Breast Cancer Disclosure in Iranian Families: A Qualitative Study of Family Roles and Women’s Agency in Managing Disclosure

Breast Cancer Disclosure in Iranian Families: A Qualitative Study of Family Roles and Women’s Agency in Managing Disclosure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breast Cancer Disclosure in Iranian Families: A Qualitative Study of Family Roles and Women’s Agency in Managing Disclosure Fatemeh Hami Kargar, Narges Nikkhah, Mohammad Ganji This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8311532/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background and Aim: Illness disclosure is a critical issue following a breast cancer diagnosis. Family members are often the first to be informed and play a central role in treatment decisions and the dissemination of information. In family-centered cultures, interactions between women and their families profoundly shape the disclosure process. Breast cancer disclosure should thus be understood not merely as an individual act but as a social and communicative process embedded within familial and cultural values. Methods This qualitative study involved in-depth, semi-structured interviews with 25 women with breast cancer in Tehran who had completed treatment, alongside five family caregivers. Participants were recruited using purposive and snowball sampling. Interviews explored family roles and interactions in managing disclosure. Data were analyzed using Braun and Clarke’s thematic analysis approach. Results Five themes emerged: ( 1 ) family values and interactional norms in disclosure, ( 2 ) the collective family image and its influence on disclosure, ( 3 ) emotional experiences of disclosure within the family, ( 4 ) women’s agency and breaking through disclosure constraints, and ( 5 ) identity formation through expressing breast cancer experiences. Disclosure decisions were guided by cultural and familial values, often constrained to protect the family’s social reputation. Emotional responses ranged from positive to negative. Women exercised agency, with some openly sharing their condition, including via social media. Positive expression and emphasis on personal growth emerged as key strategies for reconstructing identity post-diagnosis. Conclusion Breast cancer disclosure unfolds through dynamic interactions between women and their families, mediated by social norms and cultural taboos. While some women use disclosure to challenge societal perceptions, public awareness initiatives may facilitate disclosure and improve access to care. Breast cancer disclosure family role women's agency social stigma 1. Introduction Breast cancer remains the leading cancer burden among women, particularly in transitioning countries ( 1 ). In Iran, it is the most frequently diagnosed cancer among women ( 2 ). Projections from the World Health Organization suggest that the Middle East and North Africa region will experience one of the sharpest increases in cancer burden in the coming decades ( 3 ). Although advances in early detection and therapeutic strategies have significantly improved clinical outcomes, the experience of breast cancer extends beyond biological pathology, encompassing complex social and psychological dimensions that shape multiple facets of individual and family life ( 4 ). A critical yet underexplored aspect of this experience is the disclosure of a breast cancer diagnosis. While the concept of “disclosure” is frequently invoked in health and social science research, its underlying mechanisms have been subjected to limited empirical investigation. In some contexts, disclosure may be compulsory rather than discretionary; however, the factors that determine how, what, when, and why individuals choose to disclose remain inadequately understood ( 5 ). Disclosure of illness is more than simply informing others about one’s condition; it encompasses the thoughts and emotions that individuals communicate to others ( 6 ). Among patients with cancer, disclosure refers to the deliberate sharing of disease-related information—including diagnosis, emotional experiences, and concerns—with others. Within this framework, both the depth and breadth of disclosure (i.e., how much is shared and with how many individuals) are critical, as they significantly influence social support and overall well-being ( 7 ). A systematic review defines disclosure as a “complex decision influenced by individual, social, and environmental factors.” The review highlights that disclosure and secrecy are distinct processes rather than opposites, and individuals may experience both at different times or in different contexts. It emphasizes that disclosure is not a one-time act but a dynamic process shaped by personal and social factors ( 8 ). Therefore, it is essential to approach illness disclosure as a process and to consider the social and cultural contexts that influence it. Family represents one of the most significant contexts for illness disclosure, as patients often prefer that family members be among the first to learn of the diagnosis ( 9 ). Families provide not only a setting for physical and psychological care but also communicative and cultural structures that shape how disclosure occurs ( 10 ). The rising incidence of breast cancer has prompted a shift from hospital-centered to family-centered care models ( 11 , 12 ), with the processes of cancer diagnosis and treatment inherently involving the family ( 13 , 14 ). In the context of breast cancer, the family plays a pivotal role in both adaptation to and management of the disease ( 15 ), and women’s illness experiences are continuously shaped through reciprocal interactions with family members ( 16 ). Unlike Western cultures, which emphasize individualism and personal autonomy in health-related decision-making, Iranian society often prioritizes collective responsibility and active family participation in healthcare ( 17 ), with health-related decisions largely guided by the family ( 18 , 19 ). Consequently, investigating the role of family in illness disclosure is particularly important. Iranian studies indicate that women often face a “dilemma of secrecy versus disclosure.” While patients wish to inform their families to receive emotional and caregiving support, they also fear social labeling, pity, or negative judgment both within and outside the family ( 20 ). Social stigma associated with breast cancer represents a key caregiving challenge in Iran ( 21 – 23 ), and societal misconceptions make disclosure difficult ( 24 ). Research has shown that taboos and fear of stigmatization, along with reactions such as excessive pity or negative judgment, often drive women to conceal their symptoms or diagnosis ( 4 , 23 ). In the Iranian cultural context, norms of modesty and shame strongly influence women’s behavior and social interactions. These norms regulate discourse about the body, female anatomy, and experiences of bodily harm. As a result, families often struggle to discuss breast cancer openly and frequently opt to conceal related issues ( 25 ). Family members are often the first to learn of a woman’s illness and play a crucial role in treatment decisions and broader disclosure. Illness disclosure—particularly for breast cancer—is not solely an individual act but a social and communicative process embedded in familial and cultural values. This study examines how Iranian women navigate breast cancer disclosure within the family and how family dynamics shape this process. 2. Method 2.1. Research Design A qualitative approach with thematic analysis was adopted. In-depth interviews were conducted with women who had completed breast cancer treatment, alongside supplementary interviews with five family members. The focus was on the family’s role in disclosure, the women’s strategies for managing it, and how illness was revealed or concealed within familial contexts. 2.2.Sampling The study included 25 women with breast cancer, aged 27–65, all residing in Tehran and having completed treatment there. Participants were recruited via purposive and snowball sampling, based on experience with surgery and chemotherapy, ability to articulate perspectives, and Iranian nationality. Five family members who accompanied the women during treatment were also interviewed. Table 1 summarizes the participants’ demographic and clinical characteristics. 2.3. Data Collection Data were collected through semi-structured interviews with open-ended questions focused on illness disclosure. The interviews explored women’s experiences of disclosing breast cancer within their families and expressing their emotions, aiming to examine the family’s role and reactions throughout treatment and their responses to disease-related information. To obtain richer insights into familial disclosure, five accompanying family members were also interviewed. These interviews focused on the context of disclosure and their experiences supporting the women during the disclosure process. Interviews were conducted in person or by phone, depending on participants’ preference, between 2024 and 2025. Each interview lasted 45–60 minutes, and all were fully audio-recorded with participants’ consent. Participant characteristics are summarized in Table 1 . 2.4. Data Analysis In accordance with the study aims, a content-analytic approach was adopted and, for the analysis of the interviews, Braun and Clarke’s Thematic Analysis (TA) was employed. ( 26 ) Braun and Clarke offer a six-step procedure for theme extraction. The first step in any qualitative analysis is familiarisation with the data: reading and re-reading the material to achieve an in-depth understanding. Accordingly, recorded interviews were transcribed and the research team thoroughly reviewed the transcripts. The second step involved identifying meaningful units and extracting segments relevant to the study objective; from these semantic segments, initial codes were generated (Generating initial codes). In the third step the search for themes was undertaken (Searching for themes): related initial codes were grouped into categories or subthemes. By organising these subthemes, overarching themes were derived; five main themes were identified. The fourth step consisted of reviewing the themes. This review increased the analytic rigor and quality of the study and thereby enhanced its credibility. In the fifth step the themes were defined and named, and the conceptual scope of each principal theme was articulated. Finally, in the sixth step the analytic report was produced, which provided descriptive accounts of the themes, presented supporting evidence (quotations), and linked the findings to the research questions and the overall problem under investigation. 2.5. Trustworthiness of the findings Prior to conducting the study, the researchers’ personal experiences, beliefs, and assumptions were explicitly identified and documented to ensure reflexivity and minimize potential bias in data interpretation. To enhance the rigor and credibility of the study, strategies such as bracketing prior knowledge, triangulating analyses through multiple researchers, respondent validation, and iterative verification with participants during data analysis were employed ( 27 ). To ensure the trustworthiness of the data, participants were purposefully sampled to achieve variation in age, educational background, and marital status. Interview conditions were structured to promote trust, comfort, and openness, enabling participants to share their perspectives candidly and in detail. Member checking was implemented by providing transcribed and coded interview texts to three participants, who were asked to confirm the accuracy of the content and the relevance of the extracted codes to their lived experiences. To further strengthen data credibility, at least one illustrative quotation was provided for each identified theme. 