Breast and cervical cancers particularly affect low and middle-income countries [1] . In sub-Saharan Africa, 129.400 cases of breast cancer and 110.300 cases of cervical cancer are reported yearly. A woman in this region has a 1 to 4% chance of developing breast cancer and a 3 to 5% chance of developing cervical cancer before the age of 75 [2] . In Cameroon, these cancers are also the most deadly, with 20.108 deaths from breast cancer and 1787 from cervical cancer in 2020, all women [3] . The increase in the incidence of cancer in Africa is reported to be a result of changes in lifestyle, failure to take preventive measures and delays in diagnosis [4] . Given the limited resources available in terms of technical facilities, the high cost of targeted therapies and the shortage of oncology specialists in the country [4] , primary and secondary preventive measures remain the main means of the fight against cancer. To this end, the World Health Organization (WHO) has drawn up recommendations for the prevention of breast and cervical cancer by the healthcare system and by women, depending on the priorities and resources of each country [5] [6] . Preventive measures for women against breast cancer (BC) include seeking care (screening by mammography or breast ultrasound), breast self-examination and continued breastfeeding [5] . For cervical cancer (CC), this involves vaccination against the Human Papilloma Virus (HPV) for boys and girls aged from 9 to 13, and cervical cancer screening at least once for women aged from 30 to 49 [6] . Women are therefore key players in the prevention of breast and cervical cancer. As a result, their adherence to the proposed interventions guarantees their success. Knowing that the practice of these preventive measures is correlated with favorable attitudes and a good level of knowledge, this study focuses on women’s knowledge, attitudes and practices regarding preventive measures against breast and cervical cancers in a health district in Cameroon.

A total of 325 women were recruited. More than half of the participants were aged between 21 and 30 (60.9%), singles (52.9%) and had at least one child (53.2%) ( Table 1 ).

In all, 87.39% of women (N = 284) had heard of breast or cervical cancer, N = 31 study participants had never heard of breast cancer and N = 45 participants had never heard of cervical cancer. The most frequently cited sources of information were the media (51.05%) and health facilities (41.90%). For both cancers, the most frequently cited risk factors were exposure to radio waves and radiation (48.2%) and taking hormones (47.1%) ( Table 2 ). Specifically, 77.8% of participants (N = 253) were aware of breast cancer; and in terms of risk factors, 34.9% cited heredity, 28.9% old age and 24.1% obesity. Cervical cancer was known to 73.5% (N = 239) of participants, and the risk factors mentioned were sexually transmitted diseases (STDs) (58.15%) and the human immunodeficiency virus (HIV) (49 %).

Of the 284 women aware of the two cancers, 70.8% said they could be prevented. The most frequently cited preventive measures were screening (77.6%) and regular physical exercise (52.2%) ( Table 3 ). As a means of prevention specific to breast cancer, 64.7% of participants cited prolonged breastfeeding and 65.9% breast self-examination. In terms of cervical cancer prevention, 51.9% of women cited abstinence and 52.6% a single sexual partner, but only 19.9% used condoms during sex ( Table 4 ).

In terms of knowledge of measures to prevent breast and cervical, only 12% of women had a good level of knowledge and 46.76% had a poor level ( Figure 1 ).

Women in the 21 - 30 age group reported higher levels of knowledge and practice (p = 0.041 and 0.037) compared to older women. University education was reported to have a higher level of knowledge (P = 0.024). Women who had never given birth had a high level of practice compared with those who had at least one child (P < 0.001), therefore, women with one child had a better attitude (P < 0.001) ( Table 5 ).

Binary logistic regression showed a significant association between a low level of education and a poor level of knowledge [OR: 4.72; 95% CI: 2.82 - 7.89; P-value < 0.001], attitudes [OR: 1.94; 95% CI: 1.15 - 3.28; P-value = 0.012], and practices [OR: 6.76; 95% CI: 3.29 - 13.86; P-value < 0.001]. An association was also found between poor knowledge [OR: 4.69; 95% CI: 2.48 - 8.87; P-value < 0.001], harmful practices [OR: 5.10; 95% CI: 2.59 -10.04, P-value < 0.001] and an age greater than 40 years. Harmful practices were associated with poor knowledge [OR: 3.47; 95% CI: 1.59 - 7.55; P-value = 0.002], harmful attitude [OR: 56.20; 95% CI: 13.17 - 239.66; P-value < 0.001].

Concerning women’s attitudes to the prevention of breast and cervical cancer, a desire for more information about these diseases was expressed by 97% of participants, particularly on prevention (83.2%), causes (63.9%) and symptoms (60.7%).

However, when it came to breast screening, 53.8% of participants had never intended to do it, 72.3% were afraid of a bad result, 28% of participants said they didn’t need it, 36.8% didn’t find it accessible, 36% found it embarrassing, 21.3% of women said they were too busy to do it and 35.6% thought they were too young. The perception of not being at risk of breast cancer was reported by 57.3% of participants and 12.6 % said they were against breast self-examination ( Table 6 ).

