Iranian Women's Perspectives on Breast Cancer: A Phenomenological Study

Document Type : -

Authors

1 Professor, Faculty of Clinical Psychology, Kharazmi University, Iran, Tehran

2 Associate Professor Department of Clinical Psychology, Kharazmi University of Tehran. Iran

3 Associate Professor Department of Clinical Psychology, Kharazmi University, Tehran, Iran.

4 .Ph. D Student in Health Psychology, Kharazmi University, Iran, Tehran

10.30465/ws.2023.42021.3618

Abstract

Introduction and the problem statement:
Breast cancer is the most common cancer among women in Iran. Understanding non-affected women’s perspectives of breast cancer can effectively contribute to the development and implementation of preventive interventions against this disease. The aim of this study is to give more clarity to our understanding of Iranian women's perception of breast cancer.
 
Previous studies:
There are a large number of "qualitative" studies conducted on the lived experiences of "women with breast cancer" of suffering from this disease. As a matter of fact, most of the studies examining "non-infected women’s" knowledge, beliefs, attitudes, and behaviors in relation to breast cancer have used "quantitative" approaches in order to describe demographic variables associated with women's awareness of and performance in performing preventive screenings. The present study is regarded as one of the few qualitative studies on Iranian non-affected women’s views on breast cancer.
Research methodology:
In this study, a phenomenological qualitative method was used in order to accurately describe Iranian women’s views about breast cancer, and the data derived from the semi-structured interviews with 39 women aged between 20-40, who were selected in a purposeful manner, were analyzed using the Colaizzi approach. The saturation criterion was employed in order to determine the sample size and evaluate the sampling adequacy. The interviews lasted 25-40 min and were audio-recorded. Also, an interview guide was prepared for the study. The participants were asked to answer a number of questions on four subject areas including (1) women’s knowledge and perception about cancer in general and breast cancer in particular, (2) women's beliefs about the causes of breast cancer (3) women's beliefs about the probability of them getting breast cancer, and (4) women's beliefs about their possible experience in case of breast cancer and any cancer-related perceptions. The data derived from the interviews were analyzed in seven steps by the use of the Colaizzi approach.
Research findings:
This study addressed four aspects including (1) the perceived nature (e.g., scary, symptomatic, shameful, and progressive), (2) the perceived causes (e.g., hereditary, environmental, lifestyle, and psychological factors), (3) the perceived probability (e.g., immunization, acceptance of the possibility of infection), and (4) the perceived outcome of (e.g., harmful to female identity, deadly and treatable if diagnosed early) of the breast cancer in order to better understand Iranian women's point of view about this disease. Thinking about cancer is a terrifying experience for most women. The women who participated in this study considered breast cancer as a symptomatic disease and pointed out the presence of palpable (mass) and visible (bleeding, discharge, and deformity) or understandable (pain) symptoms. They considered this type of cancer as a progressive disease that can spread to other organs and parts of the body. Although they cited the changes that occurred in recent years regarding the acceptance of women-related issues and diseases such as menstruation, uterine cancer, and breast cancer, they believed that suffering from breast cancer, education, and discussion about it is still considered a shameful issue among the Iranian society. In explaining the causes of the disease, they paid more attention to the presence of hereditary factors and considered breast cancer as a hereditary disease. They believed that psychological factors play a critical role in getting cancer. They imagined two paths for the influence of these factors: First, they evaluated the presence of unpleasant emotional moods, e.g., stress and anxiety, as an important factor in the occurrence of breast cancer; and second, they evaluated thinking about the negative aspects of life, e.g., the disease itself, as a cause of the breast cancer.
Discussion and conclusion:
Several outcomes can be mentioned as implications of this research. Researchers should pay enough attention to the low level of women's information about breast cancer as a result of the lack of proper education in Iran, through either the media or the health education system, due to the taboo of topics related to women's issues and diseases. We found that one of the women's perceptions is that they strongly believe that they are immune to breast cancer; this belief that can be regarded as one of the serious obstacles to searching for information and performing preventive screenings. This immunity that they believe in is based on two main components: the immunity due to not having hereditary factors; and immunity due to avoiding thinking about the disease. Regarding the causes of breast cancer, the emphasis on hereditary factors has led a significant part of women to believe that they are immune to this disease. Therefore, when implementing interventions for increasing breast awareness, the information on the age and genetic background of the disease should be presented with more emphasis and accuracy. In suggesting the reasons for not thinking about breast cancer and, of course, not performing screening, women's other belief about the impact of thinking about the disease and calling it out was among the topics with a high frequency. Therefore, the belief that thinking about the disease is a calling of and prevents women from engaging in awareness training for enhancement of breast health should be corrected by designing interventions targeting at changing the false beliefs. When designing the education related to this disease, women's belief about breast cancer as a scary and deadly disease should be also given enough attention and the high probability of its treatment in case of early diagnosis should be explained. Women's perception that breast cancer is a symptomatic disease leads them to ignore preventive measures for early diagnosis. It also seems that one of the obstacles to preventive measures is the belief in Iranian culture that considers breast cancer as a shameful disease, and consequently, women probably avoid performing breast cancer screening in order to avoid the diagnosis of a shameful disease and the resulting negative reactions. Therefore, the normalization of issues related to breast cancer should be considered when implementing preventive interventions. The results of this study have provided a valuable contribution to the understanding of Iranian women's perception of breast cancer, which can play a critical role in designing interventions targeted at increasing awareness and promoting more effective preventive behaviors among Iranian women, and as a result, reducing deaths caused by late diagnosis of this disease.

