Women’s Breast Cancer Screening and Its Relationship with Knowledge and Awareness in Urban Communities in Accra, Ghana

Background:
Breast cancer is the leading cause of cancer-related deaths in low- and middle-income countries (LMICs), including Ghana. Despite WHO’s promotion of early detection through breast self-examination (BSE), clinical breast examination (CBE), and mammography, screening uptake in Ghana remains low. Barriers include limited knowledge of risk factors and symptoms, poor access to healthcare, and socioeconomic disparities. While prior studies explore breast cancer awareness, few focus on the interrelationship between knowledge, awareness, and screening behaviors in urban Ghanaian settings. This study aimed to assess breast cancer knowledge and screening awareness among women in Accra, providing insight to inform targeted interventions. Key research questions included: (1) Is knowledge of breast cancer associated with screening practices? (2) Is mammogram awareness linked to screening behaviors? (3) Are knowledge and awareness significantly related to BSE and mammogram practices?

Methods:
A cross-sectional survey was conducted with a convenience sample of 194 women aged 18–72 years (mean = 42.15, SD = 12.80). Participants completed a self-administered questionnaire incorporating the Breast Cancer Knowledge Test (McCance et al., 1990) and nine items from the Breast Health Questionnaire (Shirazi, 2006). Ethical approval and informed consent were obtained. Data analysis included descriptive statistics, bivariate analysis, and chi-square tests of independence.

Results:
The majority of participants were aged 40–59 (53%), with 42.3% having completed middle/junior secondary education and 38% holding college diplomas. Occupations included teaching/civil service (27%), trading (27%), and nursing (14%). Knowledge about screening was relatively high: 91% knew regular BSE is effective; 87% recognized mammography can detect lumps; and 75% were aware it is recommended for women aged 40+. However, only 40% knew BSE should be performed monthly, and fewer than 50% used correct BSE techniques.

Regarding mammogram awareness, 64% had heard of the procedure, but only 14% had ever undergone mammography. A weak negative association was found between mammogram awareness and screening practice (X²(1,116) = 6.86, p = .009, φ = -.24). No significant association was found between general breast cancer knowledge and BSE performance. However, significant positive associations were found between knowledge of abnormal breast changes and mammogram screening (X²(1,116) = 6.83, p = .009, φ = .24), and between knowledge of underarm lump detection and mammogram screening (X²(1,116) = 9.85, p = .002, φ = .29).

Conclusion and Implications:
Although awareness of breast cancer and screening methods is relatively high, knowledge gaps remain regarding correct techniques and screening frequency. Despite awareness, mammogram uptake is low. The findings suggest that awareness alone does not lead to behavioral change. For social work practice and policy, this highlights the need for culturally tailored, community-based education; empowerment of local women’s groups as health ambassadors; advocacy for subsidized screening in primary care; and social work-led case management to improve screening adherence and access to follow-up healthcare services.