Under-recognized risk factors and low perceived breast cancer risk among rural women in South-central China: A...

Many established breast cancer risk factors are poorly recognized by the public, which may contribute to low screening uptake. This study aimed to identify factors associated with perceived breast cancer risk among rural women in south-central China and to determine which objective risk factors are under-recognized.

A multisite cross-sectional study was conducted in rural areas of Hunan Province, south-central China. Women attending two county hospitals that provide annual population-based breast and cervical cancer screening programs were recruited (n = 1134). Perceived breast cancer risk was self-reported onsite. Guided by the Common-Sense Model of Self-Regulation (CSM), candidate predictors were selected from sociodemographic, self-system, and health-threat domains. Multivariable ordinal logistic regression was used to examine independent associations with perceived risk.

Of 1134 participants, 28.9% had ≤ 9 years of education and 47.4% reported a monthly family income of approximately USD 425. Most women (89.2%) reported no or low perceived risk of breast cancer. In multivariable analyses, factors in the self-system domain-poor emotion control (odd ratio [OR] 0.531, 95% confidence interval [CI] 0.391-0.722), light perceived stress (OR 0.511, 95% CI 0.348-0.750), moderate perceived stress (OR 0.477, 95% CI 0.354-0.643), and recent negative life events (OR 0.693, 95% CI 0.527-0.911)-were independently associated with perceptions of breast cancer risk. In the health-threat domain, history of benign breast disease (OR 0.725, 95% CI 0.528-0.995) and a family history of non-breast cancer (OR 0.371, 95% CI 0.228-0.604) were also associated with perceived risk, while family history of breast cancer showed a contrasting association (OR 2.004, 95% CI 1.347-2.981).

Perceived breast cancer risk was low among rural women in south-central China, and only a limited set of objective risk factors appeared to be accurately recognized. Community health education should emphasize under-recognized risk factors (for example, benign breast disease and relevant family cancer history) and incorporate tailored strategies to improve emotional regulation and risk awareness in underserved populations.