Association Between Mindfulness and Perceived Stress Among Breast Cancer Patients in Saudi Arabia

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Asiri, Ahmad Aboshaiqah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7371670/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Objectives: The perceived stress experienced by women with breast cancer in Saudi Arabia is a significant concern. Mindfulness can effectively reduce levels of perceived stress. However, the specific relationship between mindfulness practices and perceived stress among breast cancer patients in Saudi Arabia has not been thoroughly explored. This study aims to investigate the relationship between mindfulness practices and stress levels within women with breast cancer in Saudi Arabia. Method: A total of 152 women from Saudi Arabia who were diagnosed with breast cancer participated in the study, all of whom received care at a hospital located in Dammam, Eastern Province, and were selected through convenience sampling. Data collection was conducted from January to May 2025, utilizing a sociodemographic questionnaire in conjunction with the validated Perceived Stress Scale and the Cognitive and Affective Mindfulness Scale. Results: The level of perceived stress was average (Mean = 16.2, SD = 7), while mindfulness levels were also average (Mean = 34.5, SD = 5.5). The two variables exhibited a significant, strong negative correlation (r = -0.53, p < .001). Conclusion: The study's findings highlight the essential connection between perceived stress and mindfulness among breast cancer patients in Saudi Arabia. These insights can inform nurses and healthcare professionals as they implement targeted interventions that incorporate mindfulness practices, considering the cultural nuances of Saudi Arabia. Ultimately, this approach aims to reduce stress levels and enhance patients' overall well-being. Clinical trial number: not applicable. Breast cancer Cross-Sectional Studies Mindfulness Perceived Stress Saudi Arabia Background Breast cancer is a worldwide health concern. It is reported as the most common form of cancer among women and the second leading cause of death globally. The incidence of breast cancer is increasing dramatically each year. According to the World Health Organization, a report estimated that 2.3 million cases of breast cancer were diagnosed in 2022, and 670,000 deaths globally from a report that included 152 countries around the globe 1 . In Saudi Arabia, from 1990 to 2021, there were a reported 77,513 cases of female breast cancer, which resulted in 19,440 deaths 2 . Breast cancer treatment encompasses a range of therapeutic modalities internationally and in Saudi Arabia, including radiation therapy, chemotherapy, immunotherapy, hormonal therapy, and various surgical interventions. The choice and combination of these treatments are tailored to the specific stage and subtype of the tumor, allowing for a personalized approach to care. Each therapeutic option plays a critical role in managing the disease and can be utilized in sequence or in conjunction with others to optimize patient outcomes 3 , 4 . Treatment for breast cancer typically leads to a variety of side effects that can significantly impact individuals on multiple levels. These effects may manifest physically, such as fatigue, pain, and changes in appearance, as well as mentally and psychologically, contributing to anxiety, depression, and alterations in self-esteem 5 , 6 . According to different studies around the world, patients diagnosed with breast cancer frequently report heightened levels of perceived stress both at the time of diagnosis and throughout their treatment journey 7 , 8 . Perceived stress refers to how a person interprets the level of stress they experience over a certain time frame 9 . In Saudi Arabia, women diagnosed with breast cancer exhibit a high prevalence of psychological distress, including symptoms of depression, anxiety, and fear. Furthermore, they endure considerable psychological repercussions stemming from delayed diagnoses and insufficient social support systems 10 . Stress among women with breast cancer can stem from multiple sources, including worries about the disease prognosis, potential side effects of treatment, and the broader implications for their quality of life 11 . It is essential to address these concerns to enhance patients' well-being and improve the overall experience throughout their treatment journey. Understanding the psychological dimensions of patient care is crucial for delivering comprehensive support and fostering healing. Numerous studies have explored the relationship between mindfulness and perceived stress across various populations, countries, cultural backgrounds, and occupations 12 – 15 . For instance, McBride et al. reported that students with higher levels of mindfulness tend to report lower levels of stress 15 . Another study was conducted among Japanese military soldiers that addressed the negative association between mindfulness and perceived stress 14 . In their research, Borghi et al. explored the complex relationship between mindfulness and perceived stress among students and community groups. They discovered that mindfulness could either have a positive association with perceived stress or that perceived stress might negatively affect an individual's ability to maintain mindfulness in everyday situations 13 . A study conducted in the United Kingdom enrolled the adult population and found that their mindfulness significantly lowered the level of perceived stress 12 . Effective strategies for managing this stress can lead to improved treatment adherence and outcomes, ultimately fostering a more supportive healthcare environment 16 Numerous studies conducted in Arabic-speaking countries, including Saudi Arabia, have examined the psychological experiences of breast cancer patients. For instance, a phenomenological study revealed that psychological distress significantly affects the daily functioning and overall quality of life of these patients 10 . Additionally, a thematic synthesis, involving 11 Arabic countries, including Saudi Arabia, and explored the multidimensional experiences of breast cancer patients from diagnosis through their treatment. This synthesis also highlighted psychological aspects, such as anxiety experienced during this period 17 . This emphasizes the importance of addressing mental health alongside physical health in cancer care, particularly in culturally specific contexts. Moreover, in Saudi Arabia, the experience of breast cancer is profoundly shaped by cultural, religious, and social factors that influence patients’ perceptions and coping mechanisms. Many Saudi women interpret their illness through an Islamic perspective, viewing cancer as a test or trial from God. This interpretation can promote spiritual acceptance and resilience; however, it may also contribute to internalized stigma and emotional distress 18 , 19 . The support of family and community is crucial for psychological adjustment, yet misconceptions and stigmatization surrounding cancer persist, which can adversely affect mental health and overall quality of life 19 , 20 . In Saudi Arabia, numerous breast cancer patients face considerable psychological distress, which adversely affects their quality of life and daily functioning. Recognizing these cultural nuances is crucial for developing effective tailored psychosocial interventions and ensuring that mindfulness-based programs are tailored to the specific needs of Saudi breast cancer patients 18 – 20 . While global research supports the efficacy of mindfulness as a means to reduce stress in cancer care 21 – 23 , there exists a notable shortage of quantitative studies that specifically investigate the relationship between mindfulness practices and perceived stress levels among breast cancer patients in Saudi Arabia. This gap underscores the necessity for targeted research to investigate how mindfulness correlates with perceived stress within this demographic, potentially improving psychological well-being and overall treatment outcomes for breast cancer patients in the region. This study aims to investigate the relationship between mindfulness and perceived stress levels in breast cancer patients in Saudi Arabia. To achieve this, the study focused on the following objectives: (a) to assess the level of mindfulness among the participants, (b) to evaluate the level of perceived stress among the participants, and (c) to explore the connection between mindfulness and perceived stress among breast cancer patients in Saudi Arabia. Methods This research employed a cross-sectional study design with a correlational approach, which was deemed suitable for achieving the research objectives. The study was conducted at a cancer treatment facility located in the Eastern Province of Dammam, Saudi Arabia. Sample All patients, aged 18 or older, who validated their primary diagnosis of breast cancer through their medical records, any cancer therapeutic plan, and consented to participate, were included in the study. We excluded individuals diagnosed with mental illness or those who had a do-not-resuscitate order in place. The required sample size for this study was determined using an a priori power analysis conducted in G*Power. Assuming a medium effect size (r = 0.3), a significance level of α = 0.05, and a desired statistical power of 0.80 for a two-tailed test, the analysis indicated that a minimum of 138 participants is necessary to detect a significant correlation between mindfulness and perceived stress reliably 24 . A total of 152 participants were included in the study, accounting for 10% incomplete data or non-response 25 . Measurements The data collection for this study includes several components: socio-demographic information, the Cohen’s Perceived Stress Scale (PSS), and the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). The questionnaire utilized is in Arabic, and permission has been obtained from the primary authors to use these measures. Socio-demographic Characteristics The researcher created this Arabic questionnaire, which gathers information about the participants’ attributes such as age, marital status, number of children, educational background, employment status, duration of cancer diagnosis, cancer stage, type of surgery performed, and whether they have participated in any relaxation or meditation techniques, allowing them to specify a name from the provided options or to write in another strategy if it’s not listed in the form. The Cohen’s Perceived Stress Scale (PSS) The Perceived Stress Scale (PSS) is designed to evaluate individuals' perceptions of stress and feelings of lack of control in various life situations over the past month. It comprises 10 items graded on a five-point Likert scale, where zero represents "never" and four signifies "very often." Items are reverse scored (0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0). The overall score is obtained by summing all items after adjusting for the positively phrased items 4,5,7, and 8. The total score ranges from zero to 40; a higher total score indicates a greater level of perceived stress. 