Iranian Journal of

Introduction: Breast cancer screening participation remains suboptimal among Iranian women. This study examined the associations of knowledge, attitudes, and perceived barriers with breast self-examination (BSE), clinical breast examination (CBE), and mammography (MG) among women in Mazandaran Province, Iran.
Methods: This cross-sectional study included 1,449 women aged 18 years or older from Amol, Babol, and Sari, Iran (2018–2022). Data were collected using questionnaires on demographics, screening behaviors, and breast cancer screening beliefs. Binary logistic regression was used to identify associated factors, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported.
Results: After adjustment for confounders, positive attitudes toward health checkups were associated with BSE (OR=1.85, 95% CI: 1.07–3.20) and CBE (OR=1.78, 95% CI: 1.08–2.93). Greater breast cancer knowledge was associated with BSE (OR=1.78, 95% CI: 1.36–2.34) and CBE (OR=1.43, 95% CI: 1.10–1.84). Fewer perceived barriers were associated with higher participation in BSE (OR=2.20, 95% CI: 1.65–2.92), CBE (OR=1.88, 95% CI: 1.42–2.42), and MG (OR=1.53, 95% CI: 1.00–2.33). Knowledge and attitudes were not significantly associated with MG.
Conclusion: Breast cancer screening behaviors were associated with multiple cognitive factors. Knowledge and positive beliefs were associated with BSE and CBE, while lower perceived barriers were associated with all screening behaviors. Knowledge alone may not explain MG participation.