Background: During neoadjuvant therapy (NAT), patients with locally advanced breast cancer (LABC) experience psychological distress (PD) and adopt appropriate coping strategies. Objective: This systematic review aimed to examine the prevalence and changes in PD and coping strategies in patients with LABC during NAT and to evaluate effective interventions to reduce their PD. Design: Quantitative (cross-sectional, longitudinal, and interventional) and qualitative studies reporting PD and coping strategies related to NAT during LABC were included. Data sources and methods: PubMed, Cochrane Library, Scopus, ScienceDirect, Wiley Online Library, and Web of Science databases were consulted to gather relevant literature from the first publications until July 25, 2023. Selection was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 41 articles were included, of which four were qualitative. The main results showed that the prevalence of depression before NAT ranged from 0% to 46% and that of anxiety from 5.5% to 54%. After NAT, the prevalence of depression ranged from 40% to 78.5% and anxiety accounted for 27%. Additionally, PD decreased during NAT. The main determinants of PD were perceived social support, living in joint families, being affected by COVID-19 infection, delays in diagnosis, and starting neoadjuvant treatment. For coping strategies, after NAT, “resigned coping” decreased, whereas “social support” increased, and active coping strategies were correlated with better PD. Some interventions found a reduction in PD, such as a mobile health application, fasting-mimicking diet, relaxation training, and guided imaging. Conclusion: These findings highlight the importance of considering PD and coping strategies in patients with LABC from diagnosis to the end of NAT. The results suggest that effective psychological interventions should be implemented.

Background: patients with locally advanced breast cancer (LABC) are often treated by neoadjuvant chemotherapy (NACT). This study aims to determine the prevalence of psychological distress and their sociodemographic and clinical factors in patients recently diagnosed with LABC and before NACT. Methods: A total of 209 LABC patients without metastatic localization were recruited between 2021 and 2022 in the oncology hospital at Fez. A structured questionnaire and the Hospital Anxiety and Depression Scale were used. A descriptive analysis and linear model were performed. Results: a mean age of participants was 47.43 ± 9.45 years. The prevalence of depression, anxiety and psychological distress among participants was 59.62% (95% CI: 52.61–33.34), 47.85% (95% CI: 40.91–54.85), and 65.07 (95% CI: 58.19–71.52) respectively. Depression was associated to age (< 50 years) (AOR = 2.19; 95% CI = 1.13–4.23) and health insurance (AOR = 3.64; 95% CI: 1.18–11.26). Anxiety was associated to age (< 50) (AOR = 2.21; 95% CI: 1.18–4.13) and right breast cancer (AOA = 2.01; 95% CI: 1.11–3.65). Psychological distress was associated to chronic illness (AOR = 2.78; 95% CI: 1.32–5.85) and lymph node status (AOR = 2.39; 95% CI: 1.26–4.57). Conclusions: Based on the high prevalence of depression and anxiety it appears opportune to treat psychological distress among LABC patient candidates for NACT. Each psychological intervention should take into account sociodemographic and clinical factors found associated in our study. Psychological therapeutic interventions are crucial for LABC patients as early as the time of diagnosis and through subsequent steps in NACT to improve their overall mental health.

Introduction: Women with breast cancer eligible for neoadjuvant therapy (NAT) present a disorder of biopsychosocial variables and alteration of their quality of life. They cope with this changing by adopting psychological adjustment strategies, either passive or active. This systematic review aims to investigate the psychological distress, coping strategies, and quality of life in breast cancer patients under neoadjuvant therapy. Methods: Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Wiley Online library represent the databases that were searched to identify relevant published articles until September 27, 2021. Full-text published articles, written in English and assessing the main outcomes (namely: psychological distress, coping strategies, and quality of life) in women with breast cancer under NAT will be included. Also, we will integrate papers dealing with the related bio psychosocial variables to the main variables. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. We will bring together the results of all of the included studies to draw conclusions based on the body of evidence. The narrative approach will be adopted to analyze the results and conclusions extracted and we would perform quantitative groupings if we have similar data. Ethics and dissemination: Ethical approval is not required as the proposed systematic review will not use primary data. The results of this review will be disseminated through publication in a peer-reviewed journal and conference presentation(s). PROSPERO registration number: CRD42021230300.

