Background: Breast cancer awareness, knowledge, and attitudes are crucial for effective prevention, early detection, and treatment. The disease is most prevalent and deadly cancer among women in Ethiopia. This systematic review and meta-analysis investigate these aspects among different population groups in Ethiopia.

Methods: Studies were stratified based on populations, and those involving only specific groups, such as female teachers, were excluded from meta-analysis. Data were extracted and analyzed from multiple studies to determine the levels of perception, awareness, knowledge and attitudes towards breast cancer. A meta-regression analysis explored the influence of participant characteristics on outcomes.

Results: The analysis revealed that 56% (95% UI: 36-74) of health professionals, 49% (95% UI: 35-64) of students, 30% (95% UI: 21-40) of healthy women, and 58% (95% UI: 38-75) of patients had commendable knowledge of breast cancer, with an overall estimate of 46% (95% UI: 37-55). Attitudes towards breast cancer were positive in 67% (95% UI: 49-81) of health professionals, 50% (95% UI: 21-79) of healthy women, and 71% (95% UI: 2-100) of students, with an overall favorable attitude of 64% (95% UI: 53-74). Perceptions towards breast self-examination (BSE) were particularly positive among teachers, with high motivation reported. Despite moderate levels of knowledge and positive attitudes, awareness has significantly declined in recent years, with studies published from 2020 onwards showing a reduction in awareness (OR: 0.37, P-value: 0.040).

Conclusion: The study indicates moderate knowledge, positive attitudes, and perceptions towards breast cancer among various groups in Ethiopia, but highlights a concerning decline in awareness in recent years. Addressing these issues through targeted educational initiatives, improved healthcare cooperation, government policies, community engagement, private sector support, media advocacy, and philanthropic contributions is essential.

Recommendations: Collaborative efforts among stakeholders are needed to enhance breast cancer education, awareness, perceptions, and healthcare access, ultimately reducing the incidence and impact of breast cancer in Ethiopia.