Extrinsic Risk Factors for Women Breast Cancer in Gaza Strip, Palestine: Associations and Interactions in a Case-Control Study

Background: Worldwide, breast cancer (BC) is the most frequently diagnosed neoplastic disease in women around menopause that is the leading cause of DALYs, because it causes a significant reduction of these women’s ability to function normally in everyday life. Methods: The present hospital-based case-control study was carried out between January and August 2018 using a structured questionnaire on 105 breast cancer women and 210 controls who are clinically free from breast cancer. Data about the study cases were collected in the oncology day-care clinics of the two main hospitals in Gaza strip “Al-Shifa and European Gaza hospitals”. Univariate logistic regression and multivariate logistic regression analyses were employed to identify the significant factors associated with BC. Results: Multivariate logistic regression analyses with adjustment for all confounders revealed that woman with BMI more than or equal 30 kg/m2 are under risk of getting BC 2.9 times greater than those having BMI less than 29 kg/m2 (AOR = 2.895;95% CI: 1.305 - 6.423). Analysis of risk according to reaching menopause showed that the estimated AOR was greater among those reached menopause (3.137, 95% CI 1.824 - 5.395) than among those that did not reach menopause. The risk of developing BC in the case of a history of incidence of BC in the family was more than two times higher (AOR = 2.632, 95% CI 1.528 - 4.535) than in case of the history of a free family of BC. Conclusion: In this context, the above-mentioned risk factors must be taken into consideration in BC management processes in the Gaza strip.

Histo-Phenotypic Aspects of Breast Cancer in Women under 40 Years Old, in Yaoundé

Introduction: Breast cancer is the most common cancer in women worldwide, with an increasing incidence. Although it is rare and no much studied in young women, it represents 7% of cases worldwide and often appears more aggressive with a poor prognosis compared to its counterpart in older women. The main objective of our study was to describe the histological and phenotypic aspects of breast cancer in women of age under 40. Methodology: We conducted a descriptive and analytical cross-sectional study, with retrospective collection of data over a period of 05 years. All women diagnosed with breast cancer were included and divided into 2 study groups: under 40 years old and over 40 years old. Data were analyzed using SPSS version 23.0 software, compared using the Chi square or Fisher exact test. A p value Results: We retained 196 files, either 89 for those under 40 and 107 for those over 40. Young patients with breast cancer had a higher stage, grade and tumor size. Lymph node involvement was more observed in women under 40 years (69.6% vs 53.2%). Older women were more likely to be hormone receptor positive (54.2% vs 38.2%);p = 0.018. HER-2 overexpression was higher in women younger than 40 years (39.32% vs 25.23%);p = 0.080 with a high Ki67 proliferation index (30.3% versus 2.8%);p 0.001. Triple-negative and Her-2 tumors were much more frequent in young women (48.3% vs. 36.4%;p = 0.063) and (17.97% vs. 10.3%;p = 0.125). Conclusion: Breast cancer in young women remains more aggressive and is dominated by triple negative and Her-2 phenotypes.

Systematic Analysis of Factors Associated with Late Breast Cancer Screening in Women in Sub-Saharan Africa from 2014 to 2020

Research background: Breast cancer remains a major public health problem, with a high number of new cases and deaths each year. However, despite advances in research to improve this disease, there is a high rate of late detection, leading to diagnosis at an advanced stage and a reduced chance of survival. Objective: The aim of this study is to identify the factors associated with late detection of breast cancer in women in Sub-Saharan Africa from 2014 to 2020.Setting: This systematic review focuses on sub-Saharan Africa. Methods: We searched for articles in four databases (PubMed, Embase, Global-Health and CINAHL) between 2014 and 2020 and performed a narrative synthesis to organize and group the different factors associated with late breast cancer detection. Result: After reviewing 583 publications, 6 studies were selected, highlighting factors such as lack of awareness, knowledge gaps, difficulties in accessing health services and financial constraints associated with late breast cancer screening. The participants, who ranged in number from 20 to 1776, were mainly aged between 18 and 25, with a mean age of 25 years and 6 months. Conclusion: The analysis enabled us to identify various factors associated with late breast cancer screening. Collaboration between health professionals, community organizations and policy-makers is essential to foster an environment conducive to the prevention and early detection of breast cancer.

Assessment of Breast Cancer Prevention Practices among Women Attending Primary Health Care in Abha City, Aseer Region, Saudi Arabia

Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.