0–13: low, 14–26: moderate, and 27–40: high stress 26 . The Arabic version of this scale demonstrates sufficient concurrent and convergent validity. Furthermore, the internal consistency of the PSS-10 along with its positive and negative subscales was found to be satisfactory (coefficient α = 0.67, 0.79, and 0.86, respectively) 27 . The PSS-10 is a suitable instrument for assessing perceived stress among breast cancer patients and could help in identifying women who are at risk for psychological difficulties 28 . Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) The Cognitive and Affective Mindfulness Scale is designed to assess attention, awareness, and the non-judgmental acceptance of present-focused thoughts and emotions, independent of meditation practices. As a 12-item instrument utilizing a four-point Likert scale, responses range from 1 (never/rarely) to 4 (always). The total score is computed after reversing items 2,6, and 7. Items are reverse-scored (1 = 4, 2, = 3, 3 = 2,4 = 1). The score ranges between 12 and 48; a higher score indicates greater mindfulness. This scale exhibits excellent internal consistency with high Cronbach’s Alpha values of 0.875 for the exploratory sample and 0.862 for the confirmatory sample. Additionally, it has demonstrated good convergent and discriminant validity 29 . The CAMS-R scale has proven to be valuable in numerous studies, especially involving women with breast cancer. This underscores its significance and suitability for this demographic, offering meaningful insights into their distinct psychological and emotional requirements. Its application in research emphasizes the need to comprehend the experiences and difficulties encountered by these patients, which can lead to enhanced support and care strategies 30 . Procedure Following approval by the Institutional Review Board (IRB), the researcher outlined the data collection process to the internal investigators from the study site, who had obtained their ethical clearance certificates before the start of data collection. The internal investigators recruited participants from both the outpatient and inpatient departments using convenience sampling, clearly explaining the study and its objectives to the participants. Eligible participants who expressed a willingness to take part were asked to sign a consent form before completing the study’s paper-based self-administered questionnaire. The data collection lasted for an average of 10 minutes for each participant. The study acknowledges that its cross-sectional design, reliance on a single center, and use of convenience sampling limit its ability to establish causal relationships and may introduce specific biases. However, the researchers implemented several strategies to address and mitigate these potential biases throughout the research process. This includes careful selection of the sample and thorough data collection methods. Data collection was conducted by qualified oncology nurses who are actively engaged in patient care and given training to enable them to collect data, thereby enhancing their understanding of the context and improving the quality of the data. To bolster construct validity, standardized and previously validated assessment tools for both mindfulness and perceived stress—previously used in populations with breast cancer—were applied 28 , 31 . Reliability analyses were performed to verify the internal consistency of the study sample. To further reduce discrepancies or errors in data entry, the principal investigator maintained continuous communication and followed up with the data collectors during the data collection phase. Data Analysis This study utilized IBM SPSS Statistics version 30 for data analysis. Missing data was evaluated and addressed appropriately, depending on the severity and type of missing information. Descriptive statistics were performed to assess both the sample characteristics and the study variables. For categorical variables, the analysis focused on the number and percentage, while for continuous variables, the mean, median, and standard deviation were calculated. The normality of the distribution was determined based on Skewness (Sk) and Kurtosis (Ku). Specifically, an absolute skewness value exceeding two or an absolute kurtosis value greater than 7 indicates significant non-normality 32 . Moreover, two-sided p-values of less than 0.05 were considered statistically significant. The reliability of the measurement scales was assessed through the examination of internal consistency. A Cronbach's alpha value of 0.7 or greater is generally considered to demonstrate acceptable internal consistency, ensuring that the items within the scale reliably measure the same underlying construct 33 . This evaluation is crucial for validating the effectiveness of the measurement tools employed in research. The relationship between mindfulness and perceived stress was analyzed using Pearson's correlation coefficient, after verifying the normality assumptions. A correlation coefficient between .5 and 1 indicates a strong association, while coefficients of .29 or below suggest a weak association 34 . This statistical method enables researchers to quantify the extent to which increases in mindfulness are correlated with decreases in perceived stress levels. Ethical Considerations The researchers obtained Institutional Review Board (IRB) approval for the study setting under the number EXT0449. Participants were given a detailed written and verbal explanation of the study's purpose. They were assured that their participation was entirely voluntary, that they could withdraw at any time without affecting the care and treatment they received, and that their confidentiality would be strictly maintained, as no identifying information was collected. The researcher secured both verbal and written consent, requiring participants to sign a form before completing the questionnaire. The completed questionnaires were stored in a secure locker accessible only to the research team, and they will be retained for two years. Results The missing data were addressed in SPSS through pairwise deletion, meaning that participants with incomplete responses were only omitted from analyses related to the missing scale. One participant did not provide data for one of the scales in the questionnaire. Table 1 presents the descriptive statistics for the study participants and the variables examined. The average age of the participants was 48 years, with a standard deviation of 9.86 (ranging from 29 to 70 years). We divided the age into four categories: 29-40, 41-50, 51-60, and 61-70. The largest group of participants fell within the 41-50 age range, comprising 56 individuals (36.8%), followed by the 29-40 group with 39 participants (25.7%). The 51-60 age bracket included 35 individuals (23%), while the smallest group, 61-70, consisted of 22 participants (14.5%). In terms of education levels, the majority of participants held a bachelor’s degree, totaling 52 individuals (35.2%). This was followed by 38 participants (25%) who completed high school. Additionally, 22 individuals (15.5%) had received primary education, while 16 participants (10.5%) obtained a diploma. Three individuals (2%) achieved a master’s degree, and six participants (3.9%) had no formal education. Notably, one participant (0.7%) earned her doctorate degree, while another individual (0.7%) reported an alternative level of education (Table 1). Regarding marital status, most participants were married, comprising 113 women (74.3%). Additionally, 19 women (12.5%) identified as single, 12 participants (7.9%) were widowed, and only eight women (5.3%) were divorced. Furthermore, 120 participants (78.8%) reported having children. In terms of employment, most participants were unemployed. Among those who were working, 33 individuals (21.7%) reported working more than 20 hours per week, while only 7 participants (4.7%) worked less than 20 hours per week (Table 1). In terms of cancer staging, a significant number of women are unaware of their specific stage, with 45 (29.6%) reporting this uncertainty. Among those who do know, many are at stage two and stage three, with 35 (23%) and 34 (22.4%) respectively. Additionally, 28 women (18.4%) are classified as stage one, while 10 (6.6%) are at stage four (see Table 1). During the study period, the participants received various forms of breast cancer therapy. Approximately half of the participants underwent chemotherapy, totaling 71 individuals (46.7%). Surgical procedures were performed on 52 participants (34.2%), while 17 individuals (11.2%) received hormonal therapy. Additionally, 8 participants (5.3%) underwent radiotherapy sessions, and a small cohort of 4 individuals (2.6%) was treated with more than one type of therapy. This distribution highlights the diverse therapeutic approaches employed in managing breast cancer among the study cohort. However, a total of 106 (69.7%) have undergone breast cancer surgical operation since they were diagnosed with cancer; of these, 78(51.3%) had their surgeries in less than six months’ time from the study. The participants had variable breast surgical procedures. 48(31.6%) had complete mastectomy, 26(17.1%) underwent partial mastectomy, 11(7.2%) performed nipple sparing, only 2(1.3%) had breast reconstruction. Other women, 15 (9.9%), had undergone more than one surgical operation. However, the minority of 4 (2.6%) are unsure or do not know the specific surgery they had. Noticeably, only 17(11.2%) of the breast cancer patients have another form of cancer. Table 1. Overview of Participant Characteristics and Study Variables (n = 152) characteristics Range Mean Median SD N(%) Sk Ku Age 29-70 48.30 48 9.86 .17 _.66 Age categories 29-40 39(25.7) 41-50 56(36.8) 51-60 35(23) 61-70 22(14.5) Total PSS 0-31 16.2 17 7 _.02 _.8 Total CAMS-R 21-46 34.5 34 5.5 .03 _.4 Time of diagnosis/months 1-300 27 12 46.5 3.5 13.8 Educational Level Not educated 6(3.9) Primary school 22(14.5) Secondary school 13(8.6) High school 38(25) Diploma 16(10.5) Bachelor 52(35.2) Master 3(2) Doctorate 1(.7) Other 1(.7) Marital status Single (not married before) 19(12.5) Married 113(74.3) Widow 12(7.9) Divorce/separated 8(5.3) Having children Yes 120(78.9) No 32(21.1) Working hours/week Less than 20 hours/week 7(4.7) More than 20 hours/week 33(21.7) Not working (not an employee) 112(73.7) Stage of breast cancer Stage one 28(18.4) Stage two 34(22.4) Stage three 35(23) Stage four 10(6.6) Do not know 45(29.6) Type of the current therapy Chemotherapy 71(46.7) Radiotherapy 8(5.3) Surgical 52(34.2) Hormonal 17(11.2) More than one therapy 4(2.6) Underwent surgery since was diagnosed Yes 106(69.7) No 46(30.3) Time of breast cancer surgery Less than six months 78(51.3) More than six months 28(18.4) No surgery 46(30.2) Type of breast cancer surgery Complete mastectomy 48(31.6) Partial mastectomy 26(17.1) Breast reconstruction 2(1.3) Nipple sparing 11(7.2) Not sure or do not know 4(2.6) More than one surgery 15(9.9) No breast cancer surgery 46(30.3) Having another type of cancer Yes 17(11.2) No 135(88.8) Note . Continuous variables are presented as mean ± standard deviation, while categorical variables are shown as frequency (%). Regarding the study variables. The perceived stress, Sk=_.02, and. The average level of