomes because cancer inevitably leads to death.\u003c/p\u003e \u003cp\u003eThe overall mean cultural belief score was 7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08, indicating a moderate level of endorsement of culturally rooted misconceptions related to breast cancer among the participants.\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\u003eParticipants\u0026rsquo; Levels of Cultural Beliefs (N\u0026thinsp;=\u0026thinsp;384)\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=\"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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eResponse n(%)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWrong\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 \u003cp\u003e1. Breast lump characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.If a breast lump is not painful, it is not cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003cp\u003e(35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249 (68.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2. If a breast lump does not get bigger, it is not cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225 (58.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3. If a breast lump is touched/pressed often, it will turn out to be breast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003cp\u003e(35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e246 (64.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2. Self-help techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5. The more you worry about breast cancer, the more likely you will get it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e211\u003c/p\u003e \u003cp\u003e(54.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6. If you take good care of yourself, you won\u0026rsquo;t get breast cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e232\u003c/p\u003e \u003cp\u003e(60.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13. If you have a breast lump, a \u0026ldquo;natural\u0026rdquo; remedy can help to get rid of it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e241\u003c/p\u003e \u003cp\u003e(62.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3. Faith-based beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7. Faith in God can protect you from breast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e284 (74.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10. If you pray enough, sometimes breast lumps will disappear.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149 (38.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14. If a woman has enough faith in God, she won\u0026rsquo;t need treatment for breast cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003cp\u003e(58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e189 (49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e4. Futility of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11. If breast cancer is cut open in surgery, it will grow faster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193 (50.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e191 (49.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15. If a woman is poor, she will not get cured from cancer because she won\u0026rsquo;t get the best treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003cp\u003e(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e252\u003c/p\u003e \u003cp\u003e(65.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*16. If breast cancer is treated correctly, it can be cured.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003cp\u003e(23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e295\u003c/p\u003e \u003cp\u003e(76.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17. It doesn\u0026rsquo;t really matter if you get treated for breast cancer, because if you get cancer, it will kill you sooner or later\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282 (73.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal mean score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA multiple linear regression (\u003cem\u003eR\u0026sup2; = 0.355, F\u0026thinsp;=\u0026thinsp;43.13\u003c/em\u003e) analysis was conducted to identify predictors of cultural beliefs about breast cancer among adolescent girls. Class of study was a significant positive predictor of cultural belief scores (B\u0026thinsp;=\u0026thinsp;0.236, SE\u0026thinsp;=\u0026thinsp;0.113, β\u0026thinsp;=\u0026thinsp;0.089, t\u0026thinsp;=\u0026thinsp;2.097, p\u0026thinsp;=\u0026thinsp;0.037), indicating that students in higher classes were more likely to endorse cultural beliefs related to breast cancer. Family history of breast cancer emerged as a strong negative predictor (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.979, SE\u0026thinsp;=\u0026thinsp;0.181, β = \u0026minus;0.466, t\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;10.930, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that participants with a family history of breast cancer held significantly fewer cultural misconceptions compared to those without such a history. Friends as a source of information was significantly associated with higher cultural belief scores (B\u0026thinsp;=\u0026thinsp;1.358, SE\u0026thinsp;=\u0026thinsp;0.258, β\u0026thinsp;=\u0026thinsp;0.229, t\u0026thinsp;=\u0026thinsp;5.260, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that reliance on peers for information was linked to greater endorsement of cultural beliefs. In contrast, mother\u0026rsquo;s education level (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.059, SE\u0026thinsp;=\u0026thinsp;0.086, β = \u0026minus;0.028, p\u0026thinsp;=\u0026thinsp;0.497) and average monthly family income (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.277, SE\u0026thinsp;=\u0026thinsp;0.182, β = \u0026minus;0.065, p\u0026thinsp;=\u0026thinsp;0.128) were not statistically significant predictors of cultural belief scores \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eMultiple Linear Regression Analysis for Factors