THE STUDY ON RISK FACTORS ASSOCIATED WITH BREAST CANCER AMONG WOMEN IN TIANJIN, CHINA AND ADELAIDE, AUSTRALIA

To explore the possible explanation of the marked difference in the incidence of breast cancer between Chinese and Australian women, the authors have compared and analysed the results of two case-control studies completed recently in Tianjin, China and Adelaide, Australia. Of 10 known risk factors for breast cancer 9 were significantly higher in level in Adelaide women than in Tianjin women, i.e., women in Adelaide were much taller, heavier, more obese, earlier at menarche, later at first full-term pregnancy, more nulliparous, less parity, more in history of breast cancer in first degree relatives, more educated. From the 7 risk factors analysed by use of logistic regression model 5 factors, i.e., earlier age at menarche, later age at first full-term pregnancy, less parity, history of benign disease, and history of breast cancer in first degree relatives, were associated significantly with the increased risk for breast cancer in the Tianjin study, but not in Adelaide study. These factors being not associated with breast cancer in Adelaide women were unexpected. The explanation of the indefinite findings in Adelaide study was due to the fact that the level of the risk factor is universally high, relatively uniform and lack of categories. The difference in the risk factor distribution between cases and controle would not be seen in case-control studies, and significance of the risk factor therefore may not be found. According to data on diet survey in these two cities, the calories from fat was significantly higher in Adelaide women than in Tianjin women. The marked difference in incidence in women in the two cities resulted from the summing-up effect of a number of factors. The important role of fat intake in geographical incidence difference and in the development of breast cancer was also discussed.

Profiling and Determinants of Impaired Lipid Profile Parameters among Breast Cancer Women of Childbearing Age Living in Douala, Cameroon

Objective: Breast cancer in women of childbearing age (WCBA) is a major public health concern. This study aimed to determine variation and determinants in lipid profile among Cameroonian WCBA diagnosed with breast cancer. Materials and Methods: A case-control study took place at two reference hospitals in Douala, Cameroon. A total of 176 WCBA (88 cases and 88 controls) were finally enrolled. Interviewer-administered questionnaires were used to collect sociodemographic, behavioural, clinical and anthropometric data. Three millilitres of venous blood were collected for analysis of total cholesterol (TC), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) and triglycerides (TG). Results: Overweight was predominantly seen in cases and controls. Serum levels of TC and LDL-c were significantly lower in cancer women (167.02 ± 45.46 vs 183.12 ± 27.38 mg/dL, p = 0.005 for TC;85.83 ± 40.34 vs 105.25 ± 29.95 mg/dL, p = 0.0004 for LDL-c), while HDL-c levels were higher in controls (45.09 ± 7.20 vs 38.24 ± 11.14 mg/dL, p Conclusion: This study suggests the influence of breast cancer on lipid profile parameters especially HDL-c and LDL-c, and possibly their putative clinical utility for early diagnosis in premenopausal women in Cameroon.

Provision of Fertility Preservation for Young Women with Early-Stage Breast Cancer

Breast cancer is the most common cancer in women worldwide, constituting 25% of all cancer diagnoses. Even though it is only affecting 4% - 6% of women under the age of 40, it remains the most common malignancy among younger patients. Advancement in the treatment and earlier detection gives excellent 5 years of survival. However, the standard treatment that comprises surgical-chemo radiation therapy or hormonal treatment often results in an increased incidence of treatment-induced infertility. Therefore, adding fertility preservation to primary cancer treatment may offer the best opportunity for future fertility. However, despite advancements in Assisted Reproductive Technology (ART), the uptake of fertility services in this group remains low. In this review, we highlighted the effect of all breast cancer treatments on women’s fertility, the effectiveness and safety of ART in breast cancer patients as well as the safety of pregnancy in breast cancer survivors. Our aim is to improve awareness of fertility preservation for breast cancer to ensure all women diagnosed with breast cancer have multidisciplinary approaches with early referral to fertility specialists to discuss regarding potential risks and benefits of fertility preservation to improve the uptake of fertility preservation among this group of patients.