perceived stress is 16.2, SD=7(0-31), indicating a moderate level of perceived stress 26 . Regarding the mindfulness, the mean score was 34.5, SD=5.5 (21-46), Sk=.03 and Ku=-.4. Both scales indicated normal distribution 32 . The reliability of the scales was assessed with a good reliability for the PSS, Cronbach’s alpha a=.82, while it was marginally below the acceptable level for the CAMS-R scale, a=.69 (Table 2). Table 2 . The Reliability of the Study Measurements The scale Cronbach alpha N of items Perceived Stress Scale .82 10 Cognitive Affective Mindfulness Scale .69 12 Note. This table presents the internal consistency of the perceived stress scale and the cognitive and affective mindfulness scale, indicated by Cronbach’s alpha. In assessing the relationship between mindfulness and perceived stress, both variables were continuous and followed a normal distribution. Consequently, we utilized Pearson correlation to evaluate the association between perceived stress and mindfulness among women who have been diagnosed with breast cancer. Table 3 illustrates the relationship between these study variables, demonstrating a significant, strong negative correlation between mindfulness and perceived stress, with r = -0.53, P < 0.00 34 . This indicates that as mindfulness increases, the participants’ levels of perceived stress decrease. Table 3. The correlation between Perceived Stress and Mindfulness Mindfulness Perceived Stress Pearson correlation _.53** Sig. (2 tailed) <.001 N 151 ** Correlation is significant at the 0.01 level (2-tailed) Note. The relationship between Perceived Stress and Mindfulness is presented by Pearson correlation Discussion This study aimed to examine the association between perceived stress and mindfulness among 152 women with breast cancer in Saudi Arabia. Table 1 presents the descriptive statistics for the sample characteristics and study variables. In this study, the mean age of participants was 48 years, with a range from 29 to 70 years. Notably, a significant proportion of patients, 36.8%, fell within the 41- to 50-year-old age bracket. This finding aligns with the research conducted by Alagizy et al. in Egypt, which reported a mean age of 52.29 years, with a range of 30 to 75 years 7 . Additionally, the results are supported by Ng et al., who noted that the majority of patients were in the 41–60-year age group, followed by those in the 20–40-year category 35 . The age distribution aligns with both regional and international statistics, highlighting the sample's representativeness for middle-aged patients with breast cancer. Our study found that a significant number of participants were not employees, 73.7%, which is consistent with an extensive cohort study that reported that about half of the participants, 46%, experienced job disruptions after they had been diagnosed with breast cancer 36 . This finding was additionally supported by a systematic review and meta-analysis showing that cancer and related treatment contribute to an increased risk of unemployment, with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32–2.63) or a change in employment status 37 . In contrast, a previous cross-sectional study reported that only 18% of their participants had no jobs 38 . Also, another study reported that 95.8% of women were not working 39 . We found that 78.9% of the participants were married, and the same percentage of participants had children, 78.4%. Additionally, a separate study indicated that approximately 70% of breast cancer patients were married 40 , while another study reported marriage proportions ranging from 52–55% 40,41 . Variations in marital status can reveal demographic, cultural, and regional differences among study groups. Regarding educational level, our participants held a bachelor’s degree, while a minority (35.2%) had not received formal education, and only 4 participants had higher education, including master's and doctoral degrees. Alagizy et al. conducted a study revealing that only 4.7% of participants possessed a high level of education, which aligns with our findings. However, their results contradict ours, as they reported that 50% of participants had no education 7 . Regarding the duration of breast cancer diagnosis, the median time from diagnosis was recorded at 12 months, while the standard deviation was notably large at 46.5 months, with a range from 1 to 300 months. In terms of cancer staging, 69% of participants are categorized at stage two or stage three. Notably, a considerable proportion of women, 26.9%, reported that they are unaware of their cancer stage. This finding is consistent with Alagizy et al., who noted that 75% of their participants were also at stage three or two 7 . Also, a separate study reported that the majority of participants, 76%, are at stages two and three of breast cancer 41 . In contrast to our results, an earlier study suggested that all participants were in stage four. This discrepancy can be attributed to the inclusion of patients in the metastatic stage of cancer 42 . The investigation revealed that a significant 69.7% of participants underwent surgical interventions following their diagnosis. Additionally, the treatment modalities employed during the study period predominantly included chemotherapy and surgery, with administration rates of 46.7% and 34.2%, respectively. This finding was supported by a previous study, which reported that most of the participants have been treated with surgical therapy 80% and chemotherapy 48% 43 . Similar findings were reported in a cross-sectional study where 48.6% of participants were receiving chemotherapy 38 . In contrast, another study indicated that only 6.3% of women underwent surgery without any additional treatment, while 44.2% had surgery in conjunction with chemotherapy 44 . Furthermore, a separate study revealed that all participants had undergone surgery; of those, 94% received radiotherapy, and 61% received chemotherapy since their diagnosis 45 . It is important to note that this study specifically focused on the treatments that the women were receiving at the time of the study. These results underscore the variations in treatment approaches across different populations and emphasize the importance of considering local clinical practices and patient characteristics when evaluating treatment trends. In this study, the median time from breast cancer diagnosis was found to be 12 months, with a wide standard deviation of 46.5 months (ranging from 1 to 300 months). This finding aligns with the results reported by a study, which indicated an average diagnosis time of 31.84 months 38 . Similarly, in a different randomized controlled trial, corroborated this finding, reporting a mean diagnosis duration of 27 months for the intervention group. In contrast, the same study noted a significant difference in the control group, which had an average diagnosis duration of just 14.8 months 46 . In the context of the scales’ reliability, the Cronbach’s alpha of the CAMS-R scale, while slightly below the conventional threshold of 0.70 33 , demonstrates adequate internal consistency for research purposes. Future research endeavors might explore the possibility of revising or expanding the scale to enhance its reliability. This approach could contribute to more robust findings and a deeper understanding of the constructs being measured. This study found that breast cancer patients reported a moderate level of stress, with an average score of 16.1, with a range between 0 and 31, with a standard deviation of 7. In contrast, previous studies indicated an average perceived stress level of 18.95, with a standard deviation of 11.24 38 . Another study showed that 24.8% of the population experienced stress, with only 2.4% reporting moderate stress, while the majority expressed mild stress at a rate of 21.87% 39 . These discrepancies may be attributed to variations in the stress measurement scales used. In terms of mindfulness, the participants demonstrated a moderate level, with a mean score of 34.5 and a standard deviation of 5.5 (ranging from 21 to 46). This finding aligns closely with a previous study that reported a mean baseline mindfulness score of 34.02 (SD = 6.61) in breast cancer patients 30 . In contrast, Snyder et al. observed a significantly higher level of mindfulness among their participants, averaging 55.26 with a standard deviation of 7.775 (ranging from 34 to 75) 43 . It is worth noting that their study included both male and female cancer populations and had an average age of 63, which may account for the discrepancies in mindfulness levels observed. In examining the relationship between perceived stress and mindfulness, we discovered a significant negative correlation, with r = -0.53 and P < 0.001. This indicates that women with higher levels of mindfulness tend to perceive lower levels of stress. This finding is consistent with a pre- and post-experimental study that employed a mindfulness intervention, which demonstrated a reduction in perceived stress among breast cancer patients undergoing chemotherapy following the intervention (P = 0.03) 31 . In contrast, a previous study found that mindfulness did not significantly reduce perceived stress (P > 0.05) 46 . This conclusion was echoed by another study, which indicated that mindfulness was only marginally associated with a reduction in perceived stress (d = -0.40, p = 0.09) 47 . Implications The findings of this study underscore the potential of mindfulness-based interventions to reduce perceived stress and enhance psychological well-being among breast cancer patients 31 , 46 . Integrating mindfulness practices into routine supportive care may prove beneficial in alleviating anxiety and strengthening resilience, especially in culturally specific contexts where spiritual and communal values are integral to coping 18 , 46 . Clinicians should consider customizing mindfulness programs to reflect the unique cultural and religious beliefs of Saudi women, thus improving engagement and overall effectiveness. These insights advocate for the incorporation of culturally informed psychosocial care within oncology settings to optimize patient outcomes and enhance overall quality of life 20 , 46 . Limitations The current study has its limitations. Several factors potentially increase the risk of bias and restrict generalizability, including the study design, lack of causality, the use of convenience sampling, and the single-center setting. Therefore, it is important to approach the generalization of these results to other populations with caution. However, the research utilized validated measurement tools, evaluated their reliability, and provided training for the internal investigators who acted as data collectors. Conclusion The study highlights a notable connection between perceived stress levels and mindfulness practices among women diagnosed with breast cancer in Saudi Arabia. The findings suggest that enhancing mindfulness has a positive influence on the psychological well-being of these patients. To deepen this understanding, future research needs to assess the effectiveness of mindfulness-based interventions on the psychological responses of breast cancer patients in Saudi Arabia, considering their cultural distinctives. Additionally, conducting multi-center studies with probability sampling methods is recommended to ensure a more comprehensive representation of diverse geographic regions across Saudi Arabia, ultimately enriching the insights gained from this critical area of study. Declarations Corresponding Author Sahar Al-Ghareeb Conflict of interest The authors have no funding or conflicts of interest to disclose. Ethics Approval and Consent to Participate The researchers obtained Institutional Review Board (IRB) approval for the study from King Fahad Epecialist Hospital-Dammam under the number EXT0449. Informed consent was obtained from all individual participants included in the study. