Iran Journal of Nursing

Introduction
Breast cancer is the most common cancer in women worldwide, especially in Iran, where its prevalence is projected to increase to 63% by 2025. This implies the urgent need for effective prevention and control strategies. Women’s perception of breast cancer plays a key role in their preventive behaviors. The health belief model indicates that the identification of negative beliefs and attitudes towards a disease can significantly improve health-related behaviors. This perception is influenced by various factors such as age, educational level, and family history of the disease. This study aims to investigate the perception of breast cancer in women from Tabriz, Iran, and find the related factors.

Methods 
In this descriptive cross-sectional study, 372 women over 40 years of age who visited the health centers for routine medical care in Tabriz city in 2022 participated. A cluster random sampling technique was employed. The inclusion criteria were age >40 years, being covered by urban health centers in Tabriz city, and no mental illness according their electronic files available in the Iranian integrated health system (SIB). The exclusion criterion was a history of breast cancer. 
We used a demographic form and the breast cancer perception scale (BCPS), developed and validated by Taylan et al. in 2021. It consists of 24 items and 6 domains (perceived knowledge, perceived treatment belief, the perceived need for a health check, perceived stigma, perceived fear, perceived risk) using a 5-point rating system. The total score ranges from 24 to 120, with higher scores indicating a greater perception of breast cancer. We used the Persian version of this tool. The CVI and CVR values for the Persian version were obtained as 0.98 and 0.95, respectively. 
The data obtained from the questionnaires were analyzed in SPSS software, version 16. After confirming the normality of the quantitative data distribution based on the skewness and kurtosis values, descriptive statistics, including frequency and mean, were used to describe the data. Pearson correlation test, t-test, and one-way analysis of variance were used to investigate the difference in breast cancer perception based on sociodemographic factors. Multivariate logistic regression analysis was performed to predictors of breast cancer perception from among sociodemographic variables.

Results
The mean score of BCPS was 65.04±8.60. A significant difference was observed in the BCPS score based on the woman’s educational level (P<0.001), the husband’s educational level (P=0.002), the number of children (P= 0.04), and the history of a benign change in women’s breast (P<0.001). In the final regression model, it was found that the number of children (B=-0.038, 95% CI=-0.003 to -0.79, P=0.048) and woman’s educational level (B=-0.13, 95% CI=0.02-0.24, P=0.018), were the significant predictors of breast cancer perception in women.

Conclusions 
The women in Tabriz city have a relatively low perception of breast cancer. This highlights the urgent need for educational programs to improve their perceptions. Women with higher educational levels and a lower number of children have a greater perception of breast cancer. The educational programs should be developed by considering their educational level and number of children. These programs can offer guidance on potential risk factors and available screening options. Increasing women’s perceptions of breast cancer can contribute to early detection and more effective treatment of this disease, ultimately leading to improved health outcomes for women with breast cancer.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee at Tabriz University of Medical Sciences (Code IR.TBZMED.REC.1401.704). The participants were informed about the study objectives and assured of the confidentiality of their information. They signed a written informed consent form.

Funding
This article was extracted from a master’s thesis, funded by Tabriz University of Medical Sciences. 

Authors' contributions
Design, data analysis, data collection, and writing the initial draft: Elham Seyedkanani; Conceptualization, design, data analysis, supervision, and writing the final draft: Mina Hosseinzadeh; Design, data analysis: Mojgan Mirghafourvand; Data collection: Sepideh Soltani; Design, review & editing: Leila Sheikhnejad; All authors reviewed and approved the final manuscript.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of  Tabriz University of Medical Sciences for their financial support and all the women who participated in this study for their cooperation.


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