Reproductivity concerns among young women with breast cancer: Living under the shadow of fear

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For women diagnosed during their childbearing years, questions about fertility, future pregnancies, and the health of their children can significantly affect emotional well-being. Understanding the nature, severity, and cultural roots of these concerns is essential for offering meaningful support to patients and their families. Methods This quantitative and qualitative study was conducted in 2021 in northwest Iran. A descriptive, analytical, cross-sectional survey was followed by a qualitative exploration of personal experiences. The quantitative phase included 139 women under the age of 45 diagnosed with breast cancer. For the qualitative phase, 30 women who had completed cancer treatment and were willing to share their experiences were selected using purposive sampling. Quantitative data were analyzed using SPSS version 25 with a 95% confidence level, while qualitative data were examined through conventional content analysis. Results The average age of participants was 37.55 ± 5.95 years. The overall mean score for perceived reproductive concerns was 48.5 ± 6, indicating moderate to high levels of concern. Women who had undergone complementary therapies such as chemotherapy or radiotherapy reported significantly higher concern levels (mean score: 45.26 ± 4.5). Concerns related to personal health—the ability to care for themselves and their children—ranked the highest. Through qualitative interviews, two major themes emerged as the root causes of these worries: Living under the shadow of fear and Restrictions linked to illness, treatment, and financial strain. Conclusions Young women with breast cancer face considerable reproductive concerns, with personal health standing out as their greatest source of anxiety. Tailored, culturally sensitive education and support programs are urgently needed to help patients and their families cope with these challenges and maintain hope for the future. Breast Cancer Reproductive Concerns Young Women Personal Health Iran Introduction Breast cancer remains the most common cancer among women worldwide, touching the lives of millions each year ( 1 , 2 ). In 2020 alone, more than 2.26 million new cases were diagnosed globally ( 3 ). While rates have stabilized or even declined in some high-income countries, developing nations—including Iran—have seen a concerning rise in new breast cancer cases ( 2 ). In Iran, breast cancer accounts for roughly 12.5% of all cancer diagnoses in women ( 4 ). What makes the situation more alarming is that women here tend to face this disease at a younger age compared to other parts of the world—often 5 to 10 years earlier ( 5 , 6 ). Many of these women are in the prime of their lives, building careers, raising families, or dreaming of starting one. Globally, breast cancer is the most common cancer among women of childbearing age, representing nearly half of all cancers in women aged 25 to 49 ( 7 ). Over 15% of breast cancer cases affect women under 40 ( 8 ), many of whom have young children at home or hopes of becoming mothers in the future ( 9 ). While advances in treatment have dramatically improved survival rates—with more than 91% of women surviving at least five years after diagnosis ( 5 , 10 )—the journey doesn’t end with medical treatment. The emotional, social, and reproductive impacts of breast cancer often linger, particularly for young women still in their reproductive years ( 8 , 10 , and 11 ). For these women, concerns about fertility, the ability to conceive, raising children, and the health of future offspring can be overwhelming ( 12 ). Many grapple with questions: Will I be able to have children? Will my illness or treatment affect my child? How do I navigate motherhood while managing my own health? In cultures like Iran’s, where motherhood and family play a central role in a woman’s identity, these concerns are even more profound. The emotional strain, paired with fears about infertility, pregnancy complications, and the health of future children, can significantly affect mental well-being and quality of life ( 13 ). Despite these challenges, reproductive health concerns are often overlooked in cancer care. Understanding the specific fears and needs of young women with breast cancer—especially within the context of Iranian society—is essential for providing compassionate, comprehensive care. This study aimed to explore these concerns among young women with breast cancer in northwest Iran and to better understand both the measurable factors and the deeper, personal experiences shaping their reproductive worries. Methods Study Design and Participants This research combined both quantitative (descriptive analytical cross-sectional study) and qualitative approaches to capture not only the numbers but also the personal voices behind those statistics. The study was conducted in 2021 among women with breast cancer living in northwest Iran. In the first phase, 139 women under the age of 45, all diagnosed with breast cancer, took part in the survey. For the second, qualitative phase, 30 women who had completed their adjuvant treatment (such as chemotherapy, radiotherapy, or hormone therapy) and showed no signs of cancer recurrence were invited to share their personal experiences in-depth. Eligibility for the study included: Women under 45 years of age, diagnosed with breast cancer, willing and able to provide informed consent. Exclusion criteria were designed to reduce factors that could independently affect reproductive concerns, including: Cancer metastasis, polycystic ovary syndrome (PCOS), endometriosis, a history of infectious abortion or sexually transmitted infections (STIs), prior pelvic, uterine, or fallopian tube surgeries, uterine leiomyoma, known primary or secondary infertility, unwillingness to participate. Data Collection Quantitative Phase: Participants completed a structured questionnaire capturing demographic details, medical history, and reproductive concerns. Reproductive concerns were assessed using the well-established Reproductive Concerns after Cancer (RCAC) scale ( 10 ), which evaluates six key areas: Reproductive potential: Fears about being unable to conceive Partner disclosure: Anxiety around discussing reproductive issues with a spouse Child health: Concerns about how their illness might affect existing or future children Personal health: Worries about being physically able to care for a child Acceptance: Emotional difficulty accepting infertility Pregnancy: Fears regarding potential pregnancy risks after cancer Each question was rated on a 5-point Likert scale, with higher scores reflecting greater concern. The overall score ranged from 18 to 90, providing a broad picture of each woman’s reproductive worries. The RCAC scale’s reliability (Cronbach’s alpha > 0.75) and content validity were confirmed by expert review prior to use. Qualitative Phase: To dive deeper into the emotional and cultural roots of these concerns—especially around personal health and caregiving—we conducted one-on-one, semi-structured interviews with 30 women from the initial group. Participants were encouraged to share their thoughts and feelings openly, with interviews guided by broad, open-ended