Comparative analysis of knowledge, attitudes, and breast cancer screening practices among women in South Africa and the United States: a multinational study

Background Breast cancer screening is an effective prevention strategy, yet global disparities in uptake persist across and within countries from varying human development index contexts. This study compares breast cancer screening-related knowledge, attitudes, and practices among US and SA women. Methods Cross-sectional studies were conducted among 2000 age-matched SA and US women. Sociodemographic data, knowledge, attitudes, and screening practice, were assessed. Multivariate logistic regression associations between screening behaviors (ever screened, clinical breast examination (CBE), mammography) and predictors were determined. Results US women had greater breast cancer knowledge and were more likely to participate in screening (ever screened AOR = 2.078, p < 0.001, CBE AOR = 2.741, p < 0.001, and mammography AOR = 3.712, p < 0.001). SA women perceived breast cancer to be less serious than US women, but perceived greater benefits and self-efficacy for breast self-examination and greater cues to action. Screening uptake was mainly associated with availability of screening services; knowledge, family history of breast cancer, older age, tertiary education, marital status and good health also contributed to increased screening behavior. Unexpectedly, stigma associated with increased perceived benefits of screening and screening practice and self-efficacy for BSE and cues to action. Conclusions Tailored interventions should incorporate structural investments and stigma-sensitive education to increase screening participation. SA should prioritize increasing community knowledge and expanding CBE into communities and primary health care. US policies should focus on marginalized minority groups through insurance expansion, navigation support, and tailored outreach.