Associated with Cultural Beliefs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\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 \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.037*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[0.015, 0.458]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[-0.228, 0.111]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of breast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.930\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[-2.335, -1.623]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.260\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[0.851, 1.866]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage monthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[-0.635, 0.080]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eR\u0026sup2; = 0.363, Adjusted R\u0026sup2; = 0.355, F\u0026thinsp;=\u0026thinsp;43.13\u003c/h2\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a insights into knowledge, perception and predictors of cultural belief related to breast cancer among female high school students in semi-urban areas of Bangladesh.\u003c/p\u003e \u003cp\u003eThe present study found that cultural belief scores increased significantly with higher class of study, indicating that students in advanced grades held stronger culturally rooted beliefs about breast cancer. This finding is partially inconsistent with studies conducted among adult women and university students, where higher educational attainment is associated with greater health and science-related capabilities [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, similar patterns have been observed in recent study in China, cancer literacy strongly tracks education level, yet even better-educated groups have weakest literacy in prevention and risk factors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis discrepancy may be explained by the absence of structured breast health education in secondary \u0026amp; higher secondary school curriculum in Bangladesh [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. As adolescents advance academically, both the internet and parents, with friends becoming especially important for sensitive topics (e.g., sexuality) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the absence of accurate guidance, these exposures may reinforce cultural myths rather than correct them. Thus, unlike higher education settings, secondary schooling alone may be insufficient to counter deeply ingrained cultural beliefs during adolescence.\u003c/p\u003e \u003cp\u003eAdolescents with a family history of breast cancer exhibited significantly lower cultural belief scores. Similar findings have been reported in studies from in the Middle East and North Africa, knowing a family member or friend with breast cancer had a stronger impact on women\u0026rsquo;s self-care and screening than education or employment [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the most important findings is that adolescents who cited friends as a source of information had significantly higher cultural belief scores. A large reviews and meta-analyses, peers show consistent, cross-domain effects on adolescent behavior and attitudes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, it contrasts with studies among older youth and university students where peer education showed significant gains in breast cancer knowledge, health responsibility, health beliefs, and breast self-examination practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].The divergence likely reflects differences in informational quality rather than the influence mechanism itself. Among younger adolescents in semi-urban Bangladesh, peer networks may function as echo chambers for misinformation, rumors, and culturally transmitted myths, particularly in environments where adult guidance and formal health education are limited. This contrasts with university environments, where peer discussions are more likely to be informed by academic exposure and access to credible information sources.\u003c/p\u003e \u003cp\u003eContrary to several studies conducted among adult women, this study found no significant association between cultural belief scores and household income or mother\u0026rsquo;s education level in the multivariable model. Previous research has often reported higher education, income, and health insurance jointly improve breast cancer knowledge, attitudes, and preventive behaviors, whereas low SES and cultural beliefs sustain misinformation and delayed diagnosis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe high prevalence of faith-based observed in this study is consistent with findings from other South Asian and Muslim-majority contexts, where religious interpretations often coexist with biomedical explanations of disease [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Beliefs that prayer alone can eliminate illness or that cancer is inevitably fatal have been widely documented and are associated with delayed care-seeking in adulthood.\u003c/p\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, cross-sectional design prevents causal inferences regarding the relationships between sociodemographic factors and cultural beliefs about breast cancer. Second, the study was conducted among female students from semi-urban schools in a limited geographic area, which may restrict the generalizability of the results to adolescents in rural or urban settings. Third, the reliance on self-reported data may have introduced reporting or social desirability bias, particularly given the sensitive nature of breast health topics in the local cultural context. Finally, the absence of qualitative data limits a deeper exploration of the underlying reasons and contextual meanings behind the observed cultural beliefs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows that many adolescent girls in semi-urban Bangladesh hold cultural beliefs and misconceptions about breast cancer that may influence how they understand the disease and respond to it in the future. Such beliefs are influenced by levels of school, family exposure on breast cancer, and friends. Due to the importance of teens as a period during which long-term health attitudes are established, it is essential to inform about misconceptions at an early age. Elementary and culturally sensitive interventions could be undertaken in schools to make the research understandable and lower the pernicious beliefs through the incorporation of peers, families, and trusted community members. Altogether, the results indicate the necessity to educate young girls with proper and correct information to make them build healthier attitudes to breast cancer during their adulthood.