Original Research
Women’s Health

Knowledge and Practice of Breast Self-Examination Among Female Non-Medical Students in Universiti Kebangsaan Malaysia (UKM) in Bangi

Background and Context

Breast cancer is the most commonly diagnosed malignancy among Malaysian women, accounting for approximately one-third of all female cancer cases. Data from the Malaysian National Cancer Registry indicate that the age-standardised incidence rate for breast cancer has been rising steadily, with survival outcomes closely linked to stage at diagnosis. Women diagnosed at early stages (I and II) have five-year survival rates exceeding 80%, while those diagnosed at advanced stages face substantially poorer prognoses. This stage-survival gradient makes early detection — through screening programmes and self-awareness — a critical public health priority.

Breast Self-Examination (BSE) is a non-invasive, cost-free screening technique through which women systematically examine their breasts to detect abnormal lumps, swelling, skin changes, or nipple discharge. While BSE alone is not considered sufficient as a primary screening modality (mammography remains the gold standard), it plays an important complementary role, particularly in settings where access to mammographic screening is limited. BSE promotes breast health awareness, encourages familiarity with one’s own normal breast tissue, and facilitates the prompt identification of changes that warrant professional evaluation.

In Malaysia, mammographic screening is available through government hospitals, private facilities, and periodic community screening campaigns. However, uptake remains suboptimal, particularly among younger women and those in non-urban areas. Among university students — young women at a formative stage of health behaviour development — BSE knowledge and practice represent important indicators of breast health awareness that may predict lifelong screening behaviours.

Study Design and Methods

This cross-sectional study was conducted at UKM’s Bangi campus, recruiting 364 female students from non-medical faculties. The deliberate focus on non-medical students was strategically important: medical students receive formal education on breast cancer screening as part of their curriculum and therefore represent a biased population for assessing general BSE awareness. Non-medical students, by contrast, provide a more representative picture of knowledge and practice levels among the broader educated female population.

Data were collected through a self-administered, validated questionnaire adapted from previous studies. The instrument assessed sociodemographic characteristics, personal and family history of breast cancer, knowledge about BSE (including correct technique, timing, and frequency), actual BSE practice, sources of health information, and perceived barriers to BSE. Knowledge was categorised into levels (poor, moderate, good) based on composite scores.

Statistical analysis was performed using SPSS version 19. Chi-square tests were used to examine associations between categorical variables and BSE practice. Independent samples t-tests compared mean barrier scores between BSE performers and non-performers. Multivariate analysis was conducted to identify independent predictors of BSE practice.

Principal Results

The study population was predominantly Malay, single, and undergraduate — reflecting the demographic composition of UKM’s Bangi campus. The majority of respondents were single (68.9%), university graduates or current undergraduates (82.6%), and students (39.6%). This demographic profile is representative of the broader Malaysian university student population and allows the findings to be contextualised within the young adult female population.

The analysis revealed several important predictors of BSE practice. Education level showed a significant relationship, with higher educational attainment associated with greater BSE practice. Marital status emerged as another significant factor, consistent with evidence suggesting that married women may receive encouragement from partners or healthcare providers during reproductive health visits. Family history of breast cancer was significantly associated with BSE practice, aligning with the well-documented phenomenon that personal experience with cancer in close relatives heightens screening awareness and behaviour.

Knowledge level about BSE was one of the strongest predictors of actual practice. Students with higher knowledge scores were significantly more likely to perform BSE regularly. This knowledge–practice relationship, while expected, is not always observed in health behaviour research (where the “knowledge–action gap” is a common finding). The relatively strong association observed in this study suggests that BSE educational programmes targeting university students could translate effectively into behaviour change.

The finding that BSE performers had significantly lower mean barrier scores is particularly actionable. Common barriers to BSE reported in the literature include fear of finding something abnormal, embarrassment, uncertainty about correct technique, lack of time, and forgetfulness. The lower barrier scores among practitioners suggest that barrier reduction — through normalisation of breast health conversations, practical demonstration of BSE technique, and integration of BSE education into university orientation programmes — could increase practice rates.

Implications for Malaysian Women’s Health

These findings support the implementation of targeted BSE education programmes at Malaysian universities. The university setting offers a unique opportunity to reach young women at a stage when health behaviours are being established that may persist throughout adulthood. Integration of breast health education into university orientation programmes, health services, and student activities could be achieved at minimal cost and could complement national breast cancer screening initiatives.

The study also highlights the importance of addressing perceived barriers through culturally sensitive approaches. In Malaysia’s predominantly Muslim context, modesty concerns may contribute to reluctance about breast examination — even self-examination performed privately. Health education materials that acknowledge and respectfully address these concerns, while emphasising the Islamic duty of health preservation (hifz al-nafs), may be particularly effective.

Limitations

The study was conducted at a single university campus, limiting generalisability to other Malaysian universities or the broader female population. Self-reported BSE practice may be subject to social desirability bias, with respondents potentially over-reporting practice. The cross-sectional design cannot establish causality — it is possible that women who practice BSE subsequently seek more knowledge, rather than knowledge driving practice. The study did not assess BSE technique quality, meaning that respondents reporting BSE practice may not be performing it correctly. Additionally, the focus on non-medical students, while methodologically appropriate, means the findings cannot speak to BSE awareness among male students, staff, or the wider community.

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