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution S.G. wrote the main manuscript text, conceptualization, methodology, formal analysis, and investigation. M.A. prepared data curation, prepared tables, and A.A. supervised and edited the manuscript. All authors reviewed the manuscript. Acknowledgments The authors would like to extend their heartfelt appreciation to King Fahad Specialist Hospital in Dammam for their invaluable support and collaboration during this study. We are especially thankful to the internal investigators and the dedicated nursing team who facilitated data collection. Additionally, we are profoundly grateful to all the participants whose contributions made this research possible. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request References WHO. Breast cancer . Breast Cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer (accessed 2025-06-02). AL Zomia, A. S.; AL Zehefa, I. A. M.; Lahiq, L. A.; Mirdad, M. T.; Alshahrani, A. S.; Alshahrani, T.; Almahfuth, N. N.; Mirdad, M. T.; Alqarni, A. A.; Alshareef, N. M.; AL Qahtani, R. M.; Asiri, M. A.; Alshahrani, M. S.; Ghazy, R. M.; Tawhari, I. Tracking the Epidemiological Trends of Female Breast Cancer in Saudi Arabia since 1990 and Forecasting Future Statistics Using Global Burden of Disease Data, Time-Series Analysis. 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Cross-Cultural Adaptation and Validation of an Arabic Version of the Cognitive-Affective Mindfulness Scale (CAMS-R). Cogent Social Sciences 2024 , 10 (1), 2306919. https://doi.org/10.1080/23311886.2024.2306919. Reich, R. R.; Lengacher, C. A.; Alinat, C. B.; Kip, K. E.; Paterson, C.; Ramesar, S.; Han, H. S.; Ismail-Khan, R.; Johnson-Mallard, V.; Moscoso, M.; Budhrani-Shani, P.; Shivers, S.; Cox, C. E.; Goodman, M.; Park, J. Mindfulness-Based Stress Reduction in Post-Treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters. Journal of Pain and Symptom Management 2017 , 53 (1), 85–95. https://doi.org/10.1016/j.jpainsymman.2016.08.005. Naskar, S.; Dixit, S.; Varadharasu, S.; Pattnaik, J. I.; Singh, R. Effect of Mindfulness-Based Intervention on Perceived Stress among Breast Cancer Patients Undergoing Chemotherapy. J Family Med Prim Care 2024 , 13 (8), 2934–2940. https://doi.org/10.4103/jfmpc.jfmpc_1713_23. Kim, H.-Y. 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Job Loss, Return to Work, and Multidimensional Well-Being after Breast Cancer Treatment in Working-Age Black and White Women. J Cancer Surviv 2023 , 17 (3), 805–814. https://doi.org/10.1007/s11764-022-01252-6. Chimienti, M.; Morlino, G.; Ingravalle, F.; Vinci, A.; Colarusso, E.; De Santo, C.; Formosa, V.; Gentile, L.; Lorusso, G.; Mosconi, C.; Scaramella, M.; Rosca, V.; Veneziano, E.; Torino, F.; Emberti Gialloreti, L.; Palombi, L. Unemployment Status Subsequent to Cancer Diagnosis and Therapies: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023 , 15 (5), 1513. https://doi.org/10.3390/cancers15051513. Krutchan, N.; Skulphan, S.; Thapinta, D.; Thungjaroenkul, P.; Saengthong, S. Factors Predicting Self-Compassion among Patients with Breast Cancer Undergoing Chemotherapy in Thailand: A Cross-Sectional Study. Belitung Nurs J 2024 , 10 (3), 341–350. https://doi.org/10.33546/bnj.3359. Thakur, M.; Sharma, R.; Mishra, A. K.; Singh, K.; Kar, S. K. Psychological Distress and Body Image Disturbances after Modified Radical Mastectomy among Breast Cancer Survivors: A Cross-Sectional Study from a Tertiary Care Centre in North India. The Lancet Regional Health - Southeast Asia 2022 , 7 , 100077. https://doi.org/10.1016/j.lansea.2022.100077. Zhang, S.; Yang, Z.; Qiu, P.; Li, J.; Zhou, C. Research on the Role of Marriage Status Among Women Underwent Breast Reconstruction Following Mastectomy: A Competing Risk Analysis Model Based on the SEER Database, 1998-2015. Front Surg 2021 , 8 , 803223. https://doi.org/10.3389/fsurg.2021.803223. Jiao, D.; Ma, Y.; Zhu, J.; Dai, H.; Yang, Y.; Zhao, Y.; Guo, X.; Liu, Z. Impact of Marital Status on Prognosis of Patients With Invasive Breast Cancer: A Population-Based Study Using SEER Database. Front Oncol 2022 , 12 , 913929. https://doi.org/10.3389/fonc.2022.913929. Reis, J. C.; Travado, L.; Heller, A. S.; Oliveira, F. P. M.; Almeida, S. D.; Sousa, B.; Costa, D. C.; Antoni, M. H. Greater Perceived Stress Management Skills and Heightened Brain Metabolic Activity in Cortical and Subcortical Stress Processing Regions in Metastatic Breast Cancer Patients. Brain Imaging and Behavior 2024 , 18 (1), 130–140. https://doi.org/10.1007/s11682-023-00821-2. Snyder, S.; Secinti, E.; Chinh, K.; Wu, W.; Johns, S. A.; Mosher, C. E. Preliminary Validation of the Cognitive Affective Mindfulness Scale–Revised (CAMS-R) in Cancer Populations. Psychooncology 2024 , 33 (1), e6260. https://doi.org/10.1002/pon.6260. Kuswanto, C. N.; 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), 425–437. https://doi.org/10.1177/13591053231222162. Park, J.-H.; Chun, M.; Bae, S. H.; Woo, J.; Chon, E.; Kim, H. J. Factors Influencing Psychological Distress among Breast Cancer Survivors Using Machine Learning Techniques. Sci Rep 2024 , 14 (1), 1–10. https://doi.org/10.1038/s41598-024-65132-y. Mirmahmoodi, M.; Mangalian, P.; Ahmadi, A.; Dehghan, M. The Effect of Mindfulness-Based Stress Reduction Group Counseling on Psychological and Inflammatory Responses of the Women With Breast Cancer. Integr Cancer Ther 2020 , 19 , 1534735420946819. https://doi.org/10.1177/1534735420946819. Sakki, S. E.; Penttinen, H. M.; Hilgert, O. M.; Volanen, S.-M.; Saarto, T.; Raevuori, A. Mindfulness Is Associated with Improved Psychological Well-Being but No Change in Stress Biomarkers in Breast Cancer Survivors with Depression: A Single Group Clinical Pilot Study. BMC Womens Health 2022 , 22 (1), 518. https://doi.org/10.1186/s12905-022-02116-y. Additional Declarations No competing interests reported. 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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-7371670","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504864465,"identity":"b2419f30-4af6-4ab5-9cdd-ffb0ee7eccf1","order_by":0,"name":"Sahar Abdulkarim Al-Ghareeb","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYHACxgOMDUBKgvnAATD/ABF6oFrYEkjWwmPAQJQW+fbDDw5+3WGXzy/d8/HAzzYGOb4bCcwffuDRYnAmzeCw7Jlky5lzzm442NvGYCx5I4FNsgefFoYEg8OSbcwGBjdyNxzgbWNI3ADUwsCDz2H9zz8AtdQb2N/IeXDwbxtDPVAL88c/+DxzI8fg4Me2wwYGEjkMh4G2JBjcSGCQxmeLwY03BYcZ244bSNw5ZnBY5pyE4cwzD9ukZfA6LH3jw59t1Qb8s5sff3xTZiPPdzz58Mc3+BwGBMxIzpAAYnA04QeM+GJhFIyCUTAKRgEDAKaPWT6bRhnJAAAAAElFTkSuQmCC","orcid":"","institution":"BSN, King Saud University","correspondingAuthor":true,"prefix":"","firstName":"Sahar","middleName":"Abdulkarim","lastName":"Al-Ghareeb","suffix":""},{"id":504864466,"identity":"cc48cdf8-d85d-423c-8279-68e96c9b7cd9","order_by":1,"name":"Mousa Y. Asiri","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Mousa","middleName":"Y.","lastName":"Asiri","suffix":""},{"id":504864467,"identity":"4463e38c-c60e-40ff-9a2c-f47c6aca7aad","order_by":2,"name":"Ahmad Aboshaiqah","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Aboshaiqah","suffix":""}],"badges":[],"createdAt":"2025-08-14 08:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7371670/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7371670/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90196886,"identity":"6c8585ad-00a9-48d7-b1b2-520f89a49712","added_by":"auto","created_at":"2025-08-29 17:27:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1191998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7371670/v1/4ae00a5e-7904-4e2a-922a-58e2d7002566.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Mindfulness and Perceived Stress Among Breast Cancer Patients in Saudi Arabia","fulltext":[{"header":"Background","content":"\u003cp\u003eBreast cancer is a worldwide health concern. It is reported as the most common form of cancer among women and the second leading cause of death globally. The incidence of breast cancer is increasing dramatically each year. According to the World Health Organization, a report estimated that 2.3\u0026nbsp;million cases of breast cancer were diagnosed in 2022, and 670,000 deaths globally from a report that included 152 countries around the globe \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In Saudi Arabia, from 1990 to 2021, there were a reported 77,513 cases of female breast cancer, which resulted in 19,440 deaths \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBreast cancer treatment encompasses a range of therapeutic modalities internationally and in Saudi Arabia, including radiation therapy, chemotherapy, immunotherapy, hormonal therapy, and various surgical interventions. The choice and combination of these treatments are tailored to the specific stage and subtype of the tumor, allowing for a personalized approach to care. Each therapeutic option plays a critical role in managing the disease and can be utilized in sequence or in conjunction with others to optimize patient outcomes \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTreatment for breast cancer typically leads to a variety of side effects that can significantly impact individuals on multiple levels. These effects may manifest physically, such as fatigue, pain, and changes in appearance, as well as mentally and psychologically, contributing to anxiety, depression, and alterations in self-esteem \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. According to different studies around the world, patients diagnosed with breast cancer frequently report heightened levels of perceived stress both at the time of diagnosis and throughout their treatment journey \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Perceived stress refers to how a person interprets the level of stress they experience over a certain time frame \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In Saudi Arabia, women diagnosed with breast cancer exhibit a high prevalence of psychological distress, including symptoms of depression, anxiety, and fear.\u003c/p\u003e\u003cp\u003eFurthermore, they endure considerable psychological repercussions stemming from delayed diagnoses and insufficient social support systems \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Stress among women with breast cancer can stem from multiple sources, including worries about the disease prognosis, potential side effects of treatment, and the broader implications for their quality of life \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. It is essential to address these concerns to enhance patients' well-being and improve the overall experience throughout their treatment journey.