questions and gentle prompts for elaboration. The conversations lasted between 45 and 90 minutes, depending on each woman’s comfort and energy levels, and were conducted at a time and place of their choosing to ensure privacy and emotional safety. All interviews were conducted by the same trained researcher, ensuring consistency. The discussions were audio-recorded, transcribed word-for-word, and analyzed until no new themes emerged—a process known as data saturation. Data Analysis Quantitative data were analyzed using SPSS software (version 25), applying t-tests, logistic regression, and Fisher’s exact tests. Statistical significance was defined as a p-value < 0.05. Qualitative data were analyzed using conventional content analysis, following the framework established by Graneheim and Lundman ( 14 ). Through careful coding and categorization, we identified recurring themes that reflected the women’s lived experiences and cultural context. Ethical Considerations The study received ethical approval from the Ardabil University of Medical Sciences Ethics Committee (Approval Code: IR.ARUMS.REC.2019.098). Participation was entirely voluntary, and women were free to withdraw at any time without consequences. All participants provided written informed consent, and their privacy and confidentiality were fully protected throughout the study. Results The women in this study were between 18 and 45 years old, with an average age of 37.5 years. Most (67.6%) had one or two children, while 9.4% had no children. For mothers, the youngest child was, on average, just over five years old—highlighting how many participants were still raising very young children while facing breast cancer. Financial strain was common. More than half of the women reported that their household income was insufficient to meet basic living needs. Self-rated health was also concerning, with nearly half (47.5%) describing their health as poor. The average age at breast cancer diagnosis was 34.9 years—meaning many were diagnosed during the prime of their reproductive years. In terms of treatment, two-thirds (65.5%) underwent lumpectomy, while the most common additional therapy was a combination of chemotherapy and radiotherapy (39%). The overall level of reproductive concerns among participants was moderate to high, with an average score of 48.5 out of a possible 75. Women who received more intensive treatments, such as chemotherapy, reported significantly higher levels of reproductive worry, while employed women tended to report fewer concerns (see Table 1 ). Table 1 Distribution and Mean score of perceived reproductivity concerns in terms of demographic variables and disease-related variables in patients with breast cancer Category N (%) /Mean Mean ± SD P value Age 40 63 (45.3) 48.44 ± 5.71 Age at the time of diagnosis 34.9 ± 6 Level of education Elementary and secondary 84(60.4) 48.54 ± 5.7 0.98 High school 38 (27.3) 48.3 ± 6.5 University 17 (12.2) 48.5 ± 6.6 Partner level of education Elementary and secondary 59 (42.4) 48.4 ± 5 0.83 High school 46 (33.1) 47.9 ± 5 University 20 (14.4) 47.6 ± 6 No response 14 (10.1) Number of children Without child 13 (9.4) 52.46 ± 6.6 0.02 1–2 child 94 (67.6) 48.55 ± 5.9 ≥ 3 child 27 (19.4) 47.07 ± 5.5 No response 5 (3.6) - Job Housekeeper 128 (92.1) 48.59 ± 6 0.57 Occupied 11 (7.9) 47.45 ± 6.1 Menstrual status Menstrual 73 (52.5) 47.6 ± 5 0.07 Menopause 66 (47.5) 49.4 ± 6 Prevention method Natural 68 (48.9) 47.94 ± 6.17 0.62 LD Tablet 9 (6.5) 47.0 ± 5.29 IUD 16 (11.5) 47.06 ± 4.26 Condom 2 (1.4) 51.0 ± 4.23 No prevention 23 (16.5) 49.48 ± 5.96 No response 21 (15.1) - - Diagnosis stage Local 104 (74.8) 48.16 ± 6.16 0.17 Advanced localization 29 (20.8) 50.10 ± 5.87 Metastatic 3 (2.2) 44.67 ± 3.51 No response 3 (2.2) - - Type of surgery Lumpectomy 91 (65.5) 48.15 ± 6.30 0.56 Unilateral mastectomy 34 (24.5) 49.38 ± 5.33 Non-surgical 10 (7.1) 49.30 ± 7.21 No response 4 (2.9) - Adjuvant therapies No 39 (28.05) 45.26 ± 4.51 < 0.001 Yes 100 (71.95) 49.7 ± 6.16 Chemotherapy 37 (37.0) 48.14 ± 5.34 < 0.001 Hormone therapy 6 (6.0) 50.00 ± 2.36 Chemotherapy + Radiotherapy 39 (39.0) 50.54 ± 6.72 Chemotherapy + Radiotherapy + Hormonotherapy 15 (15.0) 48.73 ± 5.27 Chemotherapy + Hormonotherapy 3 (3.0) 62.00 ± 2.64 Adequacy of income Inadequate 72 (51.8) 49.28 ± 5.65 0.19 Enough 51 (36.7) 47.29 ± 6.77 Too much need 16 (11.5) 48.81 ± 5.04 Patients' self-assessment of their level of health Good 36 (25.9) 46.22 ± 5.97 0.03 Medium 37 (26.6) 49.27 ± 6.44 Weak 66 (47.5) 49.30 ± 5.63 LD : Low-Dose Birth Control, IUD : Intrauterine Device The most significant worries centered on “personal health”, followed by concerns about fertility and child health. The area of least concern involved disclosing reproductive issues to partners. Importantly, women with higher education levels, as well as those whose partners had more education, expressed fewer personal health concerns—possibly reflecting better access to health information and resources. (Respectively (P = 0.049) (P = 0.048)) Having children also influenced reproductive concerns. Women with more children reported lower levels of worry about fertility and acceptance, while childless women reported the highest levels of concern in these areas (P = 0.02 and P < 0.001, respectively). (Table 2 ). Table 2 Comparison of patients' mean scores in the six dimensions of perceived reproductivity concerns in terms of some variables Reproductivity potential Disclosing the problem Child health Personal health Acceptance Becoming pregnant Mean ± SD Total score in subscales 57/1‏±‏60/8 58/1‏±‏22/7 63/2‏±‏55/8 95/1‏±‏97/8 72/1‏±‏57/7 48/1‏±‏59/7 Number of children Without child 8.92 ± 1.7 7.6 ± 2.1 9.3 ± 2.2 8.4 ± 1 9.6 ± 1.6 8.3 ± 1.9 1–2 child 8.7 ± 1.6 7.2 ± 1.5 8.4 ± 2.6 9.1 ± 1.8 7.4 ± 1.6 7.5 ± 1.4 ≥ 3 child 7.8 ± 1.1 6.9 ± 1.3 8.8 ± 2.8 8.8 ± 2.4 7.2 ± 1.5 7.3 ± 1.3 P value 0.03 0.40 0.42 0.35 0.001 0.12 Adjuvant therapy yes 8.69 ± 1.5 7.4 ± 1.7 8.9 ± 2.8 9.34 ± 1.8 7.4 ± 1.7 7.8 ± 1.4 no 8.31 ± 1.6 6.6 ± 0.87 7.6 ± 1.8 7.9 ± 1.8 7.6 ± 1.6 7.1 ± 1.3 P value 0.24 0.001 0.01 0.001 0.64 0.01 Adequacy of income Inadequate 8.6 ± 1.5 7.4 ± 1.7 8.7 ± 2.7 9.4 ± 1.9 7.5 ± 1.6 7.5 ± 1.3 enough 8.6 ± 1.6 6.9 ± 1.4 8.3 ± 2.6 8.3 ± 1.8 7.4 ± 1.6 7.6 ± 1.7 Those who underwent comprehensive treatment (surgery, chemotherapy, radiotherapy, and hormone therapy) were significantly more concerned about both their own health (P = 0.001) and their children’s health (P = 0.008). Higher income was associated with fewer personal health concerns (P = 0.025). When asked directly, 61.6% of women identified infertility as their biggest fear, followed closely by the fear of not being able to care for their children (47.4%). Regression analysis revealed that younger age, the age of the youngest child, and age at diagnosis were significant predictors of reproductive concerns (see Table 3 ). Table 3 predictive factors of reproductivity concerns in patients with breast cancer B Sig. Exp(B) Age -0.483 0.004 0.617 Level of education 1.349 0.086 3.855 Occupation -0.233 0.894 0.792 Husband education -0.687 0.204 0.503 Menstrual status -0.269 0.665 0.764 Number of children -0.384 0.523 0.681 Last child age 0.152 0.042 1.164 Breastfeeding history 0.271 0.346 1.311 Age at diagnosis 0.367 0.010 1.444 Cancer stage 0.769 0.321 2.157 Type of surgery 0.133 0.762 1.143 Other treatment 0.101 0.589 1.106 In the second phase, qualitative interviews provided deeper insight into these fears. Two major themes emerged: 1. Living under the Shadow of Fear Women described overwhelming anxiety about their children’s future, their own health, and their ability to protect and raise their children. Common worries included: Fears of not being present to raise their children due to illness or death Feeling inadequate as a mother Anxiety about their children’s social well-being and safety Patient Voices: I’m always worried I’ll be so consumed by my illness that I won’t raise my children properly, and they’ll grow up alone. If I were healthy, I could meet their needs, but I just can’t anymore. My illness isolates us. I can’t take my daughter to parties or outside much. I feel guilty that my illness interferes with raising my children. I’m afraid I might die, and my children will end up with a stepmother. These fears contributed to feelings of being an inadequate mother, unable to protect or nurture their children as they desired. 