Background Breast cancer remains a leading cause of morbidity worldwide, necessitating innovative and accessible interventions that address both clinical and psychosocial needs. AI-powered chatbots are increasingly used in health education due to their 24/7 availability, personalization, and interactivity. However, empirical evidence on their effectiveness in enhancing knowledge, empowerment, and attitudes in oncology settings remains limited. Aim This randomized controlled trial (RCT) evaluated the impact of an AI chatbot intervention on knowledge, empowerment, and attitudes toward AI among breast cancer patients. Methods A two-arm, pre–post RCT was conducted with 122 women diagnosed with breast cancer at Kafr El-Sheikh University Hospital. Participants were randomly assigned to an intervention group (n = 61) receiving structured AI chatbot-based education plus standard care, or a control group (n = 61) receiving standard care alone. Data were collected using validated questionnaires assessing breast cancer and AI knowledge, attitudes toward AI, and perceived empowerment. G*Power analysis determined sample adequacy for between-group comparisons. Results Post-intervention, the intervention group showed significantly higher knowledge (20.3 ± 2.1 vs. 17.9 ± 3.4, p <.001) and more positive attitudes (82.4 ± 7.2 vs. 72.6 ± 8.9, p <.001) compared to controls. Logistic regression indicated that knowledge gain and higher education predicted a positive AI attitude. Path analysis revealed both direct and mediated effects of knowledge on attitude via empowerment. Usage data and chatbot session logs supported high engagement. Conclusion Integrating AI chatbots into oncology nursing care significantly enhances knowledge, empowerment, and AI acceptance. These findings support chatbot integration in patient-centered digital health strategies, particularly in oncology.