Background and Aims: Several epidemiological studies have investigated the relationship between anthropometric factors and breast cancer (BC), but the results, particularly for premenopausal BC, remain inconsistent and contradictory. The aim of this systematic review is to present an overview of studies examining the association between obesity and BC risk in African women, by menopausal status. Methods: PubMed, Scopus, Web of Science, and Google Scholar were searched until 17 February 2025 to identify published articles. The review included original studies, with no restrictions on publication date or language. The exposures studied were height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The quality of the studies was assessed using the National Institute of Health (NIH). Study selection and data extraction were carried out by two authors separately. Results: A total of fifteen case–control studies were included in this systematic review, comprising 45,056 subjects (7221 cases and 37,835 controls). Among them, fourteen studies reported stratified results for pre- and postmenopausal women, and one reported findings for only premenopausal BC. We found that BMI was associated with an increased risk of BC in both premenopausal and postmenopausal women, though the associations varied across studies. Height was associated with an increased risk of pre- and postmenopausal BC. WHR was positively associated with BC in pre- and postmenopausal women, while WC showed a positive association with the risk of postmenopausal BC, and inconsistent results with premenopausal BC. Finally, a higher HC was positively associated with premenopausal and postmenopausal BC. Conclusions: The risk of developing BC is higher in obese postmenopausal women. The protective role of BMI has not been demonstrated in African premenopausal women. WHR is a risk factor for premenopausal and postmenopausal BC. There is a need to study the influence of stages of overweight and obesity on BC risk in a large sample of African women in-depth.

The timing of a breast cancer (BC) diagnosis has a significant psychological impact on patients. However, it reported that those eligible for treatment regimens based on neoadjuvant chemotherapy may experience high levels of depression, anxiety and distress. To cope with this situation, patients deploy psychological coping strategies. The aim of this study is to explore effective and ineffective psychological adjustment mobilized by Moroccan patients newly diagnosed with BC and before receiving neoadjuvant chemotherapy, as well as to identify their associations to socio-demographic and clinical determinants. A total of 209 patients were recruited in outpatient in oncology department in the public oncology hospital of Fez city, between 2021 and 2023. Ethics approval was obtained for this study and patients has signed an informed consent form. The questionnaire interview included socio-economic and clinical variables and the Arabic version of Mini-Mental Adjustment to Cancer (Mini-MAC) scale, which measures the strategies of mental adjustment to disease, as fighting spirit (FS), hopelessness/helplessness (HH), anxious preoccupations (AP), cognitive avoidance (CA), fatalism (FA), “maladaptive coping” and “adaptive coping”. Bivariate analysis of psychological adjustment strategies and sociodemographic and clinical variables was carried out using statistical tests according to the nature of the variables, to their normality and the homogeneity of their variances. Univariate and multivariate linear regression modelling was carried out using a forward “enter” regression procedure. A mean age of 47.43 ± 9.45 was found among participants. Assessment of mental adjustment to cancer using Mini-MAC scores revealed that psychological adjustment strategies with a higher mean score were FA, FS and “adaptive coping” strategies. Based mainly on multiple linear Regression, monthly family income was negatively associated with HH, and FS and positively linked to FA and “adaptive coping” strategies. Moreover, the left side as BC laterality was negatively associated with AP and “maladaptive coping” strategies. Furthermore, positive ER status was negatively associated with HH and “maladaptive coping” strategies and high Ki-67 levels were positively linked to AP. Programs to strengthen psychological adjustment in patients with BC candidates for NACT, taking into consideration the determinants found associated in this study, are of great importance since the first oncology consultation.

Objective: Globally, breast cancer is the most common cancer among women. In 2022, it was estimated to have resulted in 670 000 deaths and 2.3 million new cases and represented 6.9% of all cancer-related deaths and 11.6% of the global cancer burden. In Middle East and North Africa (MENA) countries, screening and early detection continue to lag despite global initiatives like the WHO’s Global Breast Cancer Initiative that has pledged to reduce mortality by 2.5% annually. Despite it being a low-cost and easy-to-access screening method, breast self-examination (BSE) is far from prevalent across the region. The objective of this research is to investigate awareness about breast cancer and the practice of BSE among women in MENA. Method and analysis: An observational cross-sectional study was conducted across multiple MENA countries from March to August 2024. Convenience sampling was employed, and participants completed an online, self-administered questionnaire in Arabic or English. All analyses were conducted using R V.4.4.1. Descriptive statistics were used to summarise participant characteristics, and multivariable logistic regression models were fitted to identify factors associated with breast cancer awareness and BSE awareness. Results: A total of 5435 women participated in this study. Overall, most participants demonstrated poor awareness of breast cancer (60.8%), and BSE awareness was similarly suboptimal (56.95% poor). In this adjusted model, higher awareness clustered among women with mid-life age, higher education, high income and greater personal/clinical exposure (benign injury, knowing someone affected), and among those informed by healthcare professionals. Lower awareness was linked to suburban residence, married/divorced status and reliance on mass-media channels. These patterns suggest prioritising outreach to suburban communities and women with lower educational attainment or non-clinical information sources, while integrating health-professional-led education into public campaigns. Good BSE awareness concentrates among the youngest women and those using broadcast/social media and is lower with older age, average/high income, manual work, prior benign injury and personal acquaintance with a case; residence shows no significant association. Conclusions: Overall awareness was suboptimal, with most participants below the ‘good’ threshold. Drivers of awareness differed between general breast cancer knowledge and BSE, highlighting the need for age-tailored and education-tailored, channel-specific interventions codelivered with healthcare professionals and reinforced through targeted digital outreach. Given the cross-sectional design, these associations are non-causal and warrant confirmation in longitudinal studies.