2. Restrictions and Financial Strain Disease-related fatigue, pain, and disability—especially after surgery—made daily caregiving difficult. Additionally, many women described the financial burden of treatment draining household resources, making it even harder to care for their families. Patient Voices: I want to hug my daughter and take her out, but my hands won’t let me. I get tired so quickly—I can’t cook or play with them like before. Most of our money goes toward my treatment. These physical and financial limitations left many women feeling powerless to meet their children’s needs, deepening their concerns about motherhood and family life (see Table 4 ). Table 4 Categorizing the roots of personal health concerns Main categories Subcategory Basic concepts Code Living under shadow of fear (perceived fears and negative emotions) Fear concerning the uncertain future prospects of their children The apprehension of potential physical separation from their child due to their illness Being separated from children due to necessary treatment follow-up The mother's concern about her children living with a stepmother The mother's fear of her children becoming motherless Fear of hereditary cancer risk The mental strain induced by the costs of treatment The mother's discomfort due to not being able to meet her children's welfare needs because of medical expenses Feeling pressured to support the family financially while undergoing treatment Experiencing adverse sentiments regarding one's role as a mother The perception that a mother cannot fulfill her maternal role Drawing comparisons between one's physical health and that of healthy mothers Restrictions Physical disability and its limitations The inability to care for and protect children due to physical limitations resulting from illness Inability to use the hand on the side of mastectomy Pain in the arm on the side of the mastectomy Edema in the arm on the mastectomy side Inability to carry the child with the hand Interference of disease follow-up with children's care Resource limitations Financial difficulties stemming from medical expenses impacting the care of children most of our income are spent on my treatment Absence of cohesive support systems Inability to provide an optimal caregiving environment for children Discussion For young women, a breast cancer diagnosis can feel like life stops—and for many, fears about fertility, parenting, and their children’s future quickly rise to the surface. Our study reflects these deeply personal concerns, with reproductive worries reported at moderate to high levels.The greatest anxieties focused on personal health, reproductive potential, and child health, echoing findings from Sweden, Portugal, and other studies ( 15 – 19 ). Women who have not yet started or completed their families often experience heightened fears about fertility loss ( 20 ), which can worsen depression ( 21 ) and diminish quality of life ( 22 ). Education played a protective role. Women with higher levels of education, and those with educated partners, reported fewer personal health worries—possibly due to better understanding of treatment options ( 23 , 24 ), improved self-care, and greater access to resources ( 23 – 25 ). The number of children also influenced reproductive concerns. Women without children or with fewer children reported more intense worries about fertility and social acceptance, consistent with previous studies ( 15 , 26 – 28 ). The innate desire to become a mother—or to expand one’s family—makes the threat of infertility especially distressing ( 17 , 26 ). It has been shown that the unfulfilled desire to become a parent is associated with mental health disorders ( 27 ). Intensive treatments like chemotherapy and radiotherapy, known for their potential to harm fertility, were linked to higher reproductive concerns ( 15 , 29 ). Financial challenges further amplified these fears, particularly among women from lower-income households who struggled with both treatment costs and providing for their families. Our qualitative findings gave voice to the profound emotional struggles behind these statistics. Many women expressed fears of being unable to fulfill their role as mothers, protect their children, or shield them from social harm—an especially heavy burden in cultures like Iran’s, where motherhood is deeply valued. Limitations from fatigue, pain, and disability, alongside financial strain, made daily caregiving feel like an impossible task. Similar challenges have been documented in other studies, emphasizing the need for broader social and healthcare support ( 30 ). Conclusion Reproductive concerns are more than just medical side effects—they touch the heart of a woman’s identity, dreams, and role as a mother. Young women with breast cancer face not only fears about their health but also worries about their future fertility, ability to care for children, and family well-being. Healthcare providers must recognize these intertwined concerns and address them holistically. This means: Creating formal support networks for young breast cancer patients Offering resources to reduce financial and emotional strain Providing clear, compassionate education about fertility preservation and caregiving support Ensuring psychological services are available, especially for women with lower socioeconomic status or limited educational backgrounds Supporting these women isn’t just about managing cancer—it’s about safeguarding their hopes, families, and futures. Declarations Ethics approval and consent to participate The study was performed in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Ardabil University of Medical Sciences, Approval No. IR.ARUMS.REC 2019.098. Written informed consent was obtained from all participants prior to inclusion in the study. Confidentiality and anonymity of data were strictly maintained. This article presents part of the findings from a large-scale research project conducted over a five-year period. Consent for publication The aim of the study was presented to the patients, and composed consent was received for publishing the paper. