How do I deal with breast cancer: a qualitative inquiry into the coping strategies of Iranian women survivors

Background

Breast cancer is the most frequent cancer in Iran. Understanding the coping strategies employed by cancer survivors can provide valuable information for designing interventions to help them adapt to the problems produced by cancer and its treatment. This study aimed to explore the coping strategies of BC survivors in Iran.

Methods

This qualitative study was conducted in Mashhad, Northeast Iran, between April and December 2021. Fourteen BC survivors were selected through purposive sampling. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA 12 software was used for data organization. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered.

Results

The main categories that emerged from the participants' data analysis were “behavioral coping strategies” and “emotional coping strategies.” Behavioral coping strategies included efforts to adopt healthy nutrition, attempts to improve a healthy lifestyle, maintenance of everyday activities, use of specialized cancer support consultation services, and seeking to increase health literacy about BC. The emotional coping strategies consisted of denial as a temporary escape route, positive thinking and focusing on the positive aspects of life, reinforcement of spirituality, and seeking the support of relatives.

Conclusion

Our findings provide an in-depth understanding of Iranian women’s strategies for coping with BC. A trained team of oncologists, psychiatrists, mental health professionals, and reproductive health specialists needs to contribute significantly to improving the coping ability of patients with cancer, which could lead to enhanced health promotion and a higher quality of life.

Understanding breast cancer risk factors: is there any mismatch between laywomen perceptions and expert opinions

Background

Women’s perception and knowledge of breast cancer signs, symptoms, and risk factors could be conducive to breast cancer risk management and interventions. The present study aimed to explore Iranian laywomen perceptions and expert opinions regarding breast cancer risk factors.

Methods

This qualitative study was conducted from March to November 2019 in Mashhad, northeast of Iran. Through purposive sampling, 24 laywomen (women with and without BC) and 10 experts of different fields including oncology, surgery, gynecology and reproductive health were selected. Data collection was carried out using semi-structured interviews, which was mainly focused on the participants’ understanding and perception of BC risk factors. The data was analyzed utilizing conventional content analysis developed by Graneheim & Lundman. Components of trustworthiness, including credibility, dependability, confirmability, and transferability were considered.

Results

The main category of risk factors, which emerged from the lay participants’ data analysis, were “unhealthy lifestyle and habits” , “hormonal influences”, “environmental exposures”, “Individual susceptibility “and “belief in supernatural powers”. The experts had similar perspectives for certain risk factors, yet not for all. The category of “Individual history of disease” was emerged only from experts’ interviews.

Conclusion

In the present study, the lay participants’ perception concerning BC risk factors was found to be a mixture of cultural beliefs and the scientific knowledge dispersed by the media, internet, and health services. Primary prevention approaches, including awareness of breast cancer risk factors, are required for women to make improved health-related choices.

Night-shift work duration and breast cancer risk: an updated systematic review and meta-analysis

BACKGROUND

The International Agency for Research on Cancer (IARC) has classified shift work as a possible human carcinogen. The results of systematic on this topic is contradictory. This systematic review and meta-analysis, therefore, aimed to update the current evidence regarding the relationship between night-shift work duration and breast cancer risk.

METHODS

PubMed, Web of Science, and Scopus as well as reference list of included studies were searched until December 19, 2020. Observational case-control or cohort studies investigating the relationship between the duration of night-shift work and breast cancer in women were included, which all quantified night-shift work exposure. All statistical analyses were done by Stata version 11.2.

RESULTS

Our literature search was resulted in retrieval of 4854 publications from which 26 eligible studies with 1,313,348 participants were included in the meta-analyses. The pooled relative risk (RR) and 95% confidence intervals (CIs) of breast cancer for short-term night-shift workers (< 10 years) was 1.13 (95% CI 1.03-1.24, p = 0.008, I2 = 71.3%), and for long-term night-shift workers (≥ 10 years) was 1.08 (95% CI 0.99-1.17, p = 0.09, I2 = 42.2%), with moderate to substantial statistical heterogeneity observed in both analyses. The results of subgroup analysis showed that flight attendants with long overnight flights were at an elevated risk of breast cancer, but unmeasured confounders limited these results. The risk of breast cancer in case control studies, adjusted for reproductive factors and family history of breast cancer as well as studies with high quality was increased in both short term and long term night-shift workers.