\u003c/p\u003e\u003cp\u003eUnderstanding the psychological dimensions of patient care is crucial for delivering comprehensive support and fostering healing. Numerous studies have explored the relationship between mindfulness and perceived stress across various populations, countries, cultural backgrounds, and occupations \u003csup\u003e\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. For instance, McBride et al. reported that students with higher levels of mindfulness tend to report lower levels of stress \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Another study was conducted among Japanese military soldiers that addressed the negative association between mindfulness and perceived stress \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In their research, Borghi et al. explored the complex relationship between mindfulness and perceived stress among students and community groups. They discovered that mindfulness could either have a positive association with perceived stress or that perceived stress might negatively affect an individual's ability to maintain mindfulness in everyday situations \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. A study conducted in the United Kingdom enrolled the adult population and found that their mindfulness significantly lowered the level of perceived stress \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Effective strategies for managing this stress can lead to improved treatment adherence and outcomes, ultimately fostering a more supportive healthcare environment \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eNumerous studies conducted in Arabic-speaking countries, including Saudi Arabia, have examined the psychological experiences of breast cancer patients. For instance, a phenomenological study revealed that psychological distress significantly affects the daily functioning and overall quality of life of these patients \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Additionally, a thematic synthesis, involving 11 Arabic countries, including Saudi Arabia, and explored the multidimensional experiences of breast cancer patients from diagnosis through their treatment. This synthesis also highlighted psychological aspects, such as anxiety experienced during this period \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This emphasizes the importance of addressing mental health alongside physical health in cancer care, particularly in culturally specific contexts.\u003c/p\u003e\u003cp\u003eMoreover, in Saudi Arabia, the experience of breast cancer is profoundly shaped by cultural, religious, and social factors that influence patients\u0026rsquo; perceptions and coping mechanisms. Many Saudi women interpret their illness through an Islamic perspective, viewing cancer as a test or trial from God. This interpretation can promote spiritual acceptance and resilience; however, it may also contribute to internalized stigma and emotional distress \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The support of family and community is crucial for psychological adjustment, yet misconceptions and stigmatization surrounding cancer persist, which can adversely affect mental health and overall quality of life \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn Saudi Arabia, numerous breast cancer patients face considerable psychological distress, which adversely affects their quality of life and daily functioning. Recognizing these cultural nuances is crucial for developing effective tailored psychosocial interventions and ensuring that mindfulness-based programs are tailored to the specific needs of Saudi breast cancer patients \u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. While global research supports the efficacy of mindfulness as a means to reduce stress in cancer care \u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, there exists a notable shortage of quantitative studies that specifically investigate the relationship between mindfulness practices and perceived stress levels among breast cancer patients in Saudi Arabia.\u003c/p\u003e\u003cp\u003eThis gap underscores the necessity for targeted research to investigate how mindfulness correlates with perceived stress within this demographic, potentially improving psychological well-being and overall treatment outcomes for breast cancer patients in the region. This study aims to investigate the relationship between mindfulness and perceived stress levels in breast cancer patients in Saudi Arabia. To achieve this, the study focused on the following objectives: (a) to assess the level of mindfulness among the participants, (b) to evaluate the level of perceived stress among the participants, and (c) to explore the connection between mindfulness and perceived stress among breast cancer patients in Saudi Arabia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis research employed a cross-sectional study design with a correlational approach, which was deemed suitable for achieving the research objectives. The study was conducted at a cancer treatment facility located in the Eastern Province of Dammam, Saudi Arabia.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSample\u003c/h2\u003e\u003cp\u003eAll patients, aged 18 or older, who validated their primary diagnosis of breast cancer through their medical records, any cancer therapeutic plan, and consented to participate, were included in the study. We excluded individuals diagnosed with mental illness or those who had a do-not-resuscitate order in place. The required sample size for this study was determined using an a priori power analysis conducted in G*Power. Assuming a medium effect size (r\u0026thinsp;=\u0026thinsp;0.3), a significance level of α\u0026thinsp;=\u0026thinsp;0.05, and a desired statistical power of 0.80 for a two-tailed test, the analysis indicated that a minimum of 138 participants is necessary to detect a significant correlation between mindfulness and perceived stress reliably \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. A total of 152 participants were included in the study, accounting for 10% incomplete data or non-response \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eThe data collection for this study includes several components: socio-demographic information, the Cohen\u0026rsquo;s Perceived Stress Scale (PSS), and the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). The questionnaire utilized is in Arabic, and permission has been obtained from the primary authors to use these measures.\u003c/p\u003e\n\u003ch3\u003eSocio-demographic Characteristics\u003c/h3\u003e\n\u003cp\u003eThe researcher created this Arabic questionnaire, which gathers information about the participants\u0026rsquo; attributes such as age, marital status, number of children, educational background, employment status, duration of cancer diagnosis, cancer stage, type of surgery performed, and whether they have participated in any relaxation or meditation techniques, allowing them to specify a name from the provided options or to write in another strategy if it\u0026rsquo;s not listed in the form.\u003c/p\u003e\n\u003ch3\u003eThe Cohen’s Perceived Stress Scale (PSS)\u003c/h3\u003e\n\u003cp\u003eThe Perceived Stress Scale (PSS) is designed to evaluate individuals' perceptions of stress and feelings of lack of control in various life situations over the past month. It comprises 10 items graded on a five-point Likert scale, where zero represents \"never\" and four signifies \"very often.\" Items are reverse scored (0\u0026thinsp;=\u0026thinsp;4, 1\u0026thinsp;=\u0026thinsp;3, 2\u0026thinsp;=\u0026thinsp;2, 3\u0026thinsp;=\u0026thinsp;1, 4\u0026thinsp;=\u0026thinsp;0). The overall score is obtained by summing all items after adjusting for the positively phrased items 4,5,7, and 8. The total score ranges from zero to 40; a higher total score indicates a greater level of perceived stress. 0\u0026ndash;13: low, 14\u0026ndash;26: moderate, and 27\u0026ndash;40: high stress \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The Arabic version of this scale demonstrates sufficient concurrent and convergent validity. Furthermore, the internal consistency of the PSS-10 along with its positive and negative subscales was found to be satisfactory (coefficient α\u0026thinsp;=\u0026thinsp;0.67, 0.79, and 0.86, respectively)\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The PSS-10 is a suitable instrument for assessing perceived stress among breast cancer patients and could help in identifying women who are at risk for psychological difficulties \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eCognitive and Affective Mindfulness Scale-Revised (CAMS-R)\u003c/h3\u003e\n\u003cp\u003eThe Cognitive and Affective Mindfulness Scale is designed to assess attention, awareness, and the non-judgmental acceptance of present-focused thoughts and emotions, independent of meditation practices. As a 12-item instrument utilizing a four-point Likert scale, responses range from 1 (never/rarely) to 4 (always). The total score is computed after reversing items 2,6, and 7. Items are reverse-scored (1\u0026thinsp;=\u0026thinsp;4, 2, =\u0026thinsp;3, 3\u0026thinsp;=\u0026thinsp;2,4\u0026thinsp;=\u0026thinsp;1). The score ranges between 12 and 48; a higher score indicates greater mindfulness. This scale exhibits excellent internal consistency with high Cronbach\u0026rsquo;s Alpha values of 0.875 for the exploratory sample and 0.862 for the confirmatory sample. Additionally, it has demonstrated good convergent and discriminant validity \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The CAMS-R scale has proven to be valuable in numerous studies, especially involving women with breast cancer. This underscores its significance and suitability for this demographic, offering meaningful insights into their distinct psychological and emotional requirements. Its application in research emphasizes the need to comprehend the experiences and difficulties encountered by these patients, which can lead to enhanced support and care strategies \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003eFollowing approval by the Institutional Review Board (IRB), the researcher outlined the data collection process to the internal investigators from the study site, who had obtained their ethical clearance certificates before the start of data collection. The internal investigators recruited participants from both the outpatient and inpatient departments using convenience sampling, clearly explaining the study and its objectives to the participants. Eligible participants who expressed a willingness to take part were asked to sign a consent form before completing the study\u0026rsquo;s paper-based self-administered questionnaire. The data collection lasted for an average of 10 minutes for each participant.