2.6. Ethical consideration This study was approved by the Ethics Committee of Kashan University (Ethics ID: IR.KASHANU.REC.1402.034). The study objectives and procedures were fully explained to participants, and written informed consent was obtained. The timing and location of interviews were arranged according to participants’ preferences. Participants were assured of their voluntary participation, consent for audio recording, the right to withdraw at any stage, and the confidentiality of their identity and information, with data reported using numeric codes. All procedures were conducted in accordance with relevant guidelines and regulations. Table 1 participants’ demographic and clinical characteristics No. Age group Marital Status Education Employment Status Type of Surgery 1 60–69 Married Bachelor’s degree Retired teacher Mastectomy 2 50–59 Married Secondary school Homemaker Mastectomy 3 30–39 Married PhD Food industry engineer Lumpectomy 4 40–49 Married Bachelor’s degree Homemaker Lumpectomy 5 40–49 Married High school diploma Private-sector employee Mastectomy 6 50–59 Married Secondary school Homemaker Mastectomy 7 30–39 Single Bachelor’s degree Accountant Mastectomy 8 40–49 Divorced Master’s degree Cultural heritage specialist Mastectomy 9 40–49 Married Bachelor’s degree Homemaker Mastectomy 10 30–39 Married PhD Freelancer Mastectomy 11 40–49 Married Bachelor’s degree Public-sector employee Mastectomy 12 50–59 Married High school diploma Homemaker Mastectomy 13 30–39 Married Master’s degree Private-sector employee Lumpectomy 14 60–69 Married Secondary school Retired Mastectomy 15 50–59 Married Bachelor’s degree Tailor Mastectomy 16 20–29 Single Associate degree Illustrator Mastectomy 17 40–49 Single Bachelor’s degree Employee Lumpectomy 18 30–39 Single Master’s degree Charity work Mastectomy 19 30–39 Single High school diploma Art-related work Lumpectomy 20 50–59 Married High school diploma Homemaker Mastectomy 21 30–39 Single Bachelor’s degree Private-sector employee Mastectomy 22 60–69 Married Master’s degree Retired Mastectomy 23 30–39 Married Bachelor’s degree Homemaker Mastectomy 24 30–39 Single Bachelor’s degree Teacher Lumpectomy 25 40–49 Married Bachelor’s degree Homemaker Lumpectomy 3. Results Following the analysis and interpretation of interview data regarding the disclosure of breast cancer within families and women’s interactions with family members in managing such disclosure, a total of 118 codes were extracted and organized into 16 sub-themes and five main themes. An example of the content analysis, including explanation, coding, sub-themes, and main themes, is presented in Table 2 . These included: 1) family values and interactional norms in breast cancer disclosure, 2) the collective family image and breast cancer disclosure, 3) emotional experiences of disclosure within the family, 4) women’s agency and breaking through disclosure constraints, and 5) identity formation in expressing breast cancer. Subsequently, the themes were discussed, and relevant quotations were presented. To maintain confidentiality, participants were referred to by numbers rather than names. Table 2 An example of the analysis process. Theme Sub-theme Code Meaning Unit Explanation Family values and interactional norms in breast cancer disclosure Family Interaction Patterns Need for disclosure within the family "I first told my sister, then my husband. The family needed to know." Emphasizes the perceived necessity of informing family members about the diagnosis. Women’s expectation of family support "If the family doesn’t help you, who will? The family should be by your side during illness." Highlights the expectation of emotional and practical support from family. Institutionalized family accompaniment "A family member always accompanied me to the doctor and never left me alone." Demonstrates the routine involvement of family members in care processes. Financial provision by family "My husband fully covered my treatment expenses." Illustrates the role of family in providing financial support. Established Gender Roles Protecting others’ emotions "I didn’t show my pain in front of my son. I didn’t want my parents to worry, so I didn’t share the details of my cancer." Shows how women may conceal their suffering to protect family members’ feelings. Women’s role within the family "A woman should be patient, even for her husband; she keeps much of her pain to herself." Reflects culturally reinforced expectations of women’s endurance and emotional management. 3.1. Family values and interactional norms in breast cancer disclosure The disclosure of illness, particularly conditions such as breast cancer, is shaped by family values and interactions. In Iranian culture, family interactions are often grounded in strong emotional bonds, established gender roles, and family-centered norms and values. Families place a central emphasis on empathy and emotional support during difficult times, and interactions are oriented toward providing emotional care and addressing the needs of women with breast cancer. Women expect support and companionship from their families, and families perceive themselves as obliged to provide such support. "I first told my sister. Then I told my husband and my father and mother. My family took care of me a lot. My sisters and my mother helped me a lot. After chemotherapy, I would go to my mother’s house, she took care of me, and my sisters also helped a lot." (Woman No. 4) Women’s expectations for family support, particularly from their parental family, are rooted in family interaction patterns and values. Within the family interaction model, the expectation of receiving support from spouses, parents, siblings, and children is institutionalized, and these individuals are considered primary sources of support. Consequently, when women are diagnosed with breast cancer, the family assumes significant responsibility, with caregiving and treatment follow-up carried out collaboratively. The family represents a crucial resource for meeting women’s needs. Family values and norms create conditions that foster closer intimacy between women and family members, making their support during illness essential. This dynamic renders disclosure of the disease to the family necessary, allowing them to be informed of the details and to participate actively in treatment and care processes. "Two days before chemotherapy, I would go to my parental home, and my mother would prepare nutritious food for me and take care of me. Even my brother would bring me juice, and my sister would take care of my children." (Woman No. 11) Women often have limited financial independence, making disclosure of breast cancer necessary to secure support. In Iranian families, financial responsibility for women primarily rests with their spouse and his family, making disclosure to them common. "At first, I did not want my husband’s family to know exactly what had happened. But it was the early days of our life together, and we did not have the funds for treatment, and my husband insisted that I must have a private room for chemotherapy. That is why he told his parents so they could help. My father-in-law spent a lot on my treatment. They were almost fully aware of all stages of my treatment." (Woman No. 10) Although family values and expectations often compel women to disclose their illness to family members, entrenched gender roles within the family structure can sometimes inhibit disclosure. Women with breast cancer encounter barriers to disclosure in their feminine roles. Gender norms expect women, in roles such as mother, wife, or daughter, to protect the emotions and feelings of family members and to remain patient. Even during illness, women often modulate disclosure to protect family members’ emotions, limiting details to prevent distress, particularly for children and elderly parents. "I tried to stay calm in front of my son so that he wouldn’t get upset because he is still a child, and I didn’t want him to be hurt." (Woman No. 13) "My parents live in another city. My father has heart disease; I didn’t tell them because I didn’t want them to worry—they couldn’t do anything anyway. Only my sister knew. Even now, my parents don’t know. They only understood that I was ill." (Woman No. 1) "My mother rarely showed her pain. She didn’t want us to worry." (daughter of the patient) Women regulate the expression of their emotions and pain within the family according to prescribed feminine roles. This role-based pattern also applies to disclosure to their spouse. During painful phases such as chemotherapy and post-surgery recovery at home, women endeavored to withhold expressions of pain in front of their husbands. Although they believed that their spouse should be among the first to be informed of the illness and considered him a key source of support, they moderated the expression and disclosure of their emotions in accordance with their spousal role. "You can’t really moan and groan in front of men. I didn’t tell my husband much either. We women are used to not telling our husbands about our pain." (Woman No. 25) 3.2. The family’s collective image and breast cancer disclosure The family’s collective image refers to the social identity that a family projects as a unit in public and social contexts. Families organize their responses to crises and threatening events based on this collective image. Since breast cancer is a debilitating and distressing illness, perceived as undermining femininity, sometimes hereditary, and even socially stigmatized, a diagnosis can be seen as a threat to the family’s collective image. Disclosure of the disease thus creates a sensitive situation, challenging the boundaries between private family life and the public sphere. In the interviews, women reported that disclosing breast cancer was not solely an individual decision; rather, the family managed disclosure with priority given to preserving the family’s collective image. When there was a risk of social misjudgment or when disclosure could jeopardize the position of certain family members, disclosure was restricted. In the interviews, restricted disclosure did not merely imply concealing the illness, but often involved modifying the description of the disease and details of the treatment process. "Relatives and acquaintances knew I had breast cancer, but we didn’t tell them much about my treatment. When they asked, we said, ‘Thank God, I’m getting better.’ They didn’t even know I had my breast removed." (Woman No. 17) "My husband didn’t want his colleagues to know that I had breast cancer. He said, ‘I don’t want anyone to know.’ Men really don’t want anyone to know that their wife has breast cancer." (Woman No. 5) "I have two daughters. I really didn’t want anyone to know I had breast cancer. People think breast cancer is hereditary, so I felt that it wouldn’t be good for my daughters if everyone knew I had it." (Woman No. 8) 3.3. Emotional experiences of breast cancer disclosure within the family The emotional experience of breast cancer is one of the important dimensions of living with this disease within the family context. One of the key moments in forming this emotional experience occurs when women discuss their illness with their family and express their feelings. It is during this time that the reactions of family members shape women’s emotional experiences, and women encounter the emotional consequences of disclosing and expressing their illness. Women’s emotional experiences when expressing their illness within the family constitute a range of feelings, including positive and constructive emotions such as calmness and hope, as well as negative emotions such as shame, fear, and feeling burdensome. In the interviews, women stated that talking about the suffering and pain caused by the illness with some family members gave them a good feeling, as family members provided comfort. Women received a significant part of their sense of hope from their family. Some women indicated that their family, with patience, stood by them during these expressions of emotions, giving them calmness and hope. As a result, expressing emotions within the family became a positive experience for them. "My husband always gave me hope and said I would get better and everything would be fine." (Woman No. 4) "We gave our mother a lot of encouragement. We took turns visiting her so she wouldn’t be alone. My mother shared her feelings with us, and I think when she talked and we were with her, she felt better." (daughter of the patient) On the other hand, some women encountered negative reactions from family members when disclosing their illness. Inattention to women’s condition and minimizing their weakness and pain led to negative emotions, as families were aware of their illness but did not provide emotional responses commensurate with women’s needs and expectations. A crucial aspect of women’s emotional experiences is that, as the duration of the illness extends, their condition becomes normalized for the family, resulting in reduced attention and fewer positive emotional responses. "At first, my husband paid a lot of attention to me and would sit and listen to my concerns, but after a while, it seemed he no longer had the patience. The family’s attention also decreases over time." (Woman No. 2) Shame was another emotion reported during illness disclosure. Women often felt embarrassed when sharing their breast cancer diagnosis with male family members, especially in traditional families where discussing