CONCLUSIONS

This systematic review found a positive statistical relationship between night work and breast cancer risk in short-term night-shift workers but no increase was observed in the long-term night-shift workers.

Development and validation of a new tool to measure Iranian pregnant women's empowerment

Empowering pregnant women improves their health and reduces maternal mortality, but there is a lack of suitable tools to measure women's empowerment in some cultures. This study aimed to design and validate a questionnaire for measuring the dimensions of empowerment among Iranian pregnant women. After a literature review, and face and content validity testing, a 38-item questionnaire was developed and tested on a sample of 161 pregnant women. Factor analysis grouped the items into 3 subscales: educational empowerment (e.g. prenatal training), autonomy (e.g. financial independency and mental ability) and sociopolitical empowerment (e.g. involvement in social and political activities). Criterion validity testing showed a strong positive correlation of the total scale and subscales scores with the Kameda and the Spritzer empowerment scales. Cronbach alpha was 0.92 for total empowerment. A total of 32 items remained in the Self-Structured Pregnancy Empowerment Questionnaire, which is a valid new tool to measure the dimensions of pregnant women's empowerment.

Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis

This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and the Cochrane Library) were searched. The mean frequency of hot flashes in red clover groups was lower compared with that in the control groups (close to statistical significance). Difference in means (MD) of hot flashes frequency was - 1.99 (- 4.12-0.139; p = 0.067; heterogeneity P > 0.01; I(2) = 94.93%; Random effect model). Subjective (vaginal dryness) and objective (maturation value) symptoms of vaginal atrophy showed a significant improvement with 80-mg dose of red clover. Red clover showed less therapeutic effect on psychology status, sexual problems and sleeping disorders. Red clover consumption may decrease frequency of hot flashes, especially in women with severe hot flashes (≥ 5 per day). Red clover may reduce other menopausal symptoms. Further trials are needed to confirm the current systematic review findings.

The application of soy isoflavones for subjective symptoms and objective signs of vaginal atrophy in menopause: A systematic review of randomised controlled trials

Vaginal atrophy is a common complaint among many women in their menopause, presenting with a cluster of symptoms including dryness, itching, burning/soreness, discharge, irritation and painful intercourse. We searched for existing pertinent data in three chief registries. Specified time brackets included 1996-2013 for Medline, 1990-2013 for Scopus and 2013 for Cochrane Central Register of Controlled Trials (issue 1). Of 110 potentially relevant publications, 17 and 9 trials (7 on maturation value and 2 on vaginal dryness) were selected for qualitative and quantitative analysis, respectively. In general, soy isoflavones seem to improve vaginal symptoms as opposed to control arms. Soy isoflavones were also shown to be more efficacious in quantitative analysis, though this was statistically non-significant. Standardised difference in means of maturation value change was 0.072 (95% confidence interval [CI]: - 0.42 to 0.57), p = 0.777; heterogeneity P = 0.00; I(2) = 85.15%. Difference in means of vaginal dryness was - 0.204 (95% CI: - 0.28 to - 0.126), p < 0.001; heterogeneity P = 0.423; I(2) = 0.00. Soy isoflavones may relieve vaginal symptoms during menopause; nevertheless beneficial effects still remain uncertain due to possible publication bias or vast heterogeneity of the selected studies. Further studies with consistency in design as well as statistics are warranted.

Topical administration of isoflavones for treatment of vaginal symptoms in postmenopausal women: A systematic review of randomised controlled trials

Current systematic review evaluated the efficacy of topical isoflavones to relieve vaginal symptoms in menopausal women. MEDLINE (1966 to January 2014), Scopus (1990 to January 2014), and the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2013) were searched using keywords 'isoflavone and vagina'. Relevant studies were reviewed by two independent reviewers. Only randomised controlled trials (RCTs) were included in the systematic review. Out of 115 potentially relevant publications, four studies met the inclusion criteria. Topical isoflavones showed beneficial effects on dyspareunia, vaginal dryness and maturation value. Based on only one trial, the result of conjugated equine oestrogen cream (0.3 mg/day) was similar to use of isoflavone vaginal gel and superior to that of placebo gel. However, drawing any definite conclusion was difficult because of the limited number of RCTs, the small sample sizes, weak methodology and considerable heterogeneity of the included studies.