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.

Aim: To examine breast cancer perception, health-promoting lifestyle behaviours, and screening practices, and their sociodemographic and psychosocial correlates, among women in Abha, Saudi Arabia. Methods: A cross-sectional survey of 1,002 women aged ≥18 years in Abha (May–December 2025), recruited online through social media and instant messaging. Validated Arabic versions of the Breast Cancer Perception Scale (BCPS) and HPLP-II were self-administered online, with self-reported breast self-examination (BSE), clinical breast examination (CBE), and mammography history. Multiple linear regression identified predictors of HPLP-II and BCPS 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) were moderately high; perceived need for health checks (2.78 ± 1.23) and stigma (2.89 ± 1.14) were lower. HPLP-II mean was 2.63 ± 0.46 (spiritual growth highest 2.96 ± 0.50; physical ac-tivity lowest 2.23 ± 0.60). Ever-screening: BSE 61.1% (95% CI 58.1–64.1), CBE 22.5% (95% CI 20.0–25.1), mammography 12.8% (95% CI 10.8–14.8). Perceived knowledge (β = 0.059), treatment belief (β = 0.120), and stigma (β = 0.058) were positively, and perceived need for health checks (β = −0.259), perceived risk (β = −0.130), and fear (β = −0.028) negatively, associated with HPLP-II. Married women had higher lifestyle and perception scores; more educated and publicly employed women had higher perception scores. Conclusion: Despite moderately high perceived knowledge, clinical screening particularly mammography remains very low, and physical activity, a modifiable breast cancer risk factor, is the weakest lifestyle do-main. Awareness alone does not translate into screening; interventions should address fear and symptom-contingent care-seeking, embed screening referral in primary care, involve families, and promote culturally appropriate physical activity.