Relevant data from the selected articles were extracted and summarized in Table 1. Then, a narrative synthesis was conducted to identify patterns and trends in the learning strategies and evaluation of breast cancer knowledge among secondary school students.

A cross-sectional study conducted in Jeddah, Saudi Arabia, involving 6380 female secondary school students, assessed the students’ knowledge of breast cancer and breast self-examination (BSE) (Table 1). The results showed that only 39.6% of the students had heard about BSE, and their understanding of the risk factors of breast cancer was very limited [7]. Over 80% of participants could not correctly answer half of the questions related to the disease. However, 47.1% reported having read or heard some scientific information about it, and only 51.9% understood that breastfeeding is not a risk factor for breast cancer. Married students and those with children demonstrated higher levels of knowledge, as did students with a family history of breast cancer or those who had undergone medical procedures related to the disease. The study used self-administered questionnaires to collect data, which were analyzed using SPSS with descriptive statistics and chi-square tests. These findings highlight the urgent need for educational programs aimed at promoting early detection and increasing awareness of breast cancer among secondary school students, a critical group for such interventions.

A quasi-experimental study (Table 1), involving 255 ninth-grade female students from four public high schools (140 in the intervention group and 112 in the control group) in Peoria, Illinois, was conducted [8]. The study assessed the effectiveness of a 50-min educational program on BSE. The program included a PowerPoint presentation covering breast cancer facts and BSE techniques and a demonstration video. The primary goal was to assess whether the program improved knowledge about BSE and breast cancer and whether it influenced the intention to perform BSE regularly and encourage others to do so. The results showed that students in the intervention group achieved higher knowledge scores and retained this knowledge over a five-to-six-week period than the control group. Additionally, the percentage of students performing BSE increased from 20 to 30% in the intervention group, while it slightly declined from 10 to 9% in the control group. There was also a significant improvement in the intention to perform BSE in the future among the students in the intervention group. The study used a 17-item questionnaire consisting of multiple-choice, true/false, and yes/no questions to gather data on knowledge and behavioral intent. Data were analyzed using SPSS v11.5, Kruskal–Wallis tests, and ANOVA. The findings support the feasibility of enhancing existing health education programs with content on breast self-examination.

The third study presented a cross-sectional analysis conducted in Lagos (Nigeria), involving 200 female students from three senior secondary schools, ages between 12 and 18 years old, who received self-administered questionaries about breast cancer general knowledge and BSE among other questions (Table 1). Each school had 600, 200, and 200 students, respectively; then, the sample selection process was done based on the ratios 3: 1: 1, that is, 120, 40, and 40 students were selected from each school, respectively. Such a selection process followed a systematic methodology based on a sample fraction of 5, i.e., the first member of the sample was selected randomly between the first and the fifth student of the school and from then on, the fifth student was selected to complete the sample [9]. Most students (97%) had heard about breast cancer; however, only 54% knew of the disease. Then, 37.5% of responders knew about the warning signs of breast cancer, 54.5% believed breast cancer patients could be cured if early detected, and 51% of students acknowledged that breast cancer could be metastasized. Then, 58.5% of students had heard about BSE as a technique for early detection of breast cancer; however, less than 50% were aware of the BSE procedure, 47% of responders knew such procedures were done after menstruation, 46.5% knew it was done using the tip of one’s fingers to feel the lumps, and 45% of students acknowledged that armpits should also be examined during the procedure.

The fourth study in Table 1 is a cross-sectional analysis conducted in Colombo, Sri Lanka, involving 800 adolescent female students [10]. Its objective was to assess knowledge, attitudes, and practices related to breast cancer, focusing on detection methods, available services, breast self-examination (BSE), and sources of information. Results revealed significant deficiencies in all the areas evaluated. Only 17.1% of the students knew how to perform BSE, and just 6.17% had attempted it. Additionally, 9.4% knew early detection methods, and only 5.5% knew where to seek help for breast cancer detection. The self-administered questionnaires, available in Sinhala, Tamil, and English, consisted of 11 sections and 60 questions covering demographics, risk factors, early warning signs, detection measures, and sources of information. The sample was selected through multi-stage stratified cluster sampling, and the data were analyzed using SPSS 18.0. Among the most notable findings, only 35.6% of the students recognized mammography as an effective screening tool, while 79.4% were unaware that chemotherapy is a treatment for breast cancer. Those with a family history of the disease demonstrated higher knowledge. This study highlights the urgent need to implement educational programs designed to address these gaps and promote positive health practices among adolescents in Sri Lanka, incorporating strategies that combine theoretical knowledge with practical approaches to foster greater awareness and long-term prevention.