women’s bodies is considered taboo. "After my surgery, I felt embarrassed in front of my father and brother, and whenever we wanted to talk with my mother and sisters about my condition, it wasn’t in front of my father and brother. I couldn’t bring myself to do it in front of them." (Woman No. 17) "In our family, they don’t talk about women’s issues in front of men. My sister, who had breast cancer, didn’t want us to discuss her condition in front of my brother or my husband. They knew my sister had breast cancer, but we didn’t mention any details in front of them. In our family, breast cancer is considered a women’s issue." (sister of the patient) 3.4. Women’s agency and breaking disclosure constraints within the family Agency refers to women’s ability to make sense of their situation during illness while considering their family context. “Breaking” does not imply disobedience to family norms, but rather represents a redefinition of women’s agency in managing breast cancer disclosure. In this process, women emerge not as victims of structure, but as creative actors who, through the dialectic between self and family, shape a new form of breast cancer disclosure. In the interviews, women highlighted their efforts to normalize disclosure within the family. Aware of familial disclosure constraints, they reported that their perspective on breast cancer often differed from that of their family. Although they were cognizant of social taboos surrounding breast cancer and had experienced incorrect social judgments, they wished to raise awareness among relatives and did not hesitate to discuss their feelings, bodily changes, or treatment stages. Women’s agency and their attempts to negotiate the meaning of breast cancer within the family context represent key challenges in interacting with family members. This agency in disclosure was particularly evident among younger and more educated women. Access to social media enables women’s agency, allowing them to share information about breast cancer and their lived experiences through personal online platforms. "My family really didn’t want to explain my condition to others. But I didn’t like this situation; I wanted to be able to talk about my illness and I wasn’t afraid of others knowing." (Woman No. 11) "I had a personal page where, after my illness, I posted content about breast cancer treatment. Some relatives and acquaintances were also my followers. There, I could speak more freely. Even when I was feeling unwell, I would post stories, and I didn’t care if others knew what condition I was in." (Woman No. 19) 3.5. Women’s identity formation in expressing breast cancer One theme emerging from the interviews was women’s effort to highlight the positive aspects of the illness within family relationships. Alongside expressing pain and the need for family support during treatment, women also considered another dimension of disclosure. Through “positive expression,” they sought to emphasize the beneficial changes that the illness had brought about in their lives. This effort appears to be rooted in a redefinition of feminine identity. Some women reacted to excessive compassion and expressions of pity from family members by trying to appear strong. At times, they concealed their pain and suffering, considering this nondisclosure important for reconstructing their identity. In the interviews, women stated that they tried to share positive aspects of the illness with their family by demonstrating a more resilient self and expressing a renewed outlook on life. Presenting a new and better self-image after being diagnosed with breast cancer is thus part of women’s efforts at identity formation during the process of disclosing the illness within the family. "Many times I wanted to show that I am a strong woman. I tried to endure my pain, do my own tasks, and show that breast cancer had not defeated me." (Woman No. 10) "After a while, my sister seemed to have changed; she appeared very hopeful, saying that her outlook on life had changed. She spoke about breast cancer much more openly and showed all of us that she was much stronger than the cancer." (sister of the patient) 4. Discussion The management of breast cancer disclosure in Iran constitutes a complex network of actions, norms, and family relationships, placing women in a continuous state of negotiation with their families. The findings include five main themes, each conceptualizing a specific aspect of the disclosure process within the family. Furthermore, in this study, disclosure is not based solely on women’s lived experiences; the perspectives of family members and family dynamics are also considered, framing disclosure management as the product of the dialectic between women’s agency and family structures. In other words, managing breast cancer disclosure within the family is not a linear or single-stage process; it is a dynamic process that develops across multiple cultural, relational, and emotional layers. Although the family plays an important role in shaping, guiding, limiting, or legitimizing disclosure, women are not passive participants Based on the findings of this study, disclosure of illness to the family represents a form of obligation, and women require family support and companionship. Most Iranian studies have highlighted the positive effects of family accompaniment and emotional support for women during illness ( 28 – 31 ). Additionally, due to the high costs of breast cancer treatment ( 32 ) and women’s limited access to financial resources, they depend on family support. The results of this study emphasize that, although receiving family support and companionship facilitates breast cancer disclosure within the family, it is important to recognize that families act according to their values and norms. Providing support, following up on treatment, and accompanying women are considered family values, and women expect such support from family members during illness. In the Iranian cultural context, the family is the first and most important source of support during crises ( 33 , 34 ). Conversely, values such as preserving family harmony, fulfilling women’s emotional roles, and preventing psychological distress among other family members often lead women to conceal or postpone disclosure. Even during illness, women appear to act in accordance with prescribed familial roles and gendered norms. Cultural expectations also shape spousal interactions following a breast cancer diagnosis ( 35 ), with adherence to these norms being particularly pronounced in traditional families. For instance, a study of Japanese women indicated that entrenched traditional cultural values so strongly influenced women that, despite their illness, they endeavored to fulfill familial and societal expectations, refraining from disclosing their condition ( 36 ). Gender norms often lead women to prioritize the needs of their family, particularly their children, over their own health and well-being ( 37 ). In family-centered cultures, the mother assumes a primary role in child-rearing, and a breast cancer diagnosis can generate significant concern for mothers ( 38 ). Consequently, they often prefer not to discuss their illness with their children ( 39 ). Iranian mothers, by prioritizing their children’s needs, strive to fulfill their role as good mothers even while coping with illness ( 40 ). Women often present public narratives shaped by fear of social stigma throughout the course of breast cancer treatment and afterward ( 41 ). Negative perceptions of sharing a diagnosis and concerns about others’ reactions reflect the taboo nature of breast cancer in Iran ( 42 ). Although social stigma has been widely recognized in previous research as a key factor motivating women to conceal their illness ( 43 – 46 ), this study emphasizes the role of the family in restricting disclosure to preserve social reputation. Within the Iranian cultural context, breast cancer may be perceived as a “defective body” or “lost femininity” ( 47 ). Under such circumstances, disclosure is often managed and limited by the family. Findings from this study indicate that Iranian families, aware of the potential negative consequences of disclosure, actively regulate the sharing of information to protect the family’s collective image. One of the most important consequences of disclosure within the family is the formation of emotional experiences following disclosure. Expressing and discussing the illness within the family generates these emotional experiences, which can vary widely. Patients with cancer often face complex emotional ambivalence: on one hand, a deep desire for support, and on the other, profound fear of the consequences of sharing their condition ( 48 ). Some women report receiving positive emotions such as hope and a sense of self-worth from their family after disclosure. Others, however, encounter inappropriate reactions; indifference from some family members over time can lead women to feel burdensome. Additionally, some women experience shame following breast cancer disclosure. It appears that women’s emotional experiences within the family shape future disclosure patterns, with negative emotional experiences acting as barriers to sharing, expressing feelings, and providing detailed information about the illness in subsequent stages of treatment. Based on the findings of this study, women also play an active role in managing disclosure and are not passive in relation to their families. Efforts to normalize disclosure and a lack of fear in sharing detailed information about their illness are among women’s strategies. The new generation of Iranian women demonstrates a strong willingness to challenge social taboos, with social media activity and illness disclosure being particularly salient for young women with breast cancer. Women’s agency in the disclosure process and their actions to confront breast cancer taboos represent a key finding of this study, reflecting a shift in women’s perspectives on breast cancer and their efforts to raise awareness and change societal attitudes toward the disease. Previous research has largely overlooked women’s agency in breast cancer disclosure, often portraying them as passive. However, the findings of this study emphasize that, within the context of Iran’s cultural transition, many women actively challenge social taboos, particularly those related to the body. Another important dimension of women’s agency in disclosing breast cancer within the family is their effort to reconstruct identity after diagnosis. As Charmaz has shown, chronic illness can disrupt the continuity of identity ( 49 ). Following the challenges to their identity posed by breast cancer, women undertake actions to rebuild their sense of self ( 24 ), one of which is through disclosure of the disease. Through positive expressions and highlighting the beneficial aspects of breast cancer in their lives, women strive to reconstruct their identity. Demonstrating strength, enduring pain, and concealing negative emotions are among the strategies women employ in disclosing breast cancer within the family. The purpose of these positive expressions and concealment of negative aspects is to facilitate identity reconstruction. Research by Manouchehri et al. indicates that women, when expressing their emotions, sought to convey positive feelings and reassure their family that they were well, even when they actually felt the opposite ( 29 ). 5. Conclusion Breast cancer disclosure within families emerges from the interaction between women and their family members, shaped by familial values and norms that may encourage either concealment or revelation. Families regulate disclosure to protect social reputation, while women experience a range of emotional responses that form a key aspect of the social experience of illness. Simultaneously, women exercise agency, using strategies such as social media disclosure and positive expressions within the family to reconstruct their identity and challenge social stigma. 