Level of Knowledge Regarding Breast Cancer among Women in the Commune of Parakou in 2021

Background: Women well-informed regarding breast cancer are often most conscious about their breast health and would therefore seek medical attention when detecting the initial symptoms. Objective: This study sought to identify factors associated with a good level of knowledge regarding breast cancer among women in the commune of Parakou in 2021. Method: This was a prospective cross-sectional study with descriptive and analytical purposes, carried out from June 5 to August 5, 2022, among women residing in the first district of the commune of Parakou. A pre-designed questionnaire set up with the Kobotoolbox server was used for data collection through a cluster survey sampling technique. Pearson’s chi-square test was implemented to determine associations between variables. Result: A total of 630 women were included in this study. The prevalence of women well-informed about breast cancer was 21.75% (95% CI = [18.70 - 25.13]). Factors associated with good knowledge regarding breast cancer were age group (p-value < 0.001), school level (p-value < 0.001), occupation (p-value < 0.001), and regular attendance at a health facility (p-value Conclusion: Several women remain unaware of breast cancer in the commune of Parakou. A huge effort is still needed to increase the level of coverage of information regarding breast cancer and its prevention methods.

Women’s Awareness of Mammographic Screening for Breast Cancer in Togo

Breast cancer represents a real public health problem due to its increasing frequency, its seriousness and its psycho-social implications. The aims of this study were to determine the level of awareness of women on the performance of mammography in the diagnosis and screening for breast cancer. This was a cross-sectional study over a period of 4 months (from October 1, 2016 to January 31, 2017) in Togo. It consisted in completing a questionnaire distributed to women above 30 years of age. The mean age of the women was 42 years. 88.8% of them had heard of breast cancer. There was a link between age, occupation, level of education and awareness of breast cancer. Only 20.8% of women had heard of mammography, with a link between awareness of mammography and age, occupation, and level of education. A link was noted between awareness of breast cancer and awareness of mammography. Information on mammographic breast cancer screening is inadequate in Togo.

Association between Polymorphisms of SNPs Located at the 3’-Untranslated Region of SET8 and Codon 72 of the TP53 with Breast Cancer among Cameroonian Women

In sub-Saharan Africa, breast cancer (BC) constitutes a serious public health problem and the genetic basis of its development is remaining poorly understood. Although the SNPs at codon 72 of TP53 (rs1042522) and at the UTR of SET8 (rs16917496) have both been associated with BC development among Asian and European women, no published data has been reported within African population. We herein report on the impact of these polymorphisms on the risk of BC among Cameroonian women. Blood samples were collected from 111 breast cancer patients and 224 controls. DNA was extracted from each sample and PCR-RFLP was used to investigate the polymorphisms at SNPs rs1042522 of TP53 and rs16917496 of SET8. Association studies were performed according to ethno-linguistic groups and menopausal status. The minor allele “T” of SET8 gene revealed a protective effect in premenopausal women (OR, 0.327;95% CI 0.125 - 0.852) while the CT genotype of SET8 was associated with increased risk of BC (OR, 2.93;95% CI, 1.1 - 7.8). The minor “G” allele of TP53 gene was significantly associated (OR, 2.533;95% CI, 1.455 - 4.408) with increased disease risk in premenopausal women while the CG genotype was significantly associated (OR, 0.39;95% CI, 0.23 - 0.69) with decreased risk of BC. A synergistic genetic interaction at both loci for CC genotype of SET8 and CG genotype of TP53 was associated (OR, 0.46;95% CI, 0.24 - 0.91) with reduced disease risk. No significant association between polymorphisms at the SET8 and TP53 loci and clinical pathologic features of BC was observed. This study suggests significant associations between the SNPs located at the 3’-UTR of SET8 and codon 72 of the TP53 with the risk of breast cancer development among premenopausal women. There is an interaction between TP53 and SET8 genes.

Knowledge of Risk Factors and Means of Breast Cancer Screening by Women Seen in Gynecological Consultation at Sylvanus Olympio University Hospital-Lome Togo

Background: In Togo, awareness is very low and patients regularly present with advanced stages of breast cancer. Objective: Determine the knowledge of risk factors and means of breast cancer screening by women seen in gynecological consultation of the Sylvanus Olympio University Hospital (CHU SO). Methods: This was a descriptive cross-sectional study conducted at the gynecology-obstetrics clinic of the CHU SO of Lomé, from March 1 to July 15, 2022. Results: We surveyed 1,566 gynaecological outpatients. Six hundred (600) patients agreed to answer our questions freely, giving a participation rate of 38.3%. The average age of the respondents was 31.9 years old. In 25.5% of cases, the respondents were high school graduates. Five hundred and forty-five of the respondents, or 90.8% had already heard of breast cancer. The most frequent sources of information were medical staff in 34.1% of cases. The presence of nodule in the breast was cited as a clinical sign in 68.4% of cases, breast self-examination as a means of screening in 72.6% of cases, personal history of breast cancer in 51.7% of the cases has non-modifiable risks and smoking as a modifiable risk factor by 58.9% of the respondents. In 31% of cases, they performed breast cancer screening on their own. Breast self-examination was performed by 27.7% of them. Occupation and level of study were statistically associated with women’s knowledge of breast cancer. Conclusion: Most women recognize the existence of breast cancer but their knowledge about signs and risk factors remains low. Few of them, practice screening.