The fifth study in Table 1 is a cross-sectional analysis conducted in the Otuocha Educational Zone, Anambra State, Nigeria, involving 432 senior secondary school students from 24 schools, of which 321 completed valid questionnaires [11]. The study aimed to evaluate the knowledge, attitudes, and practices related to breast cancer and breast self-examination (BSE) to provide baseline information for designing early and targeted interventions. The results revealed that only 4.1% reported a positive family history of breast cancer. While general knowledge about breast cancer was high (75.2%), specific knowledge about risk factors (41.5%) and symptoms (46.1%) was considerably low. 73.6% of the students expressed positive attitudes toward BSE; however, only 6.1% practiced it monthly, and 55.3% had never practiced it. The data collection tool was a self-administered questionnaire adapted from previous studies and validated with a pilot group of students. The study highlighted that the primary source of information about breast cancer was television or radio. The questionnaire covered demographic factors, knowledge about risk factors, symptoms, and BSE techniques, and related attitudes and practices. Data were analyzed using SPSS version 25.0, employing descriptive statistics and binary logistic regression. This study underscored the urgent need for health campaigns that not only promote BSE practices but also explain techniques, risk factors, and symptoms, emphasizing the correct methodology, timing, and frequency of BSE. The authors recommended incorporating BSE and breast cancer-related topics into school curricula, considering the positive attitudes observed among students suggest a strong potential for implementing effective and culturally appropriate educational programs.

The final study in Table 1 is a quasi-experimental design conducted at Fiwasaye Girls Grammar School in Akure, Nigeria, involving 280 adolescent students aged 12 to 19 years [12]. This study aimed to evaluate the impact of education on the knowledge, attitude, and practice of breast self-examination (BSE) among adolescents. Data were collected using a self-administered questionnaire administered both before and eight weeks after the intervention. The educational program consisted of six sessions, each lasting 45 to 60 min, with 50 students per session. It included PowerPoint presentations, demonstration videos, and guided practical activities on BSE. The results revealed significant improvements following educational intervention. Knowledge about breast cancer increased from 68.9% in the pre-test to 97.1% in the post-test. Similarly, the percentage of students who knew how to correctly perform BSE grew from 25.4 to 56.8%, and positive attitudes toward BSE increased from 33.9 to 66.1%. Regarding the practice of BSE, 40.4% of the students reported performing it before the intervention, while this percentage rose to over 80% afterward. Additionally, following the intervention, 79.3% of the students felt confident that they could accurately detect abnormalities in the breasts. Statistical analysis was performed using SPSS version 20, applying descriptive statistics, chi-square tests, and t-tests. This study highlighted the effectiveness of educational programs in improving knowledge, attitudes, and practices related to BSE among adolescents, emphasizing the importance of including such interventions in school health programs to promote early detection behaviors.

No articles written in Spanish related to the topic were identified in the consulted databases. After screening, six articles in English were selected to obtain a representative sample of empirical studies on breast cancer knowledge and BSE in secondary school students. The articles were published in six journals, with these journals having moderate to high impact levels, suggesting good recognition and credibility in their respective fields. This is reflected in their quartiles in Fig. 2 and impact factors in Table 2.

The graph shows the quartile distribution of the journals in this review. Each journal is categorized into one of four quartiles (Q1, Q2, Q3, and Q4), with Q1 representing the highest-ranked journals in terms of impact factor and Q4 representing the lowest. This classification reflects the influence of the journals and prestige in their respective fields, providing insight into the credibility and relevance of the studies published in them. Abbreviations, 1: Q1; 2: Q2; 3: Q3; 4: Q4