Background: Recognition of breast cancer warning signs and practical palpation skills represent distinct learning outcomes in breast health education. Assessing both may help identify educational needs that knowledge-based assessments alone do not capture. This study compared breast cancer warning sign recognition, simulator-assessed palpation skills, and referral-related decision-making between reproductive-age women and adolescent girls.

Methods: This one-month comparative study in Kerman, Iran, recruited 30 employed reproductive-age women (18–45 years) and 30 adolescent female students (15–18 years) through multistage convenience sampling. A standardized 30-minute educational session used a three-dimensional warning sign display and a locally developed breast phantom containing eight concealed resin nodules. Baseline assessments covered demographics, warning sign recognition, phantom-based nodule detection, and referral-related decision-making. Between-group comparisons used independent-samples t-tests and chi-square or Fisher’s exact tests, as appropriate, in SPSS version 26.

Results: At baseline, reproductive-age women showed higher recognition of nipple discharge, breast erythema, unilateral enlargement, and peau d’orange than adolescent girls (all p < 0.05), alongside better recognition of malignant lump characteristics (76.7% vs. 40.0%; p = 0.004). Immediate medical referral was selected more frequently by women (76.7% vs. 33.3%), with significantly different overall referral-response distributions (p = 0.004). Simulator-assessed lump detection remained limited in both groups, with no statistically significant between-group difference, highlighting a contrast between warning sign recognition and practical palpation performance before the educational intervention.

Conclusion: Reproductive-age women showed better warning sign recognition and referral-related decision-making than adolescent girls, but both groups demonstrated limited palpation skills. Breast health education should assess knowledge and practical skills separately. Controlled studies with pre-intervention, post-intervention, and follow-up assessments are needed to evaluate simulator-based learning and skill retention.