BC is the leading cause of cancer among women in India, accounting for approximately 25.4% of new cases annually.¹ Early detection and treatment are associated with improved prognosis and survival.² The incidence of BC is rising among young women in India.³,⁴ In low- and middle-income countries, regular breast self-examination (BSE) is linked to earlier detection and better treatment outcomes. Prompt medical evaluation of abnormalities identified through BSE can therefore serve as an effective early-detection strategy.5,6 Increasing awareness of early signs of BC and correct BSE technique is particularly relevant in resource-constrained settings.⁷ This study assessed awareness, knowledge, and attitudes regarding breast cancer among female medical students aged 18–25 years (Generation Z) at a medical college in North India. Gaps in knowledge, sources of information, and barriers to practising BSE were examined.

Study design- An anonymous, questionnaire-based cross-sectional study was conducted among undergraduate female medical students at Gian Sagar Medical College and Hospital, Ramnagar, Rajpura, Punjab, India. Study setting- The study was conducted among the female medical students of Gian Sagar Medical College and Hospital, Ramnagar, Rajpura, Punjab. Inclusion criteria- female students aged 18–25 years who provided informed consent. Exclusion criteria- students who declined participation. Sample size- A total of 153 students volunteered and completed the questionnaire. Tools of data collection- data was collected by a self-administered close-ended questionnaire. It was divided into 4 parts -1.Demogrphics of the participant, Awareness about breast cancer, 3.Attitude for breast cancer, 4.Knowledge regarding breast cancer.

A total of 153 female undergraduate medical students participated. The mean age was 21.1 years. Most participants (86.1%) were from urban backgrounds; 13.9% were from rural areas. By religion, 63.6% were Hindu, 35.8% Sikh, and 0.7% Christian . Nearly all respondents (98.7%) were aware that BC is the most common cancer in women. The internet was the main source of information (88.7%), followed by family physicians (6.6%), television (2.6%), and friends (2%). Among online platforms, Google (40.8%), YouTube (30.3%), Instagram (26.3%), and Twitter/X (2.6%) were most frequently cited (Table 1). Awareness of BC symptoms was high (93.4%). Specific symptom awareness included breast pain (96.1–96.7%), nipple discharge (95.4–96.1%), painful lump in the breast or axilla (93.5–94.1%), nipple retraction (94.8–95.4%), skin discoloration/redness (93.5–94.1%), and change in breast size (92.2–92.8%) (Table 3). Awareness of screening and detection methods was also high: BSE (95.4%), clinical breast examination (90.2%), mammography (93.5%), ultrasound (88.9%), and MRI (87%). Awareness of any screening method was reported by 92.1% of participants. Sixty-seven percent knew that BSE should be performed monthly; however, only 43.7–44.1% correctly identified the appropriate timing as 5–7 days after the menstrual phase (Table 2). Knowledge of risk factors was generally good: female sex (95.4%), early menarche (91.5%), hormone-replacement therapy (91.3%), obesity (92.2%), benign breast disease (89.5%), diet (86.9%), and ionizing radiation (70.5%). Regarding attitudes and barriers, 34.2% reported that fear of a breast-cancer diagnosis deterred them from performing BSE. Twenty-five point seven percent believed only women with a family history were at risk. The most common barriers to BSE were absence of symptoms (58.2%), not knowing how to perform BSE (21%), time required (9.8%), embarrassment (7%), and lack of privacy (5.2%) (Table 4). Table 1- Search engines and social media platforms used for gaining knowledge on Breast Cancer Search engine/SM platform No. of respondents % of respondents Google 62 40.8% Youtube 46 30.3% Instagram 40 26.3% Twitter 5 2.6% Table 2- Appropriate time of the month to perform BSE Time of month No. of responses % of responses 5-7 days after menstrual phase of menstrual cycle 67 44.1% Don’t know 58 38.2% 7 days before menstrual phase of menstrual cycle 18 11.2% During menstrual phase of menstrual cycle 10 6.5%