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval \u0026amp; consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Biosafety, Biosecurity \u0026amp; Ethical Committee, Faculty of Biological Sciences, Jahangirnagar University (Approval No. BBEC, JU/M 2025/01(175)). Written informed consent was obtained from all participants and their legal guardians\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent for publication of anonymized data was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets supporting the conclusions of this article are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest statement:\u0026nbsp;\u003c/strong\u003eAll authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003eThis research received no external funding. All resources utilized for the study were provided by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Ryadul Alam, Md. Tajuddin Sikder\u003c/p\u003e\n\u003cp\u003eData collection and Data entry: Sadia Akter, Tanaa Mohammad, Rowshanara Rini, Mst Mariyam, Afrana Akter Priti, Aishwaria Mitra Ayshee, Md Shahriar Hossen Sayem, Afsana Mohammad Mimi,\u003c/p\u003e\n\u003cp\u003eFormal analysis: Ryadul Alam, Sadia Akter, Zubaida Iftekhar\u003c/p\u003e\n\u003cp\u003eInvestigation: Md. Habibullah Talukder, Md. Tajuddin Sikder\u003c/p\u003e\n\u003cp\u003eMethodology: Ryadul Alam, Md. Tajuddin Sikder, Zubaida Iftekhar\u003c/p\u003e\n\u003cp\u003eSupervision: Md. Habibullah Talukder, Md. Tajuddin Sikder\u003c/p\u003e\n\u003cp\u003eValidation: Md. Habibullah Talukder\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: Ryadul Alam, Sadia Akter, Tanaa Mohammad, Rowshanara Rini, Mst Mariyam, Afrana Akter Priti, Aishwaria Mitra Ayshee, Md Shahriar Hossen Sayem\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eMd. Habibullah Talukder, Zubaida Iftekhar\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e The authors sincerely thank all participants in this study. We also extend our gratitude to the school authorities and teachers for their cooperation and support during data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Global cancer burden growing, amidst mounting need for services. \u003cem\u003eWHO\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodfrey K, Agatha T, Nankumbi J. Breast Cancer Knowledge and Breast Self-Examination Practices Among Female University Students in Kampala, Uganda: A Descriptive Study. Oman Med J. 2016;31:129\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaqvi A, Zehra F, Ahmad R, Ahmad N. Developing a Research Instrument to Document Awareness, Knowledge, and Attitudes Regarding Breast Cancer and Early Detection Techniques for Pakistani Women: The Breast Cancer Inventory (BCI). Diseases. 2016;4:37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaqvi AA, et al. Awareness, knowledge and attitude towards breast cancer, breast screening and early detection techniques among women in Pakistan. JPMA J Pak Med Assoc. 2018;68:576\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJadhav CR, Srinivasamurthy BC, Sb KP, Agrawal V, Kv B. Breast tumors and college students: a study of their knowledge, attitude and practice. Indian J Pathol Oncol (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCancer Research UK. Breast cancer incidence (invasive) statistics. Cancer Res UK \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive\u003c/span\u003e\u003cspan address=\"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBegum SA, et al. Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study. Mymensingh Med J MMJ. 2019;28:96\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossain MS, Ferdous S, Karim-Kos HE. Breast cancer in South Asia: A Bangladeshi perspective. Cancer Epidemiol. 2014;38:465\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhaka Tribune. Social taboo leading cause for unchecked breast cancer in Bangladesh. \u003cem\u003eDhaka Tribune\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dhakatribune.com/bangladesh/event/159421/social-taboo-leading-cause-for-unchecked-breast\u003c/span\u003e\u003cspan address=\"https://www.dhakatribune.com/bangladesh/event/159421/social-taboo-leading-cause-for-unchecked-breast\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajaram N, et al. Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis. BMC Health Serv Res. 2023;23:206.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlam NE, et al. Evaluation of knowledge, awareness and attitudes towards breast cancer risk factors and early detection among females in Bangladesh: A hospital based cross-sectional study. PLoS ONE. 2021;16:e0257271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Ni P, Zuo T, Liu Y, Zhu B. Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China. Front Public Health. 2024;12:1367947.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Callaghan C, et al. Enhancing equitable access to cancer information for culturally and linguistically diverse (CALD) communities to complement beliefs about cancer prognosis and treatment. Support Care Cancer. 2021;29:5957\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoho AA, Mdoe MB, Masoi TJ, Yahaya JJ. Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study. Sci Rep. 2024;14:12291.