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by Ardabil University of Medical Sciences. Authors' contributions NF, KhI and IF conceived and designed the work; RN, SA, and EM contributed to the data Curation and reviewing the literatures; ME, IF, and FA, contributed to writing of the manuscript, NF, KhI and ME analyzed the statistical data or verified the accuracy of the tests. All authors read and approved the final manuscript. Acknowledgments The Ardabil University of Medical Sciences has provided support for this study. The authors express their gratitude to the patients who participated in the study. Additionally, the authors would like to acknowledge the valuable assistance provided by the staff at Imam Khomeini Hospital in Ardabil, Iran. References Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–85. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89. WHO. Cancer. Geneva: World Health Organization. 2022 [Available from: https://www.who.int/news-room/fact-sheets/detail/cancer Dolatkhah R, Somi MH, Jafarabadi MA, Hosseinalifam M, Sepahi S, Belalzadeh M, et al. Breast Cancer Survival and Incidence: 10 Years Cancer Registry Data in the Northwest, Iran. 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Fertility concerns and preservation in younger women with breast cancer. Crit Rev Oncol Hematol. 2010;74(3):175–92. Kuswanto CN, Stafford L, Schofield P, Sharp J. Self-compassion and parenting efficacy among mothers who are breast cancer survivors: Implications for psychological distress. J Health Psychol. 2024;29(5):425–37. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7554771","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532754550,"identity":"2c2f75a1-7c57-4b06-97e3-9a9576a1d3ec","order_by":0,"name":"Khatereh Isazadehfar","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khatereh","middleName":"","lastName":"Isazadehfar","suffix":""},{"id":532754551,"identity":"c59cfd46-eaa7-43da-8599-8cf9f6cd5e66","order_by":1,"name":"Iraj Feizi","email":"","orcid":"","institution":"Ardabil University of Medical 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ramesh","middleName":"","lastName":"Nazari","suffix":""},{"id":532754555,"identity":"67e36428-5176-4d07-9358-0f456c01e43e","order_by":5,"name":"Nasrin Fouladi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBAC9gbmBgYeAwYGfgYGNuK08BxghGiRbCBNC5BhcIBoLeyNjR/eFDDkGd9IfvbgQwWDPL/YAQJaeA42S84xYCg2u5FmbjjjDIPhzNkJ+LXYSyQ2SAP9krjtRoKZNG8bQ4LBbQJaeCQSm3+DtGyekf6NaC1tYFs2SOQQawvPwTZLoF8SZ5x5UyY544wEYb/wsDcfvvHmD0Nif3v6NokPFTby/NIEtEDBfwYGAbBKCaKUQwH/AVJUj4JRMApGwUgCADbxPzwiK661AAAAAElFTkSuQmCC","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Nasrin","middleName":"","lastName":"Fouladi","suffix":""}],"badges":[],"createdAt":"2025-09-07 07:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7554771/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7554771/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94166145,"identity":"5e7c46e6-f9ef-412d-afcf-c6ea968b2b45","added_by":"auto","created_at":"2025-10-23 06:37:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57024,"visible":true,"origin":"","legend":"","description":"","filename":"MainManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7554771/v1/f6f7ad10226b6acbe4e99d2f.docx"},{"id":94166146,"identity":"b77298b0-cff4-4b7d-9a65-2d77339a1184","added_by":"auto","created_at":"2025-10-23 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08:09:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":941012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7554771/v1/b554fcad-44d3-4e50-970c-4314183a31bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reproductivity concerns among young women with breast cancer: Living under the shadow of fear","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer remains the most common cancer among women worldwide, touching the lives of millions each year (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In 2020 alone, more than 2.26\u0026nbsp;million new cases were diagnosed globally (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While rates have stabilized or even declined in some high-income countries, developing nations\u0026mdash;including Iran\u0026mdash;have seen a concerning rise in new breast cancer cases (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Iran, breast cancer accounts for roughly 12.5% of all cancer diagnoses in women (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). What makes the situation more alarming is that women here tend to face this disease at a younger age compared to other parts of the world\u0026mdash;often 5 to 10 years earlier (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Many of these women are in the prime of their lives, building careers, raising families, or dreaming of starting one.\u003c/p\u003e\u003cp\u003eGlobally, breast cancer is the most common cancer among women of childbearing age, representing nearly half of all cancers in women aged 25 to 49 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Over 15% of breast cancer cases affect women under 40 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), many of whom have young children at home or hopes of becoming mothers in the future (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While advances in treatment have dramatically improved survival rates\u0026mdash;with more than 91% of women surviving at least five years after diagnosis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u0026mdash;the journey doesn\u0026rsquo;t end with medical treatment. The emotional, social, and reproductive impacts of breast cancer often linger, particularly for young women still in their reproductive years (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, and \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). For these women, concerns about fertility, the ability to conceive, raising children, and the health of future offspring can be overwhelming (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Many grapple with questions: Will I be able to have children? Will my illness or treatment affect my child? How do I navigate motherhood while managing my own health? In cultures like Iran\u0026rsquo;s, where motherhood and family play a central role in a woman\u0026rsquo;s identity, these concerns are even more profound. The emotional strain, paired with fears about infertility, pregnancy complications, and the health of future children, can significantly affect mental well-being and quality of life (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite these challenges, reproductive health concerns are often overlooked in cancer care. Understanding the specific fears and needs of young women with breast cancer\u0026mdash;especially within the context of Iranian society\u0026mdash;is essential for providing compassionate, comprehensive care. This study aimed to explore these concerns among young women with breast cancer in northwest Iran and to better understand both the measurable factors and the deeper, personal experiences shaping their reproductive worries.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis research combined both quantitative (descriptive analytical cross-sectional study) and qualitative approaches to capture not only the numbers but also the personal voices behind those statistics. The study was conducted in 2021 among women with breast cancer living in northwest Iran. In the first phase, 139 women under the age of 45, all diagnosed with breast cancer, took part in the survey. For the second, qualitative phase, 30 women who had completed their adjuvant treatment (such as chemotherapy, radiotherapy, or hormone therapy) and showed no signs of cancer recurrence were invited to share their personal experiences in-depth.