\u003c/p\u003e\u003cp\u003eThe study acknowledges that its cross-sectional design, reliance on a single center, and use of convenience sampling limit its ability to establish causal relationships and may introduce specific biases. However, the researchers implemented several strategies to address and mitigate these potential biases throughout the research process. This includes careful selection of the sample and thorough data collection methods. Data collection was conducted by qualified oncology nurses who are actively engaged in patient care and given training to enable them to collect data, thereby enhancing their understanding of the context and improving the quality of the data. To bolster construct validity, standardized and previously validated assessment tools for both mindfulness and perceived stress\u0026mdash;previously used in populations with breast cancer\u0026mdash;were applied \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Reliability analyses were performed to verify the internal consistency of the study sample. To further reduce discrepancies or errors in data entry, the principal investigator maintained continuous communication and followed up with the data collectors during the data collection phase.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThis study utilized IBM SPSS Statistics version 30 for data analysis. Missing data was evaluated and addressed appropriately, depending on the severity and type of missing information. Descriptive statistics were performed to assess both the sample characteristics and the study variables. For categorical variables, the analysis focused on the number and percentage, while for continuous variables, the mean, median, and standard deviation were calculated. The normality of the distribution was determined based on Skewness (Sk) and Kurtosis (Ku). Specifically, an absolute skewness value exceeding two or an absolute kurtosis value greater than 7 indicates significant non-normality \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Moreover, two-sided p-values of less than 0.05 were considered statistically significant.\u003c/p\u003e\u003cp\u003eThe reliability of the measurement scales was assessed through the examination of internal consistency. A Cronbach's alpha value of 0.7 or greater is generally considered to demonstrate acceptable internal consistency, ensuring that the items within the scale reliably measure the same underlying construct \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. This evaluation is crucial for validating the effectiveness of the measurement tools employed in research.\u003c/p\u003e\u003cp\u003eThe relationship between mindfulness and perceived stress was analyzed using Pearson's correlation coefficient, after verifying the normality assumptions. A correlation coefficient between .5 and 1 indicates a strong association, while coefficients of .29 or below suggest a weak association \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. This statistical method enables researchers to quantify the extent to which increases in mindfulness are correlated with decreases in perceived stress levels.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe researchers obtained Institutional Review Board (IRB) approval for the study setting under the number EXT0449. Participants were given a detailed written and verbal explanation of the study's purpose. They were assured that their participation was entirely voluntary, that they could withdraw at any time without affecting the care and treatment they received, and that their confidentiality would be strictly maintained, as no identifying information was collected. The researcher secured both verbal and written consent, requiring participants to sign a form before completing the questionnaire. The completed questionnaires were stored in a secure locker accessible only to the research team, and they will be retained for two years.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe missing data were addressed in SPSS through pairwise deletion, meaning that participants with incomplete responses were only omitted from analyses related to the missing scale. One participant did not provide data for one of the scales in the questionnaire. Table 1 presents the descriptive statistics for the study participants and the variables examined. The average age of the participants was 48 years, with a standard deviation of 9.86 (ranging from 29 to 70 years). We divided the age into four categories: 29-40, 41-50, 51-60, and 61-70. The largest group of participants fell within the 41-50 age range, comprising 56 individuals (36.8%), followed by the 29-40 group with 39 participants (25.7%). The 51-60 age bracket included 35 individuals (23%), while the smallest group, 61-70, consisted of 22 participants (14.5%).\u003c/p\u003e\n\u003cp\u003eIn terms of education levels, the majority of participants held a bachelor\u0026rsquo;s degree, totaling 52 individuals (35.2%). This was followed by 38 participants (25%) who completed high school. Additionally, 22 individuals (15.5%) had received primary education, while 16 participants (10.5%) obtained a diploma. Three individuals (2%) achieved a master\u0026rsquo;s degree, and six participants (3.9%) had no formal education. Notably, one participant (0.7%) earned her doctorate degree, while another individual (0.7%) reported an alternative level of education (Table 1).\u003c/p\u003e\n\u003cp\u003eRegarding marital status, most participants were married, comprising 113 women (74.3%). Additionally, 19 women (12.5%) identified as single, 12 participants (7.9%) were widowed, and only eight women (5.3%) were divorced. Furthermore, 120 participants (78.8%) reported having children. In terms of employment, most participants were unemployed. Among those who were working, 33 individuals (21.7%) reported working more than 20 hours per week, while only 7 participants (4.7%) worked less than 20 hours per week (Table 1).\u003c/p\u003e\n\u003cp\u003eIn terms of cancer staging, a significant number of women are unaware of their specific stage, with 45 (29.6%) reporting this uncertainty. Among those who do know, many are at stage two and stage three, with 35 (23%) and 34 (22.4%) respectively. Additionally, 28 women (18.4%) are classified as stage one, while 10 (6.6%) are at stage four (see Table 1).\u003c/p\u003e\n\u003cp\u003eDuring the study period, the participants received various forms of breast cancer therapy. Approximately half of the participants underwent chemotherapy, totaling 71 individuals (46.7%). Surgical procedures were performed on 52 participants (34.2%), while 17 individuals (11.2%) received hormonal therapy. Additionally, 8 participants (5.3%) underwent radiotherapy sessions, and a small cohort of 4 individuals (2.6%) was treated with more than one type of therapy. This distribution highlights the diverse therapeutic approaches employed in managing breast cancer among the study cohort. However, a total of 106 (69.7%) have undergone breast cancer surgical operation since they were diagnosed with cancer; of these, 78(51.3%) had their surgeries in less than six months\u0026rsquo; time from the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants had variable breast surgical procedures. 48(31.6%) had complete mastectomy, 26(17.1%) underwent partial mastectomy, 11(7.2%) performed nipple sparing, only 2(1.3%) had breast reconstruction. Other women, 15 (9.9%), had undergone more than one surgical operation. However, the minority of 4 (2.6%) are unsure or do not know the specific surgery they had. Noticeably, only 17(11.2%) of the breast cancer patients have another form of cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Overview of Participant Characteristics and Study Variables (n = 152)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003echaracteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eSk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eKu\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e29-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e48.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e_.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge categories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;29-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e39(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e56(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e35(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;61-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e22(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eTotal PSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e_.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e_.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eTotal CAMS-R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e21-46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e_.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eTime of diagnosis/months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1-300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not educated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e22(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e13(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e38(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e16(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Bachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e52(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Master\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Doctorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1(.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1(.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Single (not married before)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e19(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e113(74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e12(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Divorce/separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e8(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e120(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e32(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking hours/week \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Less than 20 hours/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e7(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;More than 20 hours/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e33(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not working (not an employee)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e112(73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage of breast cancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stage one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e28(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stage two\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e34(22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stage three\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e35(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stage four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Do not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e45(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of the current therapy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Chemotherapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e71(46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Radiotherapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e8(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Surgical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e52(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hormonal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e17(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;More