Concerning cervical cancer, the perception of not being at risk was reported by 55.7% of participants. Concerning cervical cancer screening, 58.6% of participants never intended to have it done, 72% were afraid of a bad result, 30.1% did not think they needed it, 51% of participants did not find it accessible, 20% said they were too busy to do it and 38.5% thought they were too young to do it. The HPV vaccine was disapproved of by 2.92% of participants.

Overall attitude to the prevention of breast and cervical cancer were approximate (34.15%), only 18.47% of women had the right attitudes ( Figure 2 ).

Breast and cervical cancer prevention practices were generally inadequate ( Figure 3 ). In fact, 7.05% of participants reported taking tobacco and 13.74% a prolonged hormonal treatment. In terms of breast cancer prevention, 59.7% of participants reported that they did not perform breast self-examination. Of the 40.3% who did, only 7.84% did so one week after menstruation. A total of 15.84% of participants said they had not breastfed their children for at least 6 months, and 82.2% had never been screened for breast cancer ( Table 7 ).

In terms of cervical cancer prevention practices, only 9.2% of participants had already been screened, 86.3% of them less than 5 years ago. Only 4.2% of participants had received the HPV vaccine, of whom 20% had taken one dose, 30% two doses and 50% three doses. A total of 20.5% of women reported having more than one sexual partner. Concerning condom use, only 13% of participants used condoms every time they had sex, while 45% used them rarely and 25.4% never did. The remaining 16.6% of participants said they practice abstinence ( Table 8 ).

Women’s knowledge, attitude, and practice of preventive measures against breast and cervical cancer was poor, and associated with a low level of education. A study conducted in Brazzaville reported primary education as one of the barriers to cervical cancer screening [11] . In fact, it has been shown that the less advanced the level of education, the lower the socio-educational level of women is, and the less exposure they have to various information channels [12] .

Women’s main sources of information were radio and television. This is similar to a study conducted in the Congo, where women’s primary source of information about cervical cancer was also the media [13] . Indeed, the media can be an effective means of combating these diseases through an audiovisual awareness-raising approach to strengthen communication on the subject [11] .

Knowledge of the risk factors for breast and cervical cancer was also poor. And this knowledge can be improved by investing in communication and awareness-raising resources [14] .

However, attitudes were favorable to learning more about the subject, and it was also noted that the intention to use screening, although low, improved over time with reference to studies carried out in the country [15] . This renewed interest therefore represents an opportunity to improve the prevention of these diseases, bearing in mind that the perception of a disease may depend on the level of information on the subject [16] . Most of the women who took part in the survey had a mistaken perception of risk and screening. More than half of the women said they were not at risk of breast and cervical cancer. Similar results were reported in a study conducted in Gabon [17] . This may be explained by their predominantly young age group. Because of their young age, these women did not think they were at risk of developing these diseases. However, studies have shown an increase in the incidence of cancer in young people [18] [19] . When it came to screening, more than a third of participants found it embarrassing and were afraid of discovering a serious illness. Several studies have also highlighted these remarks [17] [20] . Fear reflects a poor understanding of the natural history of these diseases and of the principle of secondary prevention that underlies screening [21] . In addition, the breasts and female genital tract are often considered to be intimate, and women sometimes feel intimidated to discuss the symptoms associated with them. Therefore, destigmatizing discussions about the female genital tract through awareness-raising would be an important strategy to encourage women to be screened and to seek care if they have associated symptoms [22] .

However, these mostly approximate attitudes of women were correlated with inadequate practices, in line with a study conducted in Bamenda [23] . This may be explained by the poor level of knowledge of these diseases in these studies. It has been shown that the use of preventive measures is correlated with a good level of knowledge about the disease [24] . The inadequacy of practices was most marked by low levels of screening for breast and cervical cancers. Results differ from those in developed countries [14] . Less than a tenth of participants had taken the HPV vaccine. This may be explained by the fact that after the age of 13, the HPV vaccine is expensive in Cameroon, so not all women can afford it easily [25] .

The practice of preventive measures against breast and cervical cancers remains insufficient. It will be wise to intensify primary and secondary prevention interventions focused on awareness strategies, vaccination and early detection of these cancers [26] . Including key actors in the region such as community health workers, traditional and religious communities, teachers, and involving the most common sources of information (media, social networks, health facilities). Extend these actions to the most remote corners of the district while targeting the youngest and least educated.

This study aimed at evaluating women’s knowledge, attitudes and practices regarding preventive measures against breast and cervical cancer. The results showed that most of the participants were between 21 and 30 years old, single, and had at least one child. Knowledge was poor overall and mainly related to prevention measures. Attitudes were approximate overall and mainly related to the fear of discovering a serious disease and the fact of not being at risk of cancers. Overall practices were inadequate, with a particular lack of screening and vaccination against HPV. Harmful practices were associated with poor knowledge and a harmful attitude. As a result, it would be advisable to raise awareness of breast and cervical cancer prevention, targeting all women and youths, particularly in the current context where cancers are increasingly occurring in young people.

Acknowledge the head of the Mbankomo health district for authorizing this study, and all participants who made the study possible.