Locally Advanced Breast Cancer in Pakistani Women: What Is Different from Rest of the World and Why It Is Difficult to Manage

Locally Advance Breast Cancer refers to a heterogeneous group of breast cancer with locally extensive disease, which may or may not involve the nodes, without any distant metastases. The study was conducted at Faisalabad Medical University (FMU), Oncology, Allied Hospital Faisalabad (Pakistan). Data of 100 patients with LABC was collected. Demographics were recorded in the form of age, socio-economic status. In clinical data, time of presentation, family history of breast cancer, the presenting symptom in the form of lump, ulceration and other skin changes were noted. Histo-pathological variables including tumor size, histopathology, Bloom & Richardson grading, estrogen receptor (ER), progesterone receptor status (PR) and HER2 status. Results showed that after following a standard trimodality treatment approach in LABC patients, 30 percent died within two years. Disease free survival for more than two years was observed in only 25% of patients. Whereas, 70% patients had eventful (Recurrence/metastases) survival. This poor outcome was observed due to lack of health care facilities, awareness and poor socioeconomic status.

The Unmet Needs of African American Women with Breast Cancer

Breast cancer is the most common cancer in women and treatment includes various combinations of surgery, chemotherapy, and/or hormone therapy. The multimodal treatment of breast cancer improves survival outcomes, but it also contributes to a prolonged period of medical intervention with associated physical and emotional consequences. However, we know less about the specific clinical experiences of African American (AA) women during treatment for breast cancer and in survivorship. The studies that have addressed the issue of breast cancer in AA women have focused primarily on early detection and epidemiological variables such a screening, mortality and staging at diagnosis. In our study, in-depth semi-structured phone interviews were conducted to explore the clinical experiences, concerns and needs of AA women who had survived breast cancer. The AA women reported that their physicians did not provide adequate disease and treatment information;did not discuss clinical trials with them;and did not offer access to support services.

Participation in Daily Activities among Working Women Following Breast Cancer

Introduction: This study aimed to identify the variables explaining retained activity level for working women with breast cancer;the variables correlating with their performance in daily activities they prioritize;and factors facilitating or restricting their return to work. Method: Sixty working women with breast cancer aged 25 - 65 years completed a personal data questionnaire, the modified Activity Card Sort, the Canadian Occupational Performance Measure;and two open- ended questions about facilitators and barriers to work. Results: Activity levels dropped by a quarter following BC treatments. Most women (67%) decreased their weekly working hours, although a third identified work as their highest priority. A higher total retained activity level was explained by fewer limitations on the range of motion (upper extremity), age younger than 45 years, and higher educational attainment. Cognitive limitations and limited range of motion negatively correlated with retained activity level at work. Personal and disease factors, job demands, and environmental factors facilitated or restricted return to work. Conclusion: Interventions should focus on physical and cognitive rehabilitation to regain functioning in the context of work and productive daily activities. Special attention should be paid to the greater needs of younger women.

Knowledge on breast cancer and its prevention among women household heads in Northern Ethiopia

Background: Breast cancer (BC) is one of the malignant diseases taking the lion’s share role in the devastating effects caused by cancer. BC related awareness and practice of females are known to have crucial contribution in the prevention and control efforts. The worst aspects of the disease in Ethiopia include absence of research and thus very limited information on any aspect. The study assessed knowledge and practice on BC among women household heads. Methods: A cross-sectional study was conducted on a sample of 845 women. The sample size was divided among five randomly selected kebeles (smallest government administrative units) proportional to the number of households. Samples were selected by systematic sampling technique. Data were collected by trained data collectors through a face-to-face interview using pre-tested, semi-structured questionnaire from female household heads. Pearson chi-square and logistic regression tests were used to assess the determinants of BC knowledge and breast cancer self examination (BSE) practice. Results: The respondents’ age ranged from 20 to 75 years with a mean age of 33.66 ± 10.8. Onefifth (19.8%) of the respondents were illiterate, while 257 (31.8%) had primary education. Majority of them were married 548 (67.7%), Orthodox Christians 649 (80.4%), and housewives 365 (45.1%). Only 675 (83.4%) of the respondents have ever heard/read about BC. Media 399 (59.1%) and colleagues/friends/neighbors 200 (29.6%) were the major information sources. Only 86 (12.7%) of the respondents had a high BC knowledge. Even though 304 (45%) of the BC informed participants had information on BSE, only 163 (53.6%) of them have ever done it. Both BC knowledge and BSE practice were significantly affected by educational level. Conclusion: Majority of women household heads in Mekelle town had low knowledge and insufficient BC related practices. The region’s health bureau and local mass-media need to work on breast cancer awareness and practice of the women in the town.