than one therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e4(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderwent surgery since was diagnosed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e106(69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e46(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime of breast cancer surgery \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Less than six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e78(51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;More than six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e28(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e46(30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of breast cancer surgery \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Complete mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e48(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Partial mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e26(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Breast reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Nipple sparing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e11(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not sure or do not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e4(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;More than one surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e15(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No breast cancer surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e46(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving another type of cancer\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e17(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e135(88.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote\u003cem\u003e.\u003c/em\u003e Continuous variables are presented as mean \u0026plusmn; standard deviation, while categorical variables are shown as frequency (%).\u003c/p\u003e\n\u003cp\u003eRegarding the study variables. The perceived stress, Sk=_.02, and. The average level of perceived stress is 16.2, SD=7(0-31), indicating a moderate level of perceived stress\u0026nbsp;\u003csup\u003e26\u003c/sup\u003e. Regarding the mindfulness, the mean score was 34.5, SD=5.5 (21-46), Sk=.03 and Ku=-.4. Both scales indicated normal distribution\u0026nbsp;\u003csup\u003e32\u003c/sup\u003e. The reliability of the scales was assessed with a good reliability for the PSS, Cronbach\u0026rsquo;s alpha a=.82, while it was marginally below the acceptable level for the CAMS-R scale, a=.69 (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003eThe Reliability of the Study Measurements\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eThe scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eCronbach alpha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eN of items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePerceived Stress Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eCognitive Affective Mindfulness Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. This table presents the internal consistency of the perceived stress scale and the cognitive and affective mindfulness scale, indicated by Cronbach\u0026rsquo;s alpha.\u003c/p\u003e\n\u003cp\u003eIn assessing the relationship between mindfulness and perceived stress, both variables were continuous and followed a normal distribution. Consequently, we utilized Pearson correlation to evaluate the association between perceived stress and mindfulness among women who have been diagnosed with breast cancer. Table 3 illustrates the relationship between these study variables, demonstrating a significant, strong negative correlation between mindfulness and perceived stress, with r = -0.53, P \u0026lt; 0.00 \u003csup\u003e34\u003c/sup\u003e. This indicates that as mindfulness increases, the participants\u0026rsquo; levels of perceived stress decrease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. The correlation between Perceived Stress and Mindfulness\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMindfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePerceived Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePearson correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e_.53**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSig. (2 tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e** Correlation is significant at the 0.01 level (2-tailed)\u003c/p\u003e\n\u003cp\u003eNote. The relationship between Perceived Stress and Mindfulness is presented by Pearson correlation\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to examine the association between perceived stress and mindfulness among 152 women with breast cancer in Saudi Arabia. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the descriptive statistics for the sample characteristics and study variables. In this study, the mean age of participants was 48 years, with a range from 29 to 70 years. Notably, a significant proportion of patients, 36.8%, fell within the 41- to 50-year-old age bracket. This finding aligns with the research conducted by Alagizy et al. in Egypt, which reported a mean age of 52.29 years, with a range of 30 to 75 years \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Additionally, the results are supported by Ng et al., who noted that the majority of patients were in the 41\u0026ndash;60-year age group, followed by those in the 20\u0026ndash;40-year category \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. The age distribution aligns with both regional and international statistics, highlighting the sample's representativeness for middle-aged patients with breast cancer.\u003c/p\u003e\u003cp\u003eOur study found that a significant number of participants were not employees, 73.7%, which is consistent with an extensive cohort study that reported that about half of the participants, 46%, experienced job disruptions after they had been diagnosed with breast cancer \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. This finding was additionally supported by a systematic review and meta-analysis showing that cancer and related treatment contribute to an increased risk of unemployment, with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32\u0026ndash;2.63) or a change in employment status \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. In contrast, a previous cross-sectional study reported that only 18% of their participants had no jobs \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Also, another study reported that 95.8% of women were not working \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWe found that 78.9% of the participants were married, and the same percentage of participants had children, 78.4%. Additionally, a separate study indicated that approximately 70% of breast cancer patients were married \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e, while another study reported marriage proportions ranging from 52\u0026ndash;55% \u003csup\u003e40,41\u003c/sup\u003e. Variations in marital status can reveal demographic, cultural, and regional differences among study groups.\u003c/p\u003e\u003cp\u003eRegarding educational level, our participants held a bachelor\u0026rsquo;s degree, while a minority (35.2%) had not received formal education, and only 4 participants had higher education, including master's and doctoral degrees. Alagizy et al. conducted a study revealing that only 4.7% of participants possessed a high level of education, which aligns with our findings. However, their results contradict ours, as they reported that 50% of participants had no education \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eRegarding the duration of breast cancer diagnosis, the median time from diagnosis was recorded at 12 months, while the standard deviation was notably large at 46.5 months, with a range from 1 to 300 months. In terms of cancer staging, 69% of participants are categorized at stage two or stage three. Notably, a considerable proportion of women, 26.9%, reported that they are unaware of their cancer stage. This finding is consistent with Alagizy et al., who noted that 75% of their participants were also at stage three or two \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Also, a separate study reported that the majority of participants, 76%, are at stages two and three of breast cancer\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. In contrast to our results, an earlier study suggested that all participants were in stage four. This discrepancy can be attributed to the inclusion of patients in the metastatic stage of cancer \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe investigation revealed that a significant 69.7% of participants underwent surgical interventions following their diagnosis. Additionally, the treatment modalities employed during the study period predominantly included chemotherapy and surgery, with administration rates of 46.7% and 34.2%, respectively. This finding was supported by a previous study, which reported that most of the participants have been treated with surgical therapy 80% and chemotherapy 48% \u003csup\u003e43\u003c/sup\u003e. Similar findings were reported in a cross-sectional study where 48.6% of participants were receiving chemotherapy \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. In contrast, another study indicated that only 6.3% of women underwent surgery without any additional treatment, while 44.2% had surgery in conjunction with chemotherapy \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Furthermore, a separate study revealed that all participants had undergone surgery; of those, 94% received radiotherapy, and 61% received chemotherapy since their diagnosis \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. It is important to note that this study specifically focused on the treatments that the women were receiving at the time of the study. These results underscore the variations in treatment approaches across different populations and emphasize the importance of considering local clinical practices and patient characteristics when evaluating treatment trends.\u003c/p\u003e\u003cp\u003eIn this study, the median time from breast cancer diagnosis was found to be 12 months, with a wide standard deviation of 46.5 months (ranging from 1 to 300 months). This finding aligns with the results reported by a study, which indicated an average diagnosis time of 31.84 months \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Similarly, in a different randomized controlled trial, corroborated this finding, reporting a mean diagnosis duration of 27 months for the intervention group. In contrast, the same study noted a significant difference in the control group, which had an average diagnosis duration of just 14.8 months \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn the context of the scales\u0026rsquo; reliability, the Cronbach\u0026rsquo;s alpha of the CAMS-R scale, while slightly below the conventional threshold of 0.70 \u003csup\u003e33\u003c/sup\u003e, demonstrates adequate internal consistency for research purposes. Future research endeavors might explore the possibility of revising or expanding the scale to enhance its reliability. This approach could contribute to more robust findings and a deeper understanding of the constructs being measured.