\u003c/p\u003e\u003cp\u003eEligibility for the study included: Women under 45 years of age, diagnosed with breast cancer, willing and able to provide informed consent. Exclusion criteria were designed to reduce factors that could independently affect reproductive concerns, including: Cancer metastasis, polycystic ovary syndrome (PCOS), endometriosis, a history of infectious abortion or sexually transmitted infections (STIs), prior pelvic, uterine, or fallopian tube surgeries, uterine leiomyoma, known primary or secondary infertility, unwillingness to participate.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eQuantitative Phase:\u003c/p\u003e\u003cp\u003eParticipants completed a structured questionnaire capturing demographic details, medical history, and reproductive concerns. Reproductive concerns were assessed using the well-established Reproductive Concerns after Cancer (RCAC) scale (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), which evaluates six key areas:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eReproductive potential: Fears about being unable to conceive\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePartner disclosure: Anxiety around discussing reproductive issues with a spouse\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eChild health: Concerns about how their illness might affect existing or future children\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePersonal health: Worries about being physically able to care for a child\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAcceptance: Emotional difficulty accepting infertility\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePregnancy: Fears regarding potential pregnancy risks after cancer\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eEach question was rated on a 5-point Likert scale, with higher scores reflecting greater concern. The overall score ranged from 18 to 90, providing a broad picture of each woman\u0026rsquo;s reproductive worries. The RCAC scale\u0026rsquo;s reliability (Cronbach\u0026rsquo;s alpha\u0026thinsp;\u0026gt;\u0026thinsp;0.75) and content validity were confirmed by expert review prior to use.\u003c/p\u003e\u003cp\u003eQualitative Phase:\u003c/p\u003e\u003cp\u003eTo dive deeper into the emotional and cultural roots of these concerns\u0026mdash;especially around personal health and caregiving\u0026mdash;we conducted one-on-one, semi-structured interviews with 30 women from the initial group. Participants were encouraged to share their thoughts and feelings openly, with interviews guided by broad, open-ended questions and gentle prompts for elaboration. The conversations lasted between 45 and 90 minutes, depending on each woman\u0026rsquo;s comfort and energy levels, and were conducted at a time and place of their choosing to ensure privacy and emotional safety. All interviews were conducted by the same trained researcher, ensuring consistency. The discussions were audio-recorded, transcribed word-for-word, and analyzed until no new themes emerged\u0026mdash;a process known as data saturation.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eQuantitative data were analyzed using SPSS software (version 25), applying t-tests, logistic regression, and Fisher\u0026rsquo;s exact tests. Statistical significance was defined as a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eQualitative data were analyzed using conventional content analysis, following the framework established by Graneheim and Lundman (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Through careful coding and categorization, we identified recurring themes that reflected the women\u0026rsquo;s lived experiences and cultural context.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe study received ethical approval from the Ardabil University of Medical Sciences Ethics Committee (Approval Code: IR.ARUMS.REC.2019.098). Participation was entirely voluntary, and women were free to withdraw at any time without consequences. All participants provided written informed consent, and their privacy and confidentiality were fully protected throughout the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe women in this study were between 18 and 45 years old, with an average age of 37.5 years. Most (67.6%) had one or two children, while 9.4% had no children. For mothers, the youngest child was, on average, just over five years old\u0026mdash;highlighting how many participants were still raising very young children while facing breast cancer.\u003c/p\u003e\u003cp\u003eFinancial strain was common. More than half of the women reported that their household income was insufficient to meet basic living needs. Self-rated health was also concerning, with nearly half (47.5%) describing their health as poor. The average age at breast cancer diagnosis was 34.9 years\u0026mdash;meaning many were diagnosed during the prime of their reproductive years. In terms of treatment, two-thirds (65.5%) underwent lumpectomy, while the most common additional therapy was a combination of chemotherapy and radiotherapy (39%). The overall level of reproductive concerns among participants was moderate to high, with an average score of 48.5 out of a possible 75. Women who received more intensive treatments, such as chemotherapy, reported significantly higher levels of reproductive worry, while employed women tended to report fewer concerns (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eDistribution and Mean score of perceived reproductivity concerns in terms of demographic variables and disease-related variables in patients with breast cancer\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\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%) /Mean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (12.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (45.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at the time of diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary and secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84(60.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePartner level of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary and secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNumber of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithout child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c6\" namest=\"c5\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJob\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousekeeper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128 (92.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccupied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMenstrual status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMenstrual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMenopause\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003ePrevention method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNatural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (48.