Critical Knowledge Gaps in Breast Cancer Awareness and Early Breast Cancer Detection among Nursing Professionals: A Cross-Sectional Survey Revealing the Need for an Innovative, Partner-Supported, Lifestyle-Integrated Strategy for Early Breast Cancer Screening—The Brahams Protocol

Background: Breast cancer remains the most frequently diagnosed cancer and a leading cause of cancer-related mortality among women worldwide. Nursing professionals play a pivotal role in breast cancer awareness, patient education, and early diagnosis; however, baseline knowledge gaps within this workforce remain inadequately characterised. This study evaluated breast cancer awareness and early detection knowledge among nursing professionals and provides the scientific rationale for the Brahams Protocol (BP), a lifestyle-integrated, partner-supported, shared-responsibility complementary breast cancer screening modality.
Methods: A questionnaire-based cross-sectional survey was conducted among 273 nursing professionals from Sarvodaya Hospital, Faridabad, and Sarvodaya Hospital, Noida, between April and June 2026. Participants completed a structured anonymous questionnaire immediately before educational sessions. Twenty-one knowledge items covering general awareness, risk/protective factors, screening, and warning symptoms were analysed. Comparisons between female and male participants were performed using chi-square or Fisher's exact tests where appropriate.
Results: General breast cancer awareness was relatively satisfactory (60.2%), whereas knowledge of risk and protective factors was poor (19.2%). Awareness of mammography as a screening tool was high (96.7%), but none of the participants knew that routine mammographic screening is generally not recommended for average-risk women younger than 40 years or that WHO recommends breast self-awareness rather than breast self-examination. Only 2.2% practised breast self-examination, and no participant reported clinical breast examination or breast cancer screening. Significant sex-based differences were observed for several knowledge domains (p<0.05).
Conclusions: Substantial evidence-based knowledge and behavioural gaps exist among nursing professionals despite satisfactory general awareness. These findings support the need for targeted educational interventions and provide the scientific rationale for prospective evaluation of the Brahams Protocol as a complementary breast cancer screening modality designed to strengthen continuous breast health vigilance, particularly in women younger than 40 years while complementing existing evidence-based screening pathways.

Breast cancer; Breast cancer screening; Brahams Protocol; Nursing professionals

1. Sung H, Filho AM, Laversanne M, Ferlay J, Siegel RL, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries. CA Cancer J Clin. 2026;76(4):e70090. doi:10.3322/caac.70090. [Google Scholar] [Crossref]

2. World Health Organization. Breast cancer [Internet]. Geneva: World Health Organization; 2026 Jul 3 [cited 2026 Jul 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer [Google Scholar] [Crossref]

3. World Health Organization. Global Breast Cancer Initiative implementation framework: assessing, strengthening and scaling-up of services for the early detection and management of breast cancer. Geneva: World Health Organization; 2023. [Google Scholar] [Crossref]

4. World Health Organization. Patient navigation for early detection, diagnosis and treatment of breast cancer: technical brief. Geneva: World Health Organization; 2024. [Google Scholar] [Crossref]

5. Bevers TB, Niell BL, Baker JL, et al. NCCN Guidelines® Insights: Breast Cancer Screening and Diagnosis, Version 1.2023. J Natl Compr Canc Netw. 2023;21(9):900-909. doi:10.6004/jnccn.2023.0046. [Google Scholar] [Crossref]

6. Oeffinger KC, Fontham ETH, Etzioni R, Herzig A, Michaelson JS, Shih YCT, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783. [Google Scholar] [Crossref]

7. Moy B, Rumble RB, Come SE, Davidson NE, DiFronzo LA, Holland JC, et al. Screening for breast cancer: American Society of Clinical Oncology resource-stratified guideline. JCO Glob Oncol. 2020;6:289-313. doi:10.1200/JGO.19.00381. [Google Scholar] [Crossref]

8. Kapur BN, Singh B, Verma V, Jaiswal HK. Breast Self-Examination: Social and Human Limitations—Evidence, Mechanisms, and the Transformative Role of the Brahams Protocol. Int J Novel Res Dev. 2025;10(12):b225-b234. doi:10.56975/IJNRD.2025.10.12.311299. [Google Scholar] [Crossref]

9. Singh B, Kapur BN, Dharmesh, Verma V, Jaiswal HK, Roy S. The Universal Paradox of Breast Cancer Stage at Diagnosis in Young Women: Evidence of a Global Failure of Screening Modalities and the Role of the Brahams Protocol (BP) as a Preclinical Detection Paradigm. Int J Res Sci Innov. 2026;13(4):1477-1482. doi:10.51244/IJRSI.2026.1304000132. [Google Scholar] [Crossref]

10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; for the STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. doi:10.1371/journal.pmed.0040296. [Google Scholar] [Crossref]

11. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053. [Google Scholar] [Crossref]

12. Taranikanti M, Panda S, Dash A, Yasmeen N, Siddique A, Behara J. Knowledge of nurses about breast cancer risk factors, general awareness and screening procedures in South India. Int J Med Sci Public Health. 2014;3(11):1372-1375. doi:10.5455/ijmsph.2014.150820144. [Google Scholar] [Crossref]

13. Akila P, Esther B, Ambekar R. Knowledge, attitude and perception on breast cancer awareness among paramedical workers. Int J Community Med Public Health. 2022;9(9):3536-3539. doi:10.18203/2394-6040.ijcmph20222220. [Google Scholar] [Crossref]

14. Choudhury A, Bezbaruah R, Ahirwar N, Dave S. Are We Breast Aware Yet? A Cross-Sectional Study of Nursing Staff in Western India. Asian Pac J Cancer Care. 2025;10(3):775-778. doi:10.31557/APJCC.2025.10.3.775-778. [Google Scholar] [Crossref]

15. Shrestha Simangainda DM, Barma A, Rawal G, Karn M, Jeevan BK, Adhikari J. Knowledge of breast cancer among nurses in a tertiary care center: a descriptive cross-sectional study. Ann Med Surg (Lond). 2025;87(4):1904-1908. doi:10.1097/MS9.0000000000003117. [Google Scholar] [Crossref]

16. Austoker J, Mansel R. Breast awareness: a review of breast awareness and breast self-examination. J Public Health (Oxf). 2009;31(1):114-124. doi:10.1093/pubmed/fdn068. [Google Scholar] [Crossref]

17. Linsell L, Burgess CC, Ramirez AJ. Breast cancer awareness among older women. Br J Cancer. 2008;99(Suppl 1):S42-S47. doi:10.1038/sj.bjc.6604538. [Google Scholar] [Crossref]

18. International Agency for Research on Cancer. Breast Cancer Screening. IARC Handbooks of Cancer Prevention. Vol. 15. Lyon (FR): International Agency for Research on Cancer; 2016. [Google Scholar] [Crossref]

19. World Health Organization. Guide to Cancer Early Diagnosis. Geneva: World Health Organization; 2017. [Google Scholar] [Crossref]

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