\u003c/p\u003e\u003cp\u003eThis study found that breast cancer patients reported a moderate level of stress, with an average score of 16.1, with a range between 0 and 31, with a standard deviation of 7. In contrast, previous studies indicated an average perceived stress level of 18.95, with a standard deviation of 11.24 \u003csup\u003e38\u003c/sup\u003e. Another study showed that 24.8% of the population experienced stress, with only 2.4% reporting moderate stress, while the majority expressed mild stress at a rate of 21.87% \u003csup\u003e39\u003c/sup\u003e. These discrepancies may be attributed to variations in the stress measurement scales used.\u003c/p\u003e\u003cp\u003eIn terms of mindfulness, the participants demonstrated a moderate level, with a mean score of 34.5 and a standard deviation of 5.5 (ranging from 21 to 46). This finding aligns closely with a previous study that reported a mean baseline mindfulness score of 34.02 (SD\u0026thinsp;=\u0026thinsp;6.61) in breast cancer patients \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In contrast, Snyder et al. observed a significantly higher level of mindfulness among their participants, averaging 55.26 with a standard deviation of 7.775 (ranging from 34 to 75) \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. It is worth noting that their study included both male and female cancer populations and had an average age of 63, which may account for the discrepancies in mindfulness levels observed.\u003c/p\u003e\u003cp\u003eIn examining the relationship between perceived stress and mindfulness, we discovered a significant negative correlation, with r = -0.53 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. This indicates that women with higher levels of mindfulness tend to perceive lower levels of stress. This finding is consistent with a pre- and post-experimental study that employed a mindfulness intervention, which demonstrated a reduction in perceived stress among breast cancer patients undergoing chemotherapy following the intervention (P\u0026thinsp;=\u0026thinsp;0.03) \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. In contrast, a previous study found that mindfulness did not significantly reduce perceived stress (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. This conclusion was echoed by another study, which indicated that mindfulness was only marginally associated with a reduction in perceived stress (d = -0.40, p\u0026thinsp;=\u0026thinsp;0.09) \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cp\u003eThe findings of this study underscore the potential of mindfulness-based interventions to reduce perceived stress and enhance psychological well-being among breast cancer patients\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Integrating mindfulness practices into routine supportive care may prove beneficial in alleviating anxiety and strengthening resilience, especially in culturally specific contexts where spiritual and communal values are integral to coping \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Clinicians should consider customizing mindfulness programs to reflect the unique cultural and religious beliefs of Saudi women, thus improving engagement and overall effectiveness. These insights advocate for the incorporation of culturally informed psychosocial care within oncology settings to optimize patient outcomes and enhance overall quality of life \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe current study has its limitations. Several factors potentially increase the risk of bias and restrict generalizability, including the study design, lack of causality, the use of convenience sampling, and the single-center setting. Therefore, it is important to approach the generalization of these results to other populations with caution. However, the research utilized validated measurement tools, evaluated their reliability, and provided training for the internal investigators who acted as data collectors.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study highlights a notable connection between perceived stress levels and mindfulness practices among women diagnosed with breast cancer in Saudi Arabia. The findings suggest that enhancing mindfulness has a positive influence on the psychological well-being of these patients. To deepen this understanding, future research needs to assess the effectiveness of mindfulness-based interventions on the psychological responses of breast cancer patients in Saudi Arabia, considering their cultural distinctives. Additionally, conducting multi-center studies with probability sampling methods is recommended to ensure a more comprehensive representation of diverse geographic regions across Saudi Arabia, ultimately enriching the insights gained from this critical area of study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCorresponding Author\u003c/h2\u003e\n\u003cp\u003eSahar Al-Ghareeb\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eThe authors have no funding or conflicts of interest to disclose.\u003c/p\u003e\n\u003ch2\u003eEthics Approval and Consent to Participate\u003c/h2\u003e\n\u003cp\u003e The researchers obtained Institutional Review Board (IRB) approval for the study from King Fahad Epecialist Hospital-Dammam under the number EXT0449.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewas obtained from all individual participants included in the study.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eS.G. wrote the main manuscript text, conceptualization, methodology, formal analysis, and investigation. M.A. prepared data curation, prepared tables, and A.A. supervised and edited the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors would like to extend their heartfelt appreciation to King Fahad Specialist Hospital in Dammam for their invaluable support and collaboration during this study. We are especially thankful to the internal investigators and the dedicated nursing team who facilitated data collection. Additionally, we are profoundly grateful to all the participants whose contributions made this research possible.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. \u003cem\u003eBreast cancer\u003c/em\u003e. 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Tracking the Epidemiological Trends of Female Breast Cancer in Saudi Arabia since 1990 and Forecasting Future Statistics Using Global Burden of Disease Data, Time-Series Analysis. \u003cem\u003eBMC Public Health\u003c/em\u003e \u003cstrong\u003e2024\u003c/strong\u003e, \u003cem\u003e24\u003c/em\u003e (1), 1953. https://doi.org/10.1186/s12889-024-19377-x.\u003c/li\u003e\n\u003cli\u003eNational Cancer Institute. \u003cem\u003eBreast Cancer Treatment (PDQ\u003c/em\u003e\u003cem\u003e\u0026reg;\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003cem\u003e\u0026ndash;\u003c/em\u003e\u003cem\u003eHealth Professional Version\u003c/em\u003e. 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Mindfulness Is Associated with Improved Psychological Well-Being but No Change in Stress Biomarkers in Breast Cancer Survivors with Depression: A Single Group Clinical Pilot Study. \u003cem\u003eBMC Womens Health\u003c/em\u003e \u003cstrong\u003e2022\u003c/strong\u003e, \u003cem\u003e22\u003c/em\u003e (1), 518. https://doi.org/10.1186/s12905-022-02116-y.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Cross-Sectional Studies, Mindfulness, Perceived Stress, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-7371670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7371670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The perceived stress experienced by women with breast cancer in Saudi Arabia is a significant concern. Mindfulness can effectively reduce levels of perceived stress. However, the specific relationship between mindfulness practices and perceived stress among breast cancer patients in Saudi Arabia has not been thoroughly explored. This study aims to investigate the relationship between mindfulness practices and stress levels within women with breast cancer in Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA total of 152 women from Saudi Arabia who were diagnosed with breast cancer participated in the study, all of whom received care at a hospital located in Dammam, Eastern Province, and were selected through convenience sampling. Data collection was conducted from January to May 2025, utilizing a sociodemographic questionnaire in conjunction with the validated Perceived Stress Scale and the Cognitive and Affective Mindfulness Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe level of perceived stress was average (Mean = 16.2, SD = 7), while mindfulness levels were also average (Mean = 34.5, SD = 5.5). The two variables exhibited a significant, strong negative correlation (r = -0.53, p \u0026lt; .001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The study's findings highlight the essential connection between perceived stress and mindfulness among breast cancer patients in Saudi Arabia. These insights can inform nurses and healthcare professionals as they implement targeted interventions that incorporate mindfulness practices, considering the cultural nuances of Saudi Arabia. Ultimately, this approach aims to reduce stress levels and enhance patients' overall well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e","manuscriptTitle":"Association Between Mindfulness and Perceived Stress Among Breast Cancer Patients in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-29 17:19:36","doi":"10.21203/rs.3.rs-7371670/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-24T07:26:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-16T13:14:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49893158239799799209775639491758457892","date":"2025-10-16T05:40:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T20:38:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230760748206792033898042909068804745475","date":"2025-09-13T19:03:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-24T17:04:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269087765800062507928605466629783796587","date":"2025-08-22T13:57:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-21T14:15:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-21T06:55:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-20T06:08:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-19T15:04:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2025-08-19T15:01:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b2f61a4-5866-4886-b448-30ad76b600f9","owner":[],"postedDate":"August 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T10:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-29 17:19:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7371670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7371670","identity":"rs-7371670","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}