6. Strengths and Limitations This study appears to be the first qualitative investigation in Iran to examine the management of breast cancer disclosure within Iranian families, with a particular focus on the role of women. The study emphasizes both the influence of family structures and women’s agency in the disclosure process. Several limitations should be acknowledged. First, convenience sampling was employed, which may not fully represent the broader population and could limit the generalizability of the findings to other groups. Additionally, data were collected through in-depth interviews, and participants may have experienced concerns about sharing sensitive experiences. To mitigate this, all interviews were conducted in private settings with only the researcher and participant present, creating a safe environment that ensured confidentiality and encouraged open expression. Another limitation is that the sample was restricted to women residing in Tehran. To gain a more comprehensive and culturally diverse understanding, future studies should include participants from different regions and ethnic backgrounds across Iran. Such efforts would enrich the findings and provide a broader, more inclusive perspective on breast cancer disclosure within Iranian families. Declarations Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics Approval All procedures performed in this study involving human participants were conducted in accordance with the Declaration of Helsinki and were approved by the Ethics Committee of Kashan University (Ethics ID: IR.KASHANU.REC.1402.034). Consent for publication Not applicable Consent to Participate Written informed consent was obtained from all individual participants included in the study. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution NN and MG conceptualised the idea, FHK obtained the data, FHK analysed the data, all author reviewed the findings, FHK drafted the manuscript, NN and MG reviewed the manuscript, and all authors read the manuscript. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to confidentiality and ethical restrictions. Selected quotations used in the manuscript are presented within the text. The full datasets are available from the corresponding author on reasonable request. References Zhang Y, Ji Y, Liu S, Li J, Wu J, Jin Q, et al. Global burden of female breast cancer: new estimates in 2022, temporal trend and future projections up to 2050 based on the latest release from GLOBOCAN. J Natl Cancer Cent. 2025;5(3):287. Sanaat Z, Dolatkhah R. Epidemiologic profile of breast cancer in Iran: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2024;26:101537. Batran RA, Tahoun S, Helmy L, Bahr A, Khalil A, Kamel M et al. Breast cancer in the Middle East and North Africa: economic burden, market trends, and care challenges. JCO Oncol Pract. 2025;OP-25. Zeighami Mohammadi S, Mohammadkhan Kermanshahi S, Vanaki Z. Pity: a qualitative study on iranian women with breast cancer. Patient Prefer Adherence. 2018;21–8. Davis M, Manderson L. Disclosure in health and illness. Routledge London; 2014. Figueiredo M, Fries E, Ingram K. The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psychooncology. 2004;13:96–105. Lee H, Jeong Y. Self-disclosure in Adult Patients With Cancer: Structural Equation Modeling. Cancer Nurs. 2025;48:289–97. Gnainsky M, Roe D, Negri-Schwartz O, Cohen-Chazani Y, Lavidor M, Hasson-Ohayon I. To disclose or not to disclose: A systematic review of factors associated with disclosure and concealment of mental illnesses. Clin Psychol Rev. 2025;122:102660. Shah S, Usman A, Zaki S, Qureshi A, Lal K, Uneeb S, et al. The role of family and culture in the disclosure of bad news: A multicentre cross-sectional study in Pakistan. PEC Innov. 2023;1:3:100200. Hilton S, Emslie C, Hunt K, Chapple A, Ziebland S. Disclosing a cancer diagnosis to friends and family: a gendered analysis of young men’s and women’s experiences. Qual Health Res. 2009;19(6):744–54. Coyne E, Heynsbergh N, Dieperink KB. Acknowledging cancer as a family disease: a systematic review of family care in the cancer setting. Eur J Oncol Nurs. 2020;49:101841. Muthanna FMS, Karuppannan M, Hassan BAR, Mohammed AH. Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy. Osong Public Health Res Perspect. 2021;12(2):115. Litzelman K, Blanch-Hartigan D, Lin CC, Han X. Correlates of the positive psychological byproducts of cancer: role of family caregivers and informational support. Palliat Support Care. 2017;15(6):693–703. Kim Y, Carver CS. Unmet needs of family cancer caregivers predict quality of life in long-term cancer survivorship. J Cancer Surviv. 2019;13(5):749–58. Ding Z, Fan Y, Zhong G, Zhang X, Li X, Qiao Y, et al. A dyadic analysis of family adaptation among breast cancer patients and their spouses based on the framework of family stress coping theory. Front Public Health. 2024;12:1453830. Malmström M, Holst-Hansson A, Olsson Möller U. The complexity of needs and roles of family members during breast cancer rehabilitation: a qualitative study. BMC Cancer. 2024;24(1):1430. Alizadeh A, Khankeh H, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): A qualitative study. BMC Psychiatry. 2020;20:494. Malek M, Rahman N, Hasan MS, Abdullah L. Islamic Considerations on the Application of Patient’s Autonomy in End-of-Life Decision. J Relig Health. 2018;57. Tareen M. Disclosure practices in Muslim patients and the impact on end-of-life care: a narrative review. Am J Hospice Palliat Medicine®. 2025;42(11):1196–211. Sedaghatgoo R, Ghodrati H, Ghodrati S. Breast Cancer Experience and Change in Self-concept among Women: A Qualitative Study in the City of Sari, Iran. J Social Continuity Change (JSCC). 2024;3(1):103–30. Abdul Razzaq Nejad R, Bagherian S, Dastjerdi R. Relationship Between Supportive Care Needs and Stigma in Women With Breast Cancer: A Cross-Sectional Study. Health Sci Rep. 2025;8(8):e70903. Dehkordi PR, Dolatshahi Z, Gorji HA, Hashemi SM, Reisi N, Khalilabad TH. A Scoping Review of 20 Years Breast Cancer Screening Programs in Iran. Iran J Public Health. 2025;54(1):88. Zamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ramezani F, Malek N, et al. Stigma and quality of life in women with breast cancer: mediation and moderation model of social support, sense of coherence, and coping strategies. Front Psychol. 2022;13:657992. Hami Kargar F, Nikkhah Ghamsari N, Ganji M. Body Identity in Women with Breast Cancer. Payavard-Salamt [Internet]. 2024;18(4):347–60. Hasani J, Mohammadkhani S, Akbari M, Adab GH. Iranian Women’s Perspectives on Breast Cancer: A Phenomenological Study. Women Stud. 2023;14(43):61–87. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handb qualitative Res. 1994;2(163–194):105. Jadidi A, Ameri F. Social support and meaning of life in women with breast cancer. Ethiop J Health Sci. 2022;32(4):709–14. Manouchehri E, Taghipour A, Ebadi A, Homaei Shandiz F, Latifnejad Roudsari R. How do I deal with breast cancer: a qualitative inquiry into the coping strategies of Iranian women survivors. BMC Womens Health. 2022;22(1):284. Hamedani B, Alavi M, Taleghani F, Fereidoonimoghadam M. Challenges of help-seeking in Iranian family caregivers of patients with Cancer: a qualitative study. Int J Cancer Manag. 2022;15(5). Zahedi H, Sahebihagh MH, Mirghafourvand M, Hosseinzadeh M. A qualitative study of family caregivers’ experiences in caring for breast cancer patients. Sci Rep [Internet]. 2025;15(1):24287. Oshima SM, Tait SD, Rushing C, Lane W, Hyslop T, Offodile AC et al. Patient Perspectives on the Financial Costs and Burdens of Breast Cancer Surgery. JCO Oncol Pract [Internet]. 2021 10;17(6):e872–81. Akbari M, Alavi M, Irajpour A, Maghsoudi J. Challenges of family caregivers of patients with mental disorders in Iran: A narrative review. Iran J Nurs Midwifery Res. 2018;23(5):329–37. Najafi Ghezeljeh T, Rezaei M, Keyvanloo Shahrestanaki S, Sheikh Milani A. Exploring family caregiver challenges in caring for patients with COVID-19 in intensive care units. Front Public Health. 2023;11:1057396. Sanabria G, Chavez M, Velez M, Munoz LP, Bastardo J, Belen A, et al. Navigating norms and expectations: the influence of culture on Latino couples and their interpersonal communication and coping post-breast cancer diagnosis. Ethn Health [Internet]. 2024;29(2):164–78. Tsuchiya M, Horn S, Ingham R. Social disclosure about lymphoedema symptoms: A qualitative study among Japanese breast cancer survivors. Psychol Health Med. 2015;20(6):680–4. Mackenzie CR. It is hard for mums to put themselves first’: how mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self. Soc Sci Med. 2014;117:96–106. Zhang Q, Gao W, Li X, Wang D, Zhang L, Xu M, et al. Motherhood role concerns in young women with breast cancer: a mixed-methods study. BMC Womens Health. 2025;25(1):313. Shands ME, Lewis FM. Parents with advanced cancer: worries about their children’s unspoken concerns. Am J Hospice Palliat Medicine®. 2021;38(8):920–6. Zamanzadeh V, Ghahramanian A, Valizadeh L, Mazaheri E. Strategies Used to by Mothers with Breast Cancer to Apply the Mothering Role: A Qualitative Study. Avicenna J Nurs Midwifery Care. 2021 Sep;1(3):220–32. [cited 2025 Nov 23];. Trusson D, Pilnick A. Between stigma and pink positivity: Women’s perceptions of social interactions during and after breast cancer treatment. Sociol Health Illn. 2016;39. faridi mahbobubeh, lotfi kashani farah, vaziri shahram. Role of culture in the life experience of women with breast cancer in Iran: A phenomenological study. J Breast Disease. 2023 Dec 1 [cited 2025 Nov 21];16(4):50–68. Tang Wzhen, Yusuf A, Jia K, Iskandar YHP, Mangantig E, Mo X, shao, et al. Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2023;31(1):55. Zamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ramezani F, Malek N, et al. Stigma and quality of life in women with breast cancer: mediation and moderation model of social support, sense of coherence, and coping strategies. Front Psychol. 2022;13:657992. Wu J, Zeng N, Wang L, Yao L. The stigma in patients with breast cancer: a concept analysis. Asia Pac J Oncol Nurs. 2023;10(10):100293. Jin R, Xie T, Zhang L, Gong N, Zhang J. Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. Eur J Oncol Nurs. 2021;52:101972. Rahbari L, Gender. Sexuality and the Moral Body: A Qualitative Study of Perceptions and Experiences of Body Management among Women in Iran and Iranian Migrant Women in Belgium. 2019. Zarei B, Kazemi A, Bahrami M, Beigi-Harchegani H. Social relationship challenges perceived by cancer patients and survivors: a qualitative meta-synthesis. BMC Psychol. 2025;13(1):1195. Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5(2):168–95. 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Kargar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYBAC9hlsDAckeGyATMbGA0Rp4bnBxnjAQiYNpKWBaC3MBypsDoM5RGqRbks4cCPnvN3a9sNAW2psoglrkTl24OCMM7eTt51JBGo5lpbbQEiLvUR6w2HJntvJZgeAWhgbDhPWwgPS8vffuWSz8w+J1pJ2ABjIB+zMbhBvS1oCUEtygtkNoC0JxPgFqMX4gwSPnb3Z+fSHDz7U2BDWAgOJYJUJxCoHAXtSFI+CUTAKRsEIAwDCB0oZLPsZaAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Kashan","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"Hami","lastName":"Kargar","suffix":""},{"id":560268307,"identity":"ed365e88-5705-448b-adb2-b88a787358bb","order_by":1,"name":"Narges Nikkhah","email":"","orcid":"","institution":"University of Kashan","correspondingAuthor":false,"prefix":"","firstName":"Narges","middleName":"","lastName":"Nikkhah","suffix":""},{"id":560268308,"identity":"6101fa61-8fd9-45aa-a852-5ab69b2df1e2","order_by":2,"name":"Mohammad 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16:54:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27312,"visible":true,"origin":"","legend":"","description":"","filename":"semistructuredinterviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-8311532/v1/f54d0713238a84b743800026.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breast Cancer Disclosure in Iranian Families: A Qualitative Study of Family Roles and Women’s Agency in Managing Disclosure","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBreast cancer remains the leading cancer burden among women, particularly in transitioning countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Iran, it is the most frequently diagnosed cancer among women (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Projections from the World Health Organization suggest that the Middle East and North Africa region will experience one of the sharpest increases in cancer burden in the coming decades (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although advances in early detection and therapeutic strategies have significantly improved clinical outcomes, the experience of breast cancer extends beyond biological pathology, encompassing complex social and psychological dimensions that shape multiple facets of individual and family life (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA critical yet underexplored aspect of this experience is the disclosure of a breast cancer diagnosis. While the concept of \u0026ldquo;disclosure\u0026rdquo; is frequently invoked in health and social science research, its underlying mechanisms have been subjected to limited empirical investigation. In some contexts, disclosure may be compulsory rather than discretionary; however, the factors that determine how, what, when, and why individuals choose to disclose remain inadequately understood (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Disclosure of illness is more than simply informing others about one\u0026rsquo;s condition; it encompasses the thoughts and emotions that individuals communicate to others (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Among patients with cancer, disclosure refers to the deliberate sharing of disease-related information\u0026mdash;including diagnosis, emotional experiences, and concerns\u0026mdash;with others. Within this framework, both the depth and breadth of disclosure (i.e., how much is shared and with how many individuals) are critical, as they significantly influence social support and overall well-being (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA systematic review defines disclosure as a \u0026ldquo;complex decision influenced by individual, social, and environmental factors.