Exploring the Association Between Breast Cancer Perception and Health-Promoting Lifestyle Behaviours Among Women: A Cross-Sectional Study in Saudi Arabia

Aim: This study aimed to describe breast cancer perceptions, health-promoting lifestyle behaviours, and lifetime breast examination and mammography practices and to examine associations between breast cancer perception subscales and health-promoting lifestyle behaviours among women in Abha, Saudi Arabia. Methods: This cross-sectional online survey included 1002 Saudi women aged ≥ 18 years living in Abha, recruited by convenience sampling through social media and instant messaging. Arabic-language versions of the Breast Cancer Perception Scale (BCPS) and HPLP-II were self-administered. Breast self-examination (BSE), clinical breast examination (CBE), and mammography were assessed as lifetime ever/never items. Multiple linear regression examined associations of sociodemographic variables and BCPS subscales with HPLP-II scores. Results: Perceived knowledge (3.64 ± 1.05), treatment belief (3.43 ± 0.77), fear (3.25 ± 1.30), and perceived risk (3.40 ± 0.89) had higher mean scores than perceived need for health checks (2.78 ± 1.23) and stigma (2.89 ± 1.14). The HPLP-II mean was 2.63 ± 0.46 (spiritual growth highest, 2.96 ± 0.50; physical activity lowest, 2.23 ± 0.60). Lifetime self-reported prevalence was 61.1% for BSE (95% CI 58.1 to 64.1), 22.5% for CBE (95% CI 19.9 to 25.0), and 12.8% for mammography (95% CI 10.7 to 14.8). Among women aged ≥ 40 years, 68 of 225 reported lifetime mammography (30.2%; 95% CI 24.2 to 36.2). In a mutually adjusted model of BCPS subscales, higher HPLP-II scores were associated with perceived knowledge (unstandardized B = 0.059, 95% CI 0.032 to 0.087, p < 0.001), treatment belief (B = 0.120, 95% CI 0.078 to 0.163, p < 0.001), and stigma (B = 0.058, 95% CI 0.023 to 0.093, p = 0.001), and lower scores were associated with perceived need for health checks (B = −0.259, 95% CI −0.293 to −0.225, p < 0.001), perceived risk (B = −0.130, 95% CI −0.176 to −0.083, p < 0.001), and fear (B = −0.028, 95% CI −0.054 to −0.003, p = 0.030). These associations were not adjusted for sociodemographic characteristics and should be interpreted cautiously. Conclusions: In this online convenience sample, lifetime mammography and CBE were less commonly reported than BSE, and physical activity was the lowest-scoring lifestyle domain. These findings do not show whether awareness or perceptions influence screening participation because screening was not modelled against these constructs. Longitudinal studies with age- and indication-specific screening measures are needed to clarify these relationships.