Appraisal of Breast Cancer Symptoms by Iranian Women: Entangled Cognitive, Emotional and Socio-Cultural Responses

Background: Breast cancer is the most common cancer in Iranian women and usually features delayedpresentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significantimpact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the processleading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranianwomen with self-detected possible breast cancer symptoms. Materials and
Methods: A qualitative method wasconducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breastcancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of TehranUniversity of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribedand analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness ofthe study was verified by prolonged engagement, member validation of codes, and thick description.
Results: Themain concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling ofsymptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breastself-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormalsymptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Socialinteraction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinitionof the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized andincurable illness associated with loss of femininity were reasons for patient worries and fear.
Conclusions: Thisstudy emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding ofsymptom seriousness require further investigation. It is suggested that programs aimed at shortening patientdelay in breast cancer should be focused on improving women’s knowledge and self-awareness of breast cancer,in addition to correcting their social beliefs.