\u0026rdquo; The review highlights that disclosure and secrecy are distinct processes rather than opposites, and individuals may experience both at different times or in different contexts. It emphasizes that disclosure is not a one-time act but a dynamic process shaped by personal and social factors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Therefore, it is essential to approach illness disclosure as a process and to consider the social and cultural contexts that influence it.\u003c/p\u003e \u003cp\u003eFamily represents one of the most significant contexts for illness disclosure, as patients often prefer that family members be among the first to learn of the diagnosis (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Families provide not only a setting for physical and psychological care but also communicative and cultural structures that shape how disclosure occurs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rising incidence of breast cancer has prompted a shift from hospital-centered to family-centered care models (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), with the processes of cancer diagnosis and treatment inherently involving the family (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In the context of breast cancer, the family plays a pivotal role in both adaptation to and management of the disease (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and women\u0026rsquo;s illness experiences are continuously shaped through reciprocal interactions with family members (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnlike Western cultures, which emphasize individualism and personal autonomy in health-related decision-making, Iranian society often prioritizes collective responsibility and active family participation in healthcare (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), with health-related decisions largely guided by the family (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Consequently, investigating the role of family in illness disclosure is particularly important.\u003c/p\u003e \u003cp\u003eIranian studies indicate that women often face a \u0026ldquo;dilemma of secrecy versus disclosure.\u0026rdquo; While patients wish to inform their families to receive emotional and caregiving support, they also fear social labeling, pity, or negative judgment both within and outside the family (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Social stigma associated with breast cancer represents a key caregiving challenge in Iran (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and societal misconceptions make disclosure difficult (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Research has shown that taboos and fear of stigmatization, along with reactions such as excessive pity or negative judgment, often drive women to conceal their symptoms or diagnosis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the Iranian cultural context, norms of modesty and shame strongly influence women\u0026rsquo;s behavior and social interactions. These norms regulate discourse about the body, female anatomy, and experiences of bodily harm. As a result, families often struggle to discuss breast cancer openly and frequently opt to conceal related issues (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily members are often the first to learn of a woman\u0026rsquo;s illness and play a crucial role in treatment decisions and broader disclosure. Illness disclosure\u0026mdash;particularly for breast cancer\u0026mdash;is not solely an individual act but a social and communicative process embedded in familial and cultural values. This study examines how Iranian women navigate breast cancer disclosure within the family and how family dynamics shape this process.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Research Design\u003c/h2\u003e \u003cp\u003eA qualitative approach with thematic analysis was adopted. In-depth interviews were conducted with women who had completed breast cancer treatment, alongside supplementary interviews with five family members. The focus was on the family\u0026rsquo;s role in disclosure, the women\u0026rsquo;s strategies for managing it, and how illness was revealed or concealed within familial contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2.Sampling\u003c/h2\u003e \u003cp\u003eThe study included 25 women with breast cancer, aged 27\u0026ndash;65, all residing in Tehran and having completed treatment there. Participants were recruited via purposive and snowball sampling, based on experience with surgery and chemotherapy, ability to articulate perspectives, and Iranian nationality. Five family members who accompanied the women during treatment were also interviewed. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the participants\u0026rsquo; demographic and clinical characteristics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data Collection\u003c/h2\u003e \u003cp\u003eData were collected through semi-structured interviews with open-ended questions focused on illness disclosure. The interviews explored women\u0026rsquo;s experiences of disclosing breast cancer within their families and expressing their emotions, aiming to examine the family\u0026rsquo;s role and reactions throughout treatment and their responses to disease-related information. To obtain richer insights into familial disclosure, five accompanying family members were also interviewed. These interviews focused on the context of disclosure and their experiences supporting the women during the disclosure process. Interviews were conducted in person or by phone, depending on participants\u0026rsquo; preference, between 2024 and 2025. Each interview lasted 45\u0026ndash;60 minutes, and all were fully audio-recorded with participants\u0026rsquo; consent. Participant characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data Analysis\u003c/h2\u003e \u003cp\u003eIn accordance with the study aims, a content-analytic approach was adopted and, for the analysis of the interviews, Braun and Clarke\u0026rsquo;s Thematic Analysis (TA) was employed. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) Braun and Clarke offer a six-step procedure for theme extraction. The first step in any qualitative analysis is familiarisation with the data: reading and re-reading the material to achieve an in-depth understanding. Accordingly, recorded interviews were transcribed and the research team thoroughly reviewed the transcripts.\u003c/p\u003e \u003cp\u003eThe second step involved identifying meaningful units and extracting segments relevant to the study objective; from these semantic segments, initial codes were generated (Generating initial codes). In the third step the search for themes was undertaken (Searching for themes): related initial codes were grouped into categories or subthemes. By organising these subthemes, overarching themes were derived; five main themes were identified.\u003c/p\u003e \u003cp\u003eThe fourth step consisted of reviewing the themes. This review increased the analytic rigor and quality of the study and thereby enhanced its credibility. In the fifth step the themes were defined and named, and the conceptual scope of each principal theme was articulated. Finally, in the sixth step the analytic report was produced, which provided descriptive accounts of the themes, presented supporting evidence (quotations), and linked the findings to the research questions and the overall problem under investigation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Trustworthiness of the findings\u003c/h2\u003e \u003cp\u003ePrior to conducting the study, the researchers\u0026rsquo; personal experiences, beliefs, and assumptions were explicitly identified and documented to ensure reflexivity and minimize potential bias in data interpretation. To enhance the rigor and credibility of the study, strategies such as bracketing prior knowledge, triangulating analyses through multiple researchers, respondent validation, and iterative verification with participants during data analysis were employed (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo ensure the trustworthiness of the data, participants were purposefully sampled to achieve variation in age, educational background, and marital status. Interview conditions were structured to promote trust, comfort, and openness, enabling participants to share their perspectives candidly and in detail.\u003c/p\u003e \u003cp\u003e Member checking was implemented by providing transcribed and coded interview texts to three participants, who were asked to confirm the accuracy of the content and the relevance of the extracted codes to their lived experiences. To further strengthen data credibility, at least one illustrative quotation was provided for each identified theme.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Ethical consideration\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of Kashan University (Ethics ID: IR.KASHANU.REC.1402.034). The study objectives and procedures were fully explained to participants, and written informed consent was obtained. The timing and location of interviews were arranged according to participants\u0026rsquo; preferences. Participants were assured of their voluntary participation, consent for audio recording, the right to withdraw at any stage, and the confidentiality of their identity and information, with data reported using numeric codes. All procedures were conducted in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eparticipants\u0026rsquo; demographic and clinical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eType of Surgery\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetired teacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFood industry engineer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh school diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrivate-sector employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccountant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCultural heritage specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFreelancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePublic-sector employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh school diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrivate-sector employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTailor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIllustrator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCharity work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh school diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eArt-related work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh school diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrivate-sector employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eFollowing the analysis and interpretation of interview data regarding the disclosure of breast cancer within families and women\u0026rsquo;s interactions with family members in managing such disclosure, a total of 118 codes were extracted and organized into 16 sub-themes and five main themes. An example of the content analysis, including explanation, coding, sub-themes, and main themes, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These included: 1) family values and interactional norms in breast cancer disclosure, 2) the collective family image and breast cancer disclosure, 3) emotional experiences of disclosure within the family, 4) women\u0026rsquo;s agency and breaking through disclosure constraints, and 5) identity formation in expressing breast cancer. Subsequently, the themes were discussed, and relevant quotations were presented. To maintain confidentiality, participants were referred to by numbers rather than names.