title: Appraisal of breast cancer symptoms by Iranian women: entangled cognitive, emotional and socio-cultural responses.
abstract: BACKGROUND
  Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms.
  
  
  METHODS
  A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description.
  
  
  RESULTS
  The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear.
  
  
  CONCLUSIONS
  This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.
authors.affiliation: Department of Midwifery, Cancer Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail : TaghipourA@mums.ac.ir.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Khakbazan
authors.forename: Robab Latifnejad
authors.initials: RL
authors.lastname: Roudsari
authors.forename: Ali
authors.initials: A
authors.lastname: Taghipour
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohammadi
authors.forename: Ramesh Omrani
authors.initials: RO
authors.lastname: Pour
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D016504:Breast Self-Examination / Q000523:psychology*; D003071:Cognition; D003466:Cultural Characteristics; D003469:Culture; D057210:Delayed Diagnosis; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007492:Iran; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D012923:Social Class