In this cohort of 153 Generation Z female medical students, awareness that BC is the most common cancer in women was very high (98.7%), comparable to findings among young women in South India (99%).⁸ The internet, particularly Google, YouTube, and Instagram, was the predominant information source, consistent with studies among university students in Arab countries and Morocco where social media played a major role.9,10. Symptom awareness and knowledge of detection methods were substantially higher than in non-medical university student populations,⁹ likely reflecting the medical curriculum. Awareness of BSE itself was high (93.4–95.4%) and similar to previous Indian medical-student studies.¹¹ However, knowledge of correct frequency and timing remained suboptimal (only ~44% knew the appropriate post-menstrual window), indicating a gap between general awareness and practical competence. Risk-factor knowledge was generally strong and aligned with earlier reports.9,11 The leading barriers—absence of symptoms and lack of technique knowledge—mirror findings from multi-country Arab and Moroccan studies.9,10 These results highlight that high awareness does not automatically translate into regular BSE practice. Strengths and limitations- Strengths include a focused Generation Z medical-student population and detailed assessment of information sources and barriers. Limitations include the single-centre design, convenience sampling, reliance on self-reported data, and absence of objective assessment of BSE technique. Generalizability beyond medical students is limited

Awareness of BC was high among female medical students at this North Indian institution, largely acquired through online platforms. However, knowledge of correct BSE timing and actual practice remained inadequate. Structured training on BSE technique and promotion of its routine adoption should be integrated into medical education and broader youth health programmes.

1. Sung H, Ferlay J, Seigel RL, Laversanne M, Soerjomatarm I, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-24. 2. Anderson BO, Jakesz R. Breast cancer issues in developing countries: An overview of the Breast Health Global Initiative. World J Surg.2008; 32(12):2578-2585. 3. Varughese AA, Poothiode U, Manjula VD. Descriptive study on selected risk factors and histopathology of breast carcinoma in a tertiary care centre in Kerala, India with special reference to women under 40 years old. Asian Pac J Cancer Prev. 2015;16(1):181-84. 4. Gogia A, Raina V, Deo SV, Shukla NK, Mohanti BK. Young breast cancer: A single center experience. Indian J Cancer. 2014;51(4):604-608. 5. Dewi TK, Ruiter RAC, Diering M, Ardi R, Massar K. Breast self-examination as a route to early detection in a lower-middle-income country: assessing psychosocial determinants among women in Surabaya, Indonesia. BMC Womens Health. 2022;22(1):179. 6. Montazeri A, Vahdaninia M, Harirchi I, Harirchi A, Sajadian A, Khaleghi F, et al. Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med. 2008;7:6. 7. Kıssal A, Kartal B, Çetin Ö. The determination of knowledge, applications and health beliefs of third-and fourth-grade nursing students regarding breast self-exam. J Breast Health. 2017;13(1):10–15. 8. NirojiniPS, Nadendla R. Knowledge and awareness of breast cancer among young women living In south India. Value in Health. 2015; Vol 18, (7), PA685 9. Gamal, A., Awwad, S.A., Abdallfatah, A. et al. Knowledge, attitudes, and awareness of breast self-examination among female university students in three Arab countries: a multi-center cross-sectional study. BMC Public Health.2025;25(1):2961. 10. Ben El-Fakir M, Aimrane A, Laaradia MA, Ait Taleb K, Issaoune MO, Lahouaoui H, El Khiat A, El-Mansoury B, Kahime K, Elmourid A, Ait-El-Mokhtar M, El Hidan MA. Awareness about breast cancer and breast self-examination among undergraduate female students at the university of Agadir, Morocco: A cross-sectional descriptive study.Epidemiologia (Basel). 2024; 165(3):385-401. 11. Joy, N., D’Souza, C., & D’Souza, C. R. S. Breast cancer awareness among undergraduate medical students in a tertiary healthcare centre in Mangalore, India. IntSurg J. 2018; 5(12): 3907–11.