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c6\" namest=\"c5\" rowspan=\"5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLD Tablet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIUD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCondom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (16.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eDiagnosis stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLocal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104 (74.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdvanced localization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMetastatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eType of surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLumpectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.15\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c6\" namest=\"c5\" rowspan=\"4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnilateral mastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eAdjuvant therapies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (28.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (71.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c6\" namest=\"c5\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChemotherapy\u0026thinsp;+\u0026thinsp;Radiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChemotherapy\u0026thinsp;+\u0026thinsp;Radiotherapy\u0026thinsp;+\u0026thinsp;Hormonotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChemotherapy\u0026thinsp;+\u0026thinsp;Hormonotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdequacy of income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72 (51.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.28\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.29\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eToo much need\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePatients' self-assessment of their level of health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eLD\u003c/b\u003e: Low-Dose Birth Control, \u003cb\u003eIUD\u003c/b\u003e: Intrauterine Device\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe most significant worries centered on \u0026ldquo;personal health\u0026rdquo;, followed by concerns about fertility and child health. The area of least concern involved disclosing reproductive issues to partners. Importantly, women with higher education levels, as well as those whose partners had more education, expressed fewer personal health concerns\u0026mdash;possibly reflecting better access to health information and resources. (Respectively (P\u0026thinsp;=\u0026thinsp;0.049) (P\u0026thinsp;=\u0026thinsp;0.048))\u003c/p\u003e\u003cp\u003eHaving children also influenced reproductive concerns. Women with more children reported lower levels of worry about fertility and acceptance, while childless women reported the highest levels of concern in these areas (P\u0026thinsp;=\u0026thinsp;0.02 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eComparison of patients' mean scores in the six dimensions of perceived reproductivity concerns in terms of some variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReproductivity potential\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisclosing the problem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChild health\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePersonal health\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAcceptance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBecoming pregnant\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score in subscales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57/1\u0026rlm;\u0026plusmn;\u0026rlm;60/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58/1\u0026rlm;\u0026plusmn;\u0026rlm;22/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63/2\u0026rlm;\u0026plusmn;\u0026rlm;55/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95/1\u0026rlm;\u0026plusmn;\u0026rlm;97/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e72/1\u0026rlm;\u0026plusmn;\u0026rlm;57/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e48/1\u0026rlm;\u0026plusmn;\u0026rlm;59/7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNumber of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eWithout child\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u0026ndash;2 child\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;3 child\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdjuvant therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eyes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eno\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.24\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAdequacy of income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eInadequate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eenough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThose who underwent comprehensive treatment (surgery, chemotherapy, radiotherapy, and hormone therapy) were significantly more concerned about both their own health (P\u0026thinsp;=\u0026thinsp;0.001) and their children\u0026rsquo;s health (P\u0026thinsp;=\u0026thinsp;0.008). Higher income was associated with fewer personal health concerns (P\u0026thinsp;=\u0026thinsp;0.025). When asked directly, 61.6% of women identified infertility as their biggest fear, followed closely by the fear of not being able to care for their children (47.4%).\u003c/p\u003e\u003cp\u003eRegression analysis revealed that younger age, the age of the youngest child, and age at diagnosis were significant predictors of reproductive concerns (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003epredictive factors of reproductivity concerns in patients with breast cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSig.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExp(B)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.792\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHusband education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMenstrual status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.764\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.681\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLast child age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreastfeeding history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCancer stage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.157\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the second phase, qualitative interviews provided deeper insight into these fears. Two major themes emerged:\u003c/p\u003e\u003cp\u003e\u003cb\u003e1. Living under the Shadow of Fear\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWomen described overwhelming anxiety about their children\u0026rsquo;s future, their own health, and their ability to protect and raise their children. Common worries included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFears of not being present to raise their children due to illness or death\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFeeling inadequate as a mother\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAnxiety about their children\u0026rsquo;s social well-being and safety\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePatient Voices:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI\u0026rsquo;m always worried I\u0026rsquo;ll be so consumed by my illness that I won\u0026rsquo;t raise my children properly, and they\u0026rsquo;ll grow up alone.