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAn example of the analysis process.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeaning Unit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExplanation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eFamily values and interactional norms in breast cancer disclosure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFamily Interaction Patterns\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeed for disclosure within the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"I first told my sister, then my husband. The family needed to know.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmphasizes the perceived necessity of informing family members about the diagnosis.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u0026rsquo;s expectation of family support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"If the family doesn\u0026rsquo;t help you, who will? The family should be by your side during illness.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHighlights the expectation of emotional and practical support from family.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitutionalized family accompaniment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"A family member always accompanied me to the doctor and never left me alone.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDemonstrates the routine involvement of family members in care processes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinancial provision by family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"My husband fully covered my treatment expenses.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIllustrates the role of family in providing financial support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEstablished Gender Roles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProtecting others\u0026rsquo; emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"I didn\u0026rsquo;t show my pain in front of my son. I didn\u0026rsquo;t want my parents to worry, so I didn\u0026rsquo;t share the details of my cancer.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShows how women may conceal their suffering to protect family members\u0026rsquo; feelings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u0026rsquo;s role within the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\"A woman should be patient, even for her husband; she keeps much of her pain to herself.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReflects culturally reinforced expectations of women\u0026rsquo;s endurance and emotional management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Family values and interactional norms in breast cancer disclosure\u003c/h2\u003e \u003cp\u003eThe disclosure of illness, particularly conditions such as breast cancer, is shaped by family values and interactions. In Iranian culture, family interactions are often grounded in strong emotional bonds, established gender roles, and family-centered norms and values. Families place a central emphasis on empathy and emotional support during difficult times, and interactions are oriented toward providing emotional care and addressing the needs of women with breast cancer. Women expect support and companionship from their families, and families perceive themselves as obliged to provide such support.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I first told my sister. Then I told my husband and my father and mother. My family took care of me a lot. My sisters and my mother helped me a lot. After chemotherapy, I would go to my mother\u0026rsquo;s house, she took care of me, and my sisters also helped a lot.\" (Woman No. 4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWomen\u0026rsquo;s expectations for family support, particularly from their parental family, are rooted in family interaction patterns and values. Within the family interaction model, the expectation of receiving support from spouses, parents, siblings, and children is institutionalized, and these individuals are considered primary sources of support. Consequently, when women are diagnosed with breast cancer, the family assumes significant responsibility, with caregiving and treatment follow-up carried out collaboratively. The family represents a crucial resource for meeting women\u0026rsquo;s needs. Family values and norms create conditions that foster closer intimacy between women and family members, making their support during illness essential. This dynamic renders disclosure of the disease to the family necessary, allowing them to be informed of the details and to participate actively in treatment and care processes.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Two days before chemotherapy, I would go to my parental home, and my mother would prepare nutritious food for me and take care of me. Even my brother would bring me juice, and my sister would take care of my children.\"\u003c/em\u003e (Woman No. 11)\u003c/p\u003e \u003cp\u003eWomen often have limited financial independence, making disclosure of breast cancer necessary to secure support. In Iranian families, financial responsibility for women primarily rests with their spouse and his family, making disclosure to them common.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"At first, I did not want my husband\u0026rsquo;s family to know exactly what had happened. But it was the early days of our life together, and we did not have the funds for treatment, and my husband insisted that I must have a private room for chemotherapy. That is why he told his parents so they could help. My father-in-law spent a lot on my treatment. They were almost fully aware of all stages of my treatment.\"\u003c/em\u003e (Woman No. 10)\u003c/p\u003e \u003cp\u003eAlthough family values and expectations often compel women to disclose their illness to family members, entrenched gender roles within the family structure can sometimes inhibit disclosure. Women with breast cancer encounter barriers to disclosure in their feminine roles. Gender norms expect women, in roles such as mother, wife, or daughter, to protect the emotions and feelings of family members and to remain patient.\u003c/p\u003e \u003cp\u003eEven during illness, women often modulate disclosure to protect family members\u0026rsquo; emotions, limiting details to prevent distress, particularly for children and elderly parents.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I tried to stay calm in front of my son so that he wouldn\u0026rsquo;t get upset because he is still a child, and I didn\u0026rsquo;t want him to be hurt.\"\u003c/em\u003e (Woman No. 13)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My parents live in another city. My father has heart disease; I didn\u0026rsquo;t tell them because I didn\u0026rsquo;t want them to worry\u0026mdash;they couldn\u0026rsquo;t do anything anyway. Only my sister knew. Even now, my parents don\u0026rsquo;t know. They only understood that I was ill.\"\u003c/em\u003e (Woman No. 1)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My mother rarely showed her pain. She didn\u0026rsquo;t want us to worry.\"\u003c/em\u003e (daughter of the patient)\u003c/p\u003e \u003cp\u003eWomen regulate the expression of their emotions and pain within the family according to prescribed feminine roles. This role-based pattern also applies to disclosure to their spouse. During painful phases such as chemotherapy and post-surgery recovery at home, women endeavored to withhold expressions of pain in front of their husbands. Although they believed that their spouse should be among the first to be informed of the illness and considered him a key source of support, they moderated the expression and disclosure of their emotions in accordance with their spousal role.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"You can\u0026rsquo;t really moan and groan in front of men. I didn\u0026rsquo;t tell my husband much either. We women are used to not telling our husbands about our pain.\"\u003c/em\u003e (Woman No. 25)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. The family\u0026rsquo;s collective image and breast cancer disclosure\u003c/h2\u003e \u003cp\u003eThe family\u0026rsquo;s collective image refers to the social identity that a family projects as a unit in public and social contexts. Families organize their responses to crises and threatening events based on this collective image. Since breast cancer is a debilitating and distressing illness, perceived as undermining femininity, sometimes hereditary, and even socially stigmatized, a diagnosis can be seen as a threat to the family\u0026rsquo;s collective image. Disclosure of the disease thus creates a sensitive situation, challenging the boundaries between private family life and the public sphere.\u003c/p\u003e \u003cp\u003eIn the interviews, women reported that disclosing breast cancer was not solely an individual decision; rather, the family managed disclosure with priority given to preserving the family\u0026rsquo;s collective image. When there was a risk of social misjudgment or when disclosure could jeopardize the position of certain family members, disclosure was restricted. In the interviews, restricted disclosure did not merely imply concealing the illness, but often involved modifying the description of the disease and details of the treatment process.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Relatives and acquaintances knew I had breast cancer, but we didn\u0026rsquo;t tell them much about my treatment. When they asked, we said, \u0026lsquo;Thank God, I\u0026rsquo;m getting better.\u0026rsquo; They didn\u0026rsquo;t even know I had my breast removed.\" (Woman No. 17)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My husband didn\u0026rsquo;t want his colleagues to know that I had breast cancer. He said, \u0026lsquo;I don\u0026rsquo;t want anyone to know.\u0026rsquo; Men really don\u0026rsquo;t want anyone to know that their wife has breast cancer.\" (Woman No. 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I have two daughters. I really didn\u0026rsquo;t want anyone to know I had breast cancer. People think breast cancer is hereditary, so I felt that it wouldn\u0026rsquo;t be good for my daughters if everyone knew I had it.\" (Woman No. 8)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Emotional experiences of breast cancer disclosure within the family\u003c/h2\u003e \u003cp\u003eThe emotional experience of breast cancer is one of the important dimensions of living with this disease within the family context. One of the key moments in forming this emotional experience occurs when women discuss their illness with their family and express their feelings. It is during this time that the reactions of family members shape women\u0026rsquo;s emotional experiences, and women encounter the emotional consequences of disclosing and expressing their illness.\u003c/p\u003e \u003cp\u003eWomen\u0026rsquo;s emotional experiences when expressing their illness within the family constitute a range of feelings, including positive and constructive emotions such as calmness and hope, as well as negative emotions such as shame, fear, and feeling burdensome. In the interviews, women stated that talking about the suffering and pain caused by the illness with some family members gave them a good feeling, as family members provided comfort. Women received a significant part of their sense of hope from their family. Some women indicated that their family, with patience, stood by them during these expressions of emotions, giving them calmness and hope. As a result, expressing emotions within the family became a positive experience for them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My husband always gave me hope and said I would get better and everything would be fine.\"\u003c/em\u003e (Woman No. 4)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We gave our mother a lot of encouragement. We took turns visiting her so she wouldn\u0026rsquo;t be alone. My mother shared her feelings with us, and I think when she talked and we were with her, she felt better.\"\u003c/em\u003e (daughter of the patient)\u003c/p\u003e \u003cp\u003eOn the other hand, some women encountered negative reactions from family members when disclosing their illness. Inattention to women\u0026rsquo;s condition and minimizing their weakness and pain led to negative emotions, as families were aware of their illness but did not provide emotional responses commensurate with women\u0026rsquo;s needs and expectations. A crucial aspect of women\u0026rsquo;s emotional experiences is that, as the duration of the illness extends, their condition becomes normalized for the family, resulting in reduced attention and fewer positive emotional responses.