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Akbari, M. E. , Akbari, A. , Nafissi, N. , Shormeij, Z. , Sayad, S. , Rasaf, M. R. , & Shojaee, L. (2016). Prognostic factors of recurrence (early and late) and death in breast cancer patients in Iranian women. International Journal of Cancer Management, 9(6).
Allicock, M. , Graves, N. , Gray, K. , & Troester, M. A. (2013). African American women’s perspectives on breast cancer: Implications for communicating risk of basal-like breast cancer. Journal of health care for the poor and underserved, 24(2), 753.
American Cancer Society. (2020). Breast Cancer Risk and Prevention Available At: https://www. cancer. org/content/dam/CRC/PDF/Public/8578. 00. pdf
American Cancer Society. (2021). American Cancer Society Recommendations for the Early Detection of Breast Cancer. Retrieved from: https://www. cancer. org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer. Html
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). https://doi-org. ezproxy. frederick. edu/10. 1176/appi. books. 9780890425596
Anderson, B. O. , Braun, S. , Lim, S. , Smith, R. A. , Taplin, S. , & Thomas, D. B. (2003). Early detection of breast cancer in countries with limited resources. The breast journal, 9, S51-S59.
Anderson, B. O. , Yip, C. H. , Smith, R. A. , Shyyan, R. , Sener, S. F. , Eniu, A. ,. . . & Harford, J. (2008). Guideline implementation for breast healthcare in low‐income and middle‐income countries: Overview of the Breast Health Global Initiative Global Summit 2007. Cancer, 113(S8), 2221-2243.
Bab, S. , Abdifard, E. , Elyasianfar, S. , Mohammadi, P. , & Heidari, M. (2019). Time trend analysis of breast cancer in Iran and its six topographical regions: a population-based study. Journal of medicine and life, 12(2), 140–149. https://doi. org/10. 25122/jml-2018-0087
Baisch, M. J. , Vang, P. C. , & Peterman, B. R. (2008). An exploration of Hmong women's perspectives on cancer. Asian nursing research, 2(2), 82-91.
Borrayo, E. A. (1999). Breast cancer screening behaviors of women of Mexican descent: A Grounded Theory approach (Doctoral dissertation, University of North Texas).
Colaizzi P (1978) Psychological research as the phenomenologist views it. In Vale RS, King M (Eds) Existential-Phenomenological Alternatives for Psychology. Oxford University Press, New York NY
Ersin, F. , & Bahar, Z. (2011). Inhibiting and facilitating factors concerning breast cancer early diagnosis behavior in Turkish women: a qualitative study according to the health belief and health development models. Asian Pac J Cancer Prev, 12(7), 1849-1854.
Fischer, C. T. (Ed. ). (2005). Qualitative research methods for psychologists: Introduction through empirical studies. Academic Press.
Ghanbari, A. , Rahmatpour, P. , Hosseini, N. , & Khalili, M. (2020). Social determinants of breast cancer screening among married women: A Cross-Sectional Study. Journal of Research in Health Sciences, 20(1), e00467.
Hätönen, H. , Suhonen, R. , Warro, H. , Pitkänen, A. , & Välimäki, M. (2010). Patients' perceptions of patient education on psychiatric inpatient wards: a qualitative study. Journal of Psychiatric and Mental Health Nursing, 17(4), 335-341.
Jahangard, L. , Behmanesh, H. , Ahmadpanah, M. , Poormoosavi, S. M. , Solitanian, A. , & Highighi, M. (2019). Risky behaviors and health-promoting behaviors in young adults: An epidemiological study. Iranian journal of psychiatry, 14(4), 302.
Marmot, M. G. , Altman, D. G. , Cameron, D. A. , Dewar, J. A. , Thompson, S. G. , & Wilcox, M. (2013). The benefits and harms of breast cancer screening: an independent review. British journal of cancer, 108(11), 2205-2240.