\u003c/p\u003e\u003cp\u003eIf I were healthy, I could meet their needs, but I just can\u0026rsquo;t anymore.\u003c/p\u003e\u003cp\u003eMy illness isolates us. I can\u0026rsquo;t take my daughter to parties or outside much.\u003c/p\u003e\u003cp\u003eI feel guilty that my illness interferes with raising my children.\u003c/p\u003e\u003cp\u003eI\u0026rsquo;m afraid I might die, and my children will end up with a stepmother.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese fears contributed to feelings of being an inadequate mother, unable to protect or nurture their children as they desired.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Restrictions and Financial Strain\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDisease-related fatigue, pain, and disability\u0026mdash;especially after surgery\u0026mdash;made daily caregiving difficult. Additionally, many women described the financial burden of treatment draining household resources, making it even harder to care for their families.\u003c/p\u003e\u003cp\u003ePatient Voices:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI want to hug my daughter and take her out, but my hands won\u0026rsquo;t let me.\u003c/p\u003e\u003cp\u003eI get tired so quickly\u0026mdash;I can\u0026rsquo;t cook or play with them like before.\u003c/p\u003e\u003cp\u003eMost of our money goes toward my treatment.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese physical and financial limitations left many women feeling powerless to meet their children\u0026rsquo;s needs, deepening their concerns about motherhood and family life (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCategorizing the roots of personal health concerns\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubcategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBasic concepts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eLiving under shadow of fear\u003c/p\u003e\u003cp\u003e(perceived fears and negative emotions)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eFear concerning the uncertain future prospects of their children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eThe apprehension of potential physical separation from their child due to their illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBeing separated from children due to necessary treatment follow-up\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe mother's concern about her children living with a stepmother\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe mother's fear of her children becoming motherless\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFear of hereditary cancer risk\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eThe mental strain induced by the costs of treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe mother's discomfort due to not being able to meet her children's welfare needs because of medical expenses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFeeling pressured to support the family financially while undergoing treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExperiencing adverse sentiments regarding one's role as a mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe perception that a mother cannot fulfill her maternal role\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDrawing comparisons between one's physical health and that of healthy mothers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eRestrictions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003ePhysical disability and its limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eThe inability to care for and protect children due to physical limitations resulting from illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInability to use the hand on the side of mastectomy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePain in the arm on the side of the mastectomy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEdema in the arm on the mastectomy side\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInability to carry the child with the hand\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInterference of disease follow-up with children's care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResource limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFinancial difficulties stemming from medical expenses impacting the care of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003emost of our income are spent on my treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAbsence of cohesive support systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInability to provide an optimal caregiving environment for children\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFor young women, a breast cancer diagnosis can feel like life stops\u0026mdash;and for many, fears about fertility, parenting, and their children\u0026rsquo;s future quickly rise to the surface. Our study reflects these deeply personal concerns, with reproductive worries reported at moderate to high levels.The greatest anxieties focused on personal health, reproductive potential, and child health, echoing findings from Sweden, Portugal, and other studies (\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Women who have not yet started or completed their families often experience heightened fears about fertility loss (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which can worsen depression (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and diminish quality of life (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEducation played a protective role. Women with higher levels of education, and those with educated partners, reported fewer personal health worries\u0026mdash;possibly due to better understanding of treatment options (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), improved self-care, and greater access to resources (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The number of children also influenced reproductive concerns. Women without children or with fewer children reported more intense worries about fertility and social acceptance, consistent with previous studies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The innate desire to become a mother\u0026mdash;or to expand one\u0026rsquo;s family\u0026mdash;makes the threat of infertility especially distressing (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). It has been shown that the unfulfilled desire to become a parent is associated with mental health disorders (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Intensive treatments like chemotherapy and radiotherapy, known for their potential to harm fertility, were linked to higher reproductive concerns (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Financial challenges further amplified these fears, particularly among women from lower-income households who struggled with both treatment costs and providing for their families.