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"At first, my husband paid a lot of attention to me and would sit and listen to my concerns, but after a while, it seemed he no longer had the patience. The family\u0026rsquo;s attention also decreases over time.\"\u003c/em\u003e (Woman No. 2)\u003c/p\u003e \u003cp\u003eShame was another emotion reported during illness disclosure. Women often felt embarrassed when sharing their breast cancer diagnosis with male family members, especially in traditional families where discussing women\u0026rsquo;s bodies is considered taboo.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After my surgery, I felt embarrassed in front of my father and brother, and whenever we wanted to talk with my mother and sisters about my condition, it wasn\u0026rsquo;t in front of my father and brother. I couldn\u0026rsquo;t bring myself to do it in front of them.\" (Woman No. 17)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"In our family, they don\u0026rsquo;t talk about women\u0026rsquo;s issues in front of men. My sister, who had breast cancer, didn\u0026rsquo;t want us to discuss her condition in front of my brother or my husband. They knew my sister had breast cancer, but we didn\u0026rsquo;t mention any details in front of them. In our family, breast cancer is considered a women\u0026rsquo;s issue.\" (sister of the patient)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Women\u0026rsquo;s agency and breaking disclosure constraints within the family\u003c/h2\u003e \u003cp\u003eAgency refers to women\u0026rsquo;s ability to make sense of their situation during illness while considering their family context. \u0026ldquo;Breaking\u0026rdquo; does not imply disobedience to family norms, but rather represents a redefinition of women\u0026rsquo;s agency in managing breast cancer disclosure. In this process, women emerge not as victims of structure, but as creative actors who, through the dialectic between self and family, shape a new form of breast cancer disclosure.\u003c/p\u003e \u003cp\u003eIn the interviews, women highlighted their efforts to normalize disclosure within the family. Aware of familial disclosure constraints, they reported that their perspective on breast cancer often differed from that of their family. Although they were cognizant of social taboos surrounding breast cancer and had experienced incorrect social judgments, they wished to raise awareness among relatives and did not hesitate to discuss their feelings, bodily changes, or treatment stages. Women\u0026rsquo;s agency and their attempts to negotiate the meaning of breast cancer within the family context represent key challenges in interacting with family members. This agency in disclosure was particularly evident among younger and more educated women.\u003c/p\u003e \u003cp\u003eAccess to social media enables women\u0026rsquo;s agency, allowing them to share information about breast cancer and their lived experiences through personal online platforms.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My family really didn\u0026rsquo;t want to explain my condition to others. But I didn\u0026rsquo;t like this situation; I wanted to be able to talk about my illness and I wasn\u0026rsquo;t afraid of others knowing.\" (Woman No. 11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I had a personal page where, after my illness, I posted content about breast cancer treatment. Some relatives and acquaintances were also my followers. There, I could speak more freely. Even when I was feeling unwell, I would post stories, and I didn\u0026rsquo;t care if others knew what condition I was in.\" (Woman No. 19)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Women\u0026rsquo;s identity formation in expressing breast cancer\u003c/h2\u003e \u003cp\u003eOne theme emerging from the interviews was women\u0026rsquo;s effort to highlight the positive aspects of the illness within family relationships. Alongside expressing pain and the need for family support during treatment, women also considered another dimension of disclosure. Through \u0026ldquo;positive expression,\u0026rdquo; they sought to emphasize the beneficial changes that the illness had brought about in their lives. This effort appears to be rooted in a redefinition of feminine identity.\u003c/p\u003e \u003cp\u003eSome women reacted to excessive compassion and expressions of pity from family members by trying to appear strong. At times, they concealed their pain and suffering, considering this nondisclosure important for reconstructing their identity. In the interviews, women stated that they tried to share positive aspects of the illness with their family by demonstrating a more resilient self and expressing a renewed outlook on life. Presenting a new and better self-image after being diagnosed with breast cancer is thus part of women\u0026rsquo;s efforts at identity formation during the process of disclosing the illness within the family.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Many times I wanted to show that I am a strong woman. I tried to endure my pain, do my own tasks, and show that breast cancer had not defeated me.\" (Woman No. 10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After a while, my sister seemed to have changed; she appeared very hopeful, saying that her outlook on life had changed. She spoke about breast cancer much more openly and showed all of us that she was much stronger than the cancer.\" (sister of the patient)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe management of breast cancer disclosure in Iran constitutes a complex network of actions, norms, and family relationships, placing women in a continuous state of negotiation with their families. The findings include five main themes, each conceptualizing a specific aspect of the disclosure process within the family. Furthermore, in this study, disclosure is not based solely on women\u0026rsquo;s lived experiences; the perspectives of family members and family dynamics are also considered, framing disclosure management as the product of the dialectic between women\u0026rsquo;s agency and family structures. In other words, managing breast cancer disclosure within the family is not a linear or single-stage process; it is a dynamic process that develops across multiple cultural, relational, and emotional layers. Although the family plays an important role in shaping, guiding, limiting, or legitimizing disclosure, women are not passive participants\u003c/p\u003e \u003cp\u003eBased on the findings of this study, disclosure of illness to the family represents a form of obligation, and women require family support and companionship. Most Iranian studies have highlighted the positive effects of family accompaniment and emotional support for women during illness (\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Additionally, due to the high costs of breast cancer treatment (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and women\u0026rsquo;s limited access to financial resources, they depend on family support. The results of this study emphasize that, although receiving family support and companionship facilitates breast cancer disclosure within the family, it is important to recognize that families act according to their values and norms. Providing support, following up on treatment, and accompanying women are considered family values, and women expect such support from family members during illness. In the Iranian cultural context, the family is the first and most important source of support during crises (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, values such as preserving family harmony, fulfilling women\u0026rsquo;s emotional roles, and preventing psychological distress among other family members often lead women to conceal or postpone disclosure. Even during illness, women appear to act in accordance with prescribed familial roles and gendered norms. Cultural expectations also shape spousal interactions following a breast cancer diagnosis (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), with adherence to these norms being particularly pronounced in traditional families. For instance, a study of Japanese women indicated that entrenched traditional cultural values so strongly influenced women that, despite their illness, they endeavored to fulfill familial and societal expectations, refraining from disclosing their condition (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGender norms often lead women to prioritize the needs of their family, particularly their children, over their own health and well-being (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In family-centered cultures, the mother assumes a primary role in child-rearing, and a breast cancer diagnosis can generate significant concern for mothers (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Consequently, they often prefer not to discuss their illness with their children (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Iranian mothers, by prioritizing their children\u0026rsquo;s needs, strive to fulfill their role as good mothers even while coping with illness (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWomen often present public narratives shaped by fear of social stigma throughout the course of breast cancer treatment and afterward (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Negative perceptions of sharing a diagnosis and concerns about others\u0026rsquo; reactions reflect the taboo nature of breast cancer in Iran (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Although social stigma has been widely recognized in previous research as a key factor motivating women to conceal their illness (\u003cspan additionalcitationids=\"CR44 CR45\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), this study emphasizes the role of the family in restricting disclosure to preserve social reputation. Within the Iranian cultural context, breast cancer may be perceived as a \u0026ldquo;defective body\u0026rdquo; or \u0026ldquo;lost femininity\u0026rdquo; (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Under such circumstances, disclosure is often managed and limited by the family. Findings from this study indicate that Iranian families, aware of the potential negative consequences of disclosure, actively regulate the sharing of information to protect the family\u0026rsquo;s collective image.\u003c/p\u003e \u003cp\u003eOne of the most important consequences of disclosure within the family is the formation of emotional experiences following disclosure. Expressing and discussing the illness within the family generates these emotional experiences, which can vary widely. Patients with cancer often face complex emotional ambivalence: on one hand, a deep desire for support, and on the other, profound fear of the consequences of sharing their condition (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Some women report receiving positive emotions such as hope and a sense of self-worth from their family after disclosure. Others, however, encounter inappropriate reactions; indifference from some family members over time can lead women to feel burdensome. Additionally, some women experience shame following breast cancer disclosure. It appears that women\u0026rsquo;s emotional experiences within the family shape future disclosure patterns, with negative emotional experiences acting as barriers to sharing, expressing feelings, and providing detailed information about the illness in subsequent stages of treatment.\u003c/p\u003e \u003cp\u003eBased on the findings of this study, women also play an active role in managing disclosure and are not passive in relation to their families. Efforts to normalize disclosure and a lack of fear in sharing detailed information about their illness are among women\u0026rsquo;s strategies. The new generation of Iranian women demonstrates a strong willingness to challenge social taboos, with social media activity and illness disclosure being particularly salient for young women with breast cancer. Women\u0026rsquo;s agency in the disclosure process and their actions to confront breast cancer taboos represent a key finding of this study, reflecting a shift in women\u0026rsquo;s perspectives on breast cancer and their efforts to raise awareness and change societal attitudes toward the disease. Previous research has largely overlooked women\u0026rsquo;s agency in breast cancer disclosure, often portraying them as passive. However, the findings of this study emphasize that, within the context of Iran\u0026rsquo;s cultural transition, many women actively challenge social taboos, particularly those related to the body.