Movahed, M. , Alborzi, S. , & Abasi, M. T. (2011). A Study of Socio-Cultural Factors Pertaining to Breast Self-Examination Knowledge, Attitude and Performance of Female Students of Shiraz University. Quarterly Journal of Women and Society, 2(7), 1-20.
Paknejad, H. (2019). Knowledge, attitudes and practice of breast self-examination among over 20-year females in Tehran. Razi Journal of Medical Sciences, 25(11), 34-41.
Panieri E. (2012). Breast cancer screening in developing countries. Best practice & research. Clinical obstetrics & gynaecology, 26(2), 283–290. https://doi. org/10. 1016/j. bpobgyn. 2011. 11. 007
Rakhshani, T. , Asadi, Z. S. , Taravatmanesh, S. , Kashfi, S. M. , & Ebrahimi, M. R. (2018). Study of the women’s breast cancer screening behavior in Shiraz, 2016. The Iranian Journal of Obstetrics, Gynecology and Infertility, 21(8), 39-46.
Rezabeigi-Davarani, E. , Khanjani, N. , Falahi, M. , Daneshi, S. , & Iranpour, A. (2016). Breast self-examination and its effective factors based on the theory of planned behavior among women in Kerman, Iran. Journal of Education and Community Health, 3(3), 1-8.
Roshandel, G. , Ferlay, J. , Ghanbari‐Motlagh, A. , Partovipour, E. , Salavati, F. , Aryan, K. ,. . . & Bray, F. (2021). Cancer in Iran 2008 to 2025: Recent incidence trends and short‐term predictions of the future burden. International journal of cancer, 149(3), 594-605.
Roshandel, G., Ferlay, J., Semnani, S., Fazel, A., Naeimi-Tabiei, M., Ashaari, M., Amiriani, T., Honarvar, M., Sedaghat, S., Hasanpour-Heidari, S., Salamat, F., Mansoury, M., Ghasemi-Kebria, F., Mirkarimi, H., Jafari-Delouei, N., Shokoohifar, N., Vignat, J., Weiderpass, E., Malekzadeh, R., & Bray, F. (2020). Recent cancer incidence trends and short-term predictions in Golestan, Iran 2004-2025. Cancer epidemiology, 67, 101728.
Safarpour, M. , Tiyuri, A. , & Mohamadzade, M. (2018). Knowledge, Attitudes and Practice of Women towards Breast Cancer and Its Screening: Babol City, Iran–2017. Iranian Journal of Health Sciences.
Sung, H. , Ferlay, J. , Siegel, R. L. , Laversanne, M. , Soerjomataram, I. , Jemal, A. , & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
Taha, H. , Al-Qutob, R. , Nyström, L. , Wahlström, R. , & Berggren, V. (2012). “Voices of Fear and Safety” Women’s ambivalence towards breast cancer and breast health: a qualitative study from Jordan. BMC Women's Health, 12(1), 1-10.
Tashakkori, A. , & Teddlie, C. (2010). Sage handbook of mixed methods in social & behavioral research. SAGE publications.
Tilburt, J. C. , James, K. M. , Sinicrope, P. S. , Eton, D. T. , Costello, B. A. , Carey, J. ,. . . & Murad, M. H. (2011). Factors influencing cancer risk perception in high risk populations: a systematic review. Hereditary cancer in clinical practice, 9(1), 1-15.
World Health Organization. (2020a). Cancer Country Profile 2020, BURDEN OF CANCER, ISLAMIC REPUBLIC OF IRAN, Available At: https://www. who. int/cancer/country-profiles/IRN_2020. pdf?ua=1
World Health Organization. (2020b). Regional Strategic Framework for accelerating universal access to sexual and reproductive health in the WHO South-East Asia Region 2020–2024.
World Health Organization. (2023). Global breast cancer initiative implementation framework: assessing, strengthening and scaling up of services for the early detection and management of breast cancer: executive summary.
Yadegarfar, G. , Salami, F. , Mostajeran, M. , Ansari, R. , Rejali, M. , & Aghdak, P. (2018). Factors Engaged With Women Performance in Doing Regular Breast Self-examination or Referring to Health Centers for Examination and Mammography. The Horizon of Medical Sciences, 24(1), 53-60.