\u003c/p\u003e\u003cp\u003eOur qualitative findings gave voice to the profound emotional struggles behind these statistics. Many women expressed fears of being unable to fulfill their role as mothers, protect their children, or shield them from social harm\u0026mdash;an especially heavy burden in cultures like Iran\u0026rsquo;s, where motherhood is deeply valued. Limitations from fatigue, pain, and disability, alongside financial strain, made daily caregiving feel like an impossible task. Similar challenges have been documented in other studies, emphasizing the need for broader social and healthcare support (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eReproductive concerns are more than just medical side effects\u0026mdash;they touch the heart of a woman\u0026rsquo;s identity, dreams, and role as a mother. Young women with breast cancer face not only fears about their health but also worries about their future fertility, ability to care for children, and family well-being. Healthcare providers must recognize these intertwined concerns and address them holistically. This means:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCreating formal support networks for young breast cancer patients\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOffering resources to reduce financial and emotional strain\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eProviding clear, compassionate education about fertility preservation and caregiving support\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEnsuring psychological services are available, especially for women with lower socioeconomic status or limited educational backgrounds\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eSupporting these women isn\u0026rsquo;t just about managing cancer\u0026mdash;it\u0026rsquo;s about safeguarding their hopes, families, and futures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Ardabil University of Medical Sciences, Approval No. IR.ARUMS.REC 2019.098. Written informed consent was obtained from all participants prior to inclusion in the study. Confidentiality and anonymity of data were strictly maintained. This article presents part of the findings from a large-scale research project conducted over a five-year period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of the study was presented to the patients, and composed consent was received for publishing the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Ardabil University of Medical Sciences. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNF, KhI and IF conceived and designed the work; RN, SA, and EM contributed to the data Curation and reviewing the literatures; ME, IF, and FA, contributed to\u0026nbsp;writing of the manuscript, NF, KhI and ME analyzed the statistical data or verified the accuracy of the tests.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ardabil University of Medical Sciences has provided support for this study. The authors express their gratitude to the patients who participated in the study. Additionally, the authors would like to acknowledge the valuable assistance provided by the staff at Imam Khomeini Hospital in Ardabil, Iran.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMiller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Cancer. 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Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Support Care Cancer. 2014;22(10):2805\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCanada AL, Schover LR. The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology. 2012;21(2):134\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan den Berg M, Baysal O, Nelen W, Braat DDM, Beerendonk CCM, Hermens R. Professionals' barriers in female oncofertility care and strategies for improvement. Hum Reprod. 2019;34(6):1074\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnchan RM, Ginsburg ES. Fertility concerns and preservation in younger women with breast cancer. Crit Rev Oncol Hematol. 2010;74(3):175\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuswanto CN, Stafford L, Schofield P, Sharp J. Self-compassion and parenting efficacy among mothers who are breast cancer survivors: Implications for psychological distress. J Health Psychol. 2024;29(5):425\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast Cancer, Reproductive Concerns, Young Women, Personal Health, Iran","lastPublishedDoi":"10.21203/rs.3.rs-7554771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7554771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFacing breast cancer at a young age brings many challenges, and reproductive concerns are often among the most distressing. For women diagnosed during their childbearing years, questions about fertility, future pregnancies, and the health of their children can significantly affect emotional well-being. Understanding the nature, severity, and cultural roots of these concerns is essential for offering meaningful support to patients and their families.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis quantitative and qualitative study was conducted in 2021 in northwest Iran. A descriptive, analytical, cross-sectional survey was followed by a qualitative exploration of personal experiences. The quantitative phase included 139 women under the age of 45 diagnosed with breast cancer. For the qualitative phase, 30 women who had completed cancer treatment and were willing to share their experiences were selected using purposive sampling. Quantitative data were analyzed using SPSS version 25 with a 95% confidence level, while qualitative data were examined through conventional content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe average age of participants was 37.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95 years. The overall mean score for perceived reproductive concerns was 48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6, indicating moderate to high levels of concern. Women who had undergone complementary therapies such as chemotherapy or radiotherapy reported significantly higher concern levels (mean score: 45.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5). Concerns related to personal health\u0026mdash;the ability to care for themselves and their children\u0026mdash;ranked the highest. Through qualitative interviews, two major themes emerged as the root causes of these worries: Living under the shadow of fear and Restrictions linked to illness, treatment, and financial strain.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eYoung women with breast cancer face considerable reproductive concerns, with personal health standing out as their greatest source of anxiety. Tailored, culturally sensitive education and support programs are urgently needed to help patients and their families cope with these challenges and maintain hope for the future.\u003c/p\u003e","manuscriptTitle":"Reproductivity concerns among young women with breast cancer: Living under the shadow of fear","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 06:37:53","doi":"10.21203/rs.3.rs-7554771/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"44fb3854-25d5-4320-aeba-afbd1dc83300","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T08:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 06:37:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7554771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7554771","identity":"rs-7554771","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}