\u003c/p\u003e \u003cp\u003eAnother important dimension of women\u0026rsquo;s agency in disclosing breast cancer within the family is their effort to reconstruct identity after diagnosis. As Charmaz has shown, chronic illness can disrupt the continuity of identity (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Following the challenges to their identity posed by breast cancer, women undertake actions to rebuild their sense of self (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), one of which is through disclosure of the disease. Through positive expressions and highlighting the beneficial aspects of breast cancer in their lives, women strive to reconstruct their identity. Demonstrating strength, enduring pain, and concealing negative emotions are among the strategies women employ in disclosing breast cancer within the family. The purpose of these positive expressions and concealment of negative aspects is to facilitate identity reconstruction. Research by Manouchehri et al. indicates that women, when expressing their emotions, sought to convey positive feelings and reassure their family that they were well, even when they actually felt the opposite (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eBreast cancer disclosure within families emerges from the interaction between women and their family members, shaped by familial values and norms that may encourage either concealment or revelation. Families regulate disclosure to protect social reputation, while women experience a range of emotional responses that form a key aspect of the social experience of illness. Simultaneously, women exercise agency, using strategies such as social media disclosure and positive expressions within the family to reconstruct their identity and challenge social stigma.\u003c/p\u003e"},{"header":"6. Strengths and Limitations","content":"\u003cp\u003eThis study appears to be the first qualitative investigation in Iran to examine the management of breast cancer disclosure within Iranian families, with a particular focus on the role of women. The study emphasizes both the influence of family structures and women\u0026rsquo;s agency in the disclosure process. Several limitations should be acknowledged. First, convenience sampling was employed, which may not fully represent the broader population and could limit the generalizability of the findings to other groups. Additionally, data were collected through in-depth interviews, and participants may have experienced concerns about sharing sensitive experiences. To mitigate this, all interviews were conducted in private settings with only the researcher and participant present, creating a safe environment that ensured confidentiality and encouraged open expression.\u003c/p\u003e \u003cp\u003eAnother limitation is that the sample was restricted to women residing in Tehran. To gain a more comprehensive and culturally diverse understanding, future studies should include participants from different regions and ethnic backgrounds across Iran. Such efforts would enrich the findings and provide a broader, more inclusive perspective on breast cancer disclosure within Iranian families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDeclaration of Competing Interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval\u003c/strong\u003e \u003cp\u003e All procedures performed in this study involving human participants were conducted in accordance with the Declaration of Helsinki and were approved by the Ethics Committee of Kashan University (Ethics ID: IR.KASHANU.REC.1402.034).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Participate\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNN and MG conceptualised the idea, FHK obtained the data, FHK analysed the data, all author reviewed the findings, FHK drafted the manuscript, NN and MG reviewed the manuscript, and all authors read the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to confidentiality and ethical restrictions. Selected quotations used in the manuscript are presented within the text. The full datasets are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Ji Y, Liu S, Li J, Wu J, Jin Q, et al. Global burden of female breast cancer: new estimates in 2022, temporal trend and future projections up to 2050 based on the latest release from GLOBOCAN. J Natl Cancer Cent. 2025;5(3):287.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanaat Z, Dolatkhah R. Epidemiologic profile of breast cancer in Iran: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2024;26:101537.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatran RA, Tahoun S, Helmy L, Bahr A, Khalil A, Kamel M et al. Breast cancer in the Middle East and North Africa: economic burden, market trends, and care challenges. 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Int J Cancer Manag. 2022;15(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZahedi H, Sahebihagh MH, Mirghafourvand M, Hosseinzadeh M. A qualitative study of family caregivers\u0026rsquo; experiences in caring for breast cancer patients. Sci Rep [Internet]. 2025;15(1):24287.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOshima SM, Tait SD, Rushing C, Lane W, Hyslop T, Offodile AC et al. Patient Perspectives on the Financial Costs and Burdens of Breast Cancer Surgery. JCO Oncol Pract [Internet]. 2021 10;17(6):e872\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkbari M, Alavi M, Irajpour A, Maghsoudi J. Challenges of family caregivers of patients with mental disorders in Iran: A narrative review. Iran J Nurs Midwifery Res. 2018;23(5):329\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNajafi Ghezeljeh T, Rezaei M, Keyvanloo Shahrestanaki S, Sheikh Milani A. Exploring family caregiver challenges in caring for patients with COVID-19 in intensive care units. Front Public Health. 2023;11:1057396.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanabria G, Chavez M, Velez M, Munoz LP, Bastardo J, Belen A, et al. Navigating norms and expectations: the influence of culture on Latino couples and their interpersonal communication and coping post-breast cancer diagnosis. Ethn Health [Internet]. 2024;29(2):164\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsuchiya M, Horn S, Ingham R. Social disclosure about lymphoedema symptoms: A qualitative study among Japanese breast cancer survivors. Psychol Health Med. 2015;20(6):680\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackenzie CR. It is hard for mums to put themselves first\u0026rsquo;: how mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self. 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Between stigma and pink positivity: Women\u0026rsquo;s perceptions of social interactions during and after breast cancer treatment. Sociol Health Illn. 2016;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003efaridi mahbobubeh, lotfi kashani farah, vaziri shahram. Role of culture in the life experience of women with breast cancer in Iran: A phenomenological study. J Breast Disease. 2023 Dec 1 [cited 2025 Nov 21];16(4):50\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang Wzhen, Yusuf A, Jia K, Iskandar YHP, Mangantig E, Mo X, shao, et al. Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2023;31(1):55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ramezani F, Malek N, et al. Stigma and quality of life in women with breast cancer: mediation and moderation model of social support, sense of coherence, and coping strategies. Front Psychol. 2022;13:657992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu J, Zeng N, Wang L, Yao L. The stigma in patients with breast cancer: a concept analysis. Asia Pac J Oncol Nurs. 2023;10(10):100293.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin R, Xie T, Zhang L, Gong N, Zhang J. Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. Eur J Oncol Nurs. 2021;52:101972.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahbari L, Gender. Sexuality and the Moral Body: A Qualitative Study of Perceptions and Experiences of Body Management among Women in Iran and Iranian Migrant Women in Belgium. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarei B, Kazemi A, Bahrami M, Beigi-Harchegani H. Social relationship challenges perceived by cancer patients and survivors: a qualitative meta-synthesis. BMC Psychol. 2025;13(1):1195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5(2):168\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer disclosure, family role, women's agency, social stigma","lastPublishedDoi":"10.21203/rs.3.rs-8311532/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8311532/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Aim:\u003c/h2\u003e \u003cp\u003eIllness disclosure is a critical issue following a breast cancer diagnosis. Family members are often the first to be informed and play a central role in treatment decisions and the dissemination of information. In family-centered cultures, interactions between women and their families profoundly shape the disclosure process. Breast cancer disclosure should thus be understood not merely as an individual act but as a social and communicative process embedded within familial and cultural values.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This qualitative study involved in-depth, semi-structured interviews with 25 women with breast cancer in Tehran who had completed treatment, alongside five family caregivers. Participants were recruited using purposive and snowball sampling. Interviews explored family roles and interactions in managing disclosure. Data were analyzed using Braun and Clarke\u0026rsquo;s thematic analysis approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive themes emerged: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) family values and interactional norms in disclosure, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the collective family image and its influence on disclosure, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) emotional experiences of disclosure within the family, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) women\u0026rsquo;s agency and breaking through disclosure constraints, and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) identity formation through expressing breast cancer experiences. Disclosure decisions were guided by cultural and familial values, often constrained to protect the family\u0026rsquo;s social reputation. Emotional responses ranged from positive to negative. Women exercised agency, with some openly sharing their condition, including via social media. Positive expression and emphasis on personal growth emerged as key strategies for reconstructing identity post-diagnosis.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBreast cancer disclosure unfolds through dynamic interactions between women and their families, mediated by social norms and cultural taboos. While some women use disclosure to challenge societal perceptions, public awareness initiatives may facilitate disclosure and improve access to care.\u003c/p\u003e","manuscriptTitle":"Breast Cancer Disclosure in Iranian Families: A Qualitative Study of Family Roles and Women’s Agency in Managing Disclosure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-16 07:14:33","doi":"10.21203/rs.3.rs-8311532/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-07T08:47:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T10:30:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330053030620811220211564708535237833451","date":"2026-03-02T05:56:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176430159589251246627657033028733787342","date":"2026-02-26T06:21:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-24T09:07:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301922288666561512802848267773378729139","date":"2026-02-24T06:09:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T06:01:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-03T06:31:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-15T04:22:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-12T19:02:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-12-12T18:56:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"effa1238-b687-4c7a-92f1-87ec6d1d274e","owner":[],"postedDate":"December 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T06:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-16 07:14:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8311532","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8311532","identity":"rs-8311532","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}