Knowledge, Attitude and Practice of Breast Self-Examination Among Nurses in Tertiary Hospitals in Malaysia

Raja Gopal R, Md Isa Z, Daud W, Nurumal M, Syed Zakaria S

Malaysian Journal of Public Health Medicine, 2014; 14(3): 54–62

Affiliations: Faculty of Health Sciences, National University of Malaysia (UKM)

Last reviewed: March 2026

Background and Context

Breast cancer remains the most frequently diagnosed cancer among Malaysian women, irrespective of age group and ethnicity. According to the Malaysian National Cancer Registry, breast cancer accounts for approximately 34.1% of all female cancers in the country. Late-stage diagnosis continues to be a significant problem: a substantial proportion of breast cancers in Malaysia are detected at stages III and IV, contributing to lower survival rates compared with countries where screening uptake is higher.

Breast self-examination (BSE) is a cost-free, non-invasive screening method that empowers women to identify changes in their breast tissue early. While BSE alone has not been demonstrated to reduce breast cancer mortality in randomised controlled trials, it remains an important component of breast awareness, particularly in low- and middle-income settings where access to clinical breast examination and mammography may be limited. In Malaysia, BSE is promoted as part of the national breast cancer awareness programme.

Nurses, as frontline healthcare providers, occupy a uniquely important position in breast cancer screening. They serve as both potential role models for screening behaviour and as educators who can influence patients’ uptake of early detection practices. Understanding nurses’ own knowledge, attitudes, and practices regarding BSE is therefore critical. If nurses themselves do not practise BSE or lack confidence in performing it, their capacity to counsel and motivate patients is likely compromised.

Study Design and Methods

This cross-sectional study was conducted among nurses employed at tertiary hospitals in Malaysia. Data were collected using a structured, pre-validated questionnaire covering three domains: knowledge about BSE and breast cancer, attitudes toward BSE, and BSE practice behaviour. Sociodemographic variables including age, education level, marital status, family history of breast cancer, and years of nursing experience were recorded.

Statistical analysis employed SPSS software. Descriptive statistics were used to characterise the sample, while chi-square tests examined associations between sociodemographic variables and the three KAP domains. Significance was set at p < 0.05.

Results and Analysis

The study population comprised nurses of varying ages and career stages working across multiple departments within Malaysian tertiary hospitals. The findings revealed several important patterns.

Regarding knowledge, the majority of participating nurses were aware of BSE as a screening method and could identify at least some correct steps in performing BSE. However, knowledge scores varied considerably across the sample. Respondents with higher educational qualifications (diploma and degree-level nurses) demonstrated statistically significantly better knowledge compared with those with lower educational attainment (p < 0.05). This finding aligns with international evidence suggesting that more extensive clinical training provides greater exposure to breast cancer education.

Attitudes toward BSE were generally positive. Most nurses agreed that BSE was a useful screening tool and expressed belief in its ability to contribute to early detection of breast abnormalities. This positive attitudinal orientation, however, was not uniformly translated into practice.

BSE practice showed a notable gap. Despite positive attitudes and reasonable knowledge, a significant proportion of nurses did not perform BSE regularly. Marital status emerged as a significant factor; married nurses were more likely to practise BSE than their unmarried counterparts (p < 0.05). This may reflect heightened health awareness associated with reproductive life stages, maternity experiences, or partner encouragement.

Sociodemographic Determinants

Among all sociodemographic variables tested, only education level and marital status achieved statistical significance in relation to both knowledge and practice domains. Other factors, including age, years of nursing experience, and family history of breast cancer, did not reach significance, although trends suggested that older nurses and those with a family history of breast cancer tended toward better knowledge scores.

Comparison with Other Studies

These findings are consistent with other studies conducted in Southeast Asia and the broader international literature. Research among nursing students at Malaysian universities found that approximately 63.7% had performed BSE, and knowledge was influenced by academic training. Studies from the Middle East and sub-Saharan Africa have similarly documented a knowledge-practice gap among healthcare workers, where satisfactory knowledge does not translate into regular BSE practice.

A study conducted among women in suburban Terengganu, Malaysia, found that only 7.0% demonstrated good BSE practice despite 73.3% having positive attitudes. This community-based finding, compared with the current hospital-based study, underscores that the knowledge-practice gap extends beyond healthcare professionals into the general population, but is particularly concerning when observed among nurses who are expected to be leaders in health promotion.

Implications for Public Health

The study has several important implications for Malaysian healthcare policy and nursing education. First, the association between education level and BSE knowledge underscores the importance of integrating comprehensive breast cancer screening education into nursing curricula at all levels. Continuing professional development programmes should include regular updates on BSE technique, breast cancer risk factors, and the role of nurses as advocates for screening.

Second, workplace-based interventions in hospitals may help to bridge the knowledge-practice gap. Structured BSE promotion programmes within hospital settings, including regular reminders, peer support groups, and annual competency assessments, could improve nurses’ personal practice of BSE.

Third, the finding that married nurses were more likely to practise BSE suggests that social support and life stage factors influence screening behaviour. Targeted programmes for younger, unmarried nurses could help normalise BSE as a routine health behaviour regardless of marital status.

Limitations

As a cross-sectional study, this research cannot establish causal relationships between sociodemographic variables and BSE behaviour. The study was limited to tertiary hospitals and may not represent nurses in primary care or rural health settings. Self-reported BSE practice is susceptible to social desirability bias, and actual competency in performing BSE was not objectively assessed. Future research should consider longitudinal designs and observational assessment of BSE technique.

Conclusion

This study demonstrates that while Malaysian nurses in tertiary hospitals generally possess positive attitudes toward BSE, knowledge levels vary and regular practice remains suboptimal. Education level and marital status were the key sociodemographic factors influencing knowledge and practice. Addressing the knowledge-practice gap among nurses is essential, as they play a pivotal role in promoting breast cancer awareness and screening behaviour among patients and the broader community.