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMastorci F, Lazzeri MFL, Vassalle C, Pingitore A. The Transition from Childhood to Adolescence: Between Health and Vulnerability. \u003cem\u003eChildren\u003c/em\u003e 11, 989 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahalakshmi S, Suresh S. Barriers to Cancer Screening Uptake in Women: A Qualitative Study from Tamil Nadu, India. Asian Pac J Cancer Prev. 2020;21:1081\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkarak S et al. Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study. \u003cem\u003eCureus\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.58324\u003c/span\u003e\u003cspan address=\"10.7759/cureus.58324\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024) doi:10.7759/cureus.58324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgan TT, Jenkins C, Minh HV, Donnelly M, O\u0026rsquo;Neill C. Breast cancer screening practices among Vietnamese women and factors associated with clinical breast examination uptake. PLoS ONE. 2022;17:e0269228.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoon PKM, et al. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front Oncol. 2023;12:1053698.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JG, Hong HC, Lee H, Ferrans CE, Kim E-M. Cultural beliefs about breast cancer in Vietnamese women. BMC Womens Health. 2019;19:74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXue X, Cheng M, Zhang W. DOES EDUCATION REALLY IMPROVE HEALTH? A META-ANALYSIS. J Econ Surv. 2021;35:71\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZajacova A, Lawrence EM. The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach. Annu Rev Public Health. 2018;39:273\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Ni P, Zuo T, Liu Y, Zhu B. Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China. Front Public Health. 2024;12:1367947.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamid F, Roy T. Unveiling Sociocultural Barriers to Breast Cancer Awareness Among the South Asian Population: Case Study of Bangladesh and West Bengal, India. JMIR Hum Factors. 2025;12:e53969.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaraipour F, Panahi S, Nemati-Anaraki L, Shahraki-Mohammadi A. Adolescents\u0026rsquo; Health Information\u0026ndash;Seeking Behavior: A Scoping Review. J Adolesc Health. 2025;77:592\u0026ndash;601.\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;17:6802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaursen B, Veenstra R. Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research. J Res Adolesc. 2021;31:889\u0026ndash;907.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoskun S, Alibekiroğlu N, Gen\u0026ccedil;y\u0026uuml;rek G. Effect of Peer Education on Early Breast Cancer Detection, Health Responsibility, Health Beliefs, Knowledge, and Practices Among University Students. Public Health Nurs. 2025;42:1694\u0026ndash;706.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarmakar R, Nagisetti Y, Mukundan A, Wang H-C. Impact of the family and socioeconomic factors as a tool of prevention of breast cancer. World J Clin Oncol 16, (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArabiat D, et al. Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families. J Multidiscip Healthc. 2021;14:1755\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cultural Belief, Breast Cancer, Adolescent Girls, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-8628237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8628237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBreast cancer is the most common cancer among women and poses a growing public health burden in developing countries, including Bangladesh. Cultural stigma, limited awareness, and delayed recognition contribute to late diagnosis, particularly among younger females. This study examines cultural beliefs and perceptions of breast cancer among adolescent girls in semi-urban Bangladesh.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA school-based cross-sectional study was conducted among adolescent girls in semi-urban Savar, Dhaka, Bangladesh, from January to May 2025. Four schools were randomly selected and 384 participants were recruited using stratified random sampling. Cultural beliefs about breast cancer were assessed using a modified 13-item Ferrans Cultural Beliefs Scale, translated into Bangla using a committee-based approach. Data were analyzed using SPSS version 26 with descriptive statistics, t-tests, one-way ANOVA, and multiple linear regression.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eCultural belief score is 7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08, rooted misconceptions among participants. Multiple linear regression analysis showed that higher class of study was positively associated with cultural belief scores (β\u0026thinsp;=\u0026thinsp;0.236, p\u0026thinsp;=\u0026thinsp;0.037), while having a family history of breast cancer was strongly associated with lower cultural belief scores (β = \u0026minus;1.979, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Reliance on friends as a source of information significantly increased cultural belief scores (β\u0026thinsp;=\u0026thinsp;1.358, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Parental education and average monthly family income were not significant predictors (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCultural beliefs about breast cancer are common among adolescent girls in semi-urban Bangladesh that underscoring the need for early, culturally sensitive school-based education.\u003c/p\u003e","manuscriptTitle":"Cultural Beliefs and Perceptions of Breast Cancer among Adolescent Girls in Semi-Urban Bangladesh: A School-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 15:45:00","doi":"10.21203/rs.3.rs-8628237/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92cba18c-46f4-41e1-9ce8-db97fa9f2f78","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T08:56:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 15:45:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8628237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8628237","identity":"rs-8628237","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}