Magnetic Resonance Imaging for Screening of Woman at High-Risk of Breast Cancer

MRI is an excellent option for detection of breast cancer for some selected groups, including those patients with a high probability to hit the disease. However, the high costs and low availability of the device have led to a decline in the application of imaging MRI. The aim of this study was to review usefulness of MRI as a new complementary way to detect breast cancer in routine annual checkup for women breasts of certain ages and breast mass. A cross-sectional Descriptive MRI study was performed on 105 asymptomatic women with a mean age of 49 years. The study group with at least one risk factor of breast cancer were presenting for routine annual screening or follow up at King Abdulaziz University Hospital in Jeddah. It has been found that, 48 patients had biopsy, they were recommended by magnetic resonance imaging and only 14 had positive results, while magnetic resonance imaging suggested 16 and mammography had 62 positive results. Magnetic resonance imaging is not recommended for the average-risk or the general population either;it had been advised for screening the high-risk women of breast cancer. Sensitivity of magnetic resonance imaging has been found to be much higher than of mammography but specificity was generally lower. We propose that it is reasonable to consider MRI as a complement to mammography in screening patients who were at high risk for breast cancer because Magnetic Resonance Imaging can detect small foci that are occult in mammography but we don’t advise to check with the general population.

Common non-synonymous polymorphisms in the BRCA1 Associated RING Domain (BARD1) gene are associated with breast cancer susceptibility:a case-control analysis

The BRCA1 Associated RING Domain(BARD1) gene has been identified as a high penetrance gene for breast cancer, whose germline and somatic mutations were reported in both non-BRCA1/2 hereditary site-specific and sporadic breast cancer cases. BARD1 plays a crucial role in tumor repression, along with its heterodimeric partner BRCA1. In the current study, we tested the hypothesis that common non-synonymous polymorphisms in BARD1 are associated with breast cancer susceptibility in a case-control study of 507 patients with incident breast cancer and 539 frequency-matched cancer-free controls in Chinese women. We genotyped all three common(minor allele frequency (MAF) > 0.10) non-synonymous polymorphisms(Pro24Ser, Arg378Ser, and Val507Met) in BARD1. We found that the BARD1 Pro24Ser variant genotypes(24Pro/Ser and 24Ser/Ser) and Arg378Ser variant homozygote 378Ser/Ser were associated with a significantly decreased breast cancer risk, compared with their wild-type homozygotes, respectively. Furthermore, a significant locus-locus interaction was evident between Pro24Ser and Arg378Ser (P-int = 0.032). Among the 378Ser variant allele carriers, the 24Pro/Pro wild-type homozygote was associated with a significantly increased breast cancer risk (adjusted OR = 1.81, 95% CI = 1.11-2.95), but the subjects having 24Pro/Ser or Ser/Ser variant genotypes had a significantly decreased risk(adjusted OR = 0.74, 95% CI = 0.56-0.99). In stratified analysis, this locus-locus interaction was more evident among subjects without family cancer history, those with positive estrogen receptor (ER) and individuals with negative progesterone receptor(PR). These findings indicate that the potentially functional polymorphisms Pro24Ser and Arg378Ser in BARD1 may jointly contribute to the susceptibility of breast cancer.

Breast Cancer Paradox: High Curability versus High Mortality from a Gender Perspective

Despite being considered a potentially curable disease, breast cancer is the most frequent cause of cancer death in women worldwide, establishing the following paradox: high curability versus high mortality. Among the conditions conducive to this situation, such as difficult access to diagnosis and treatment and social support by the State, there is the need to discuss the impact of women’s caregiving, the backbone of the female gender role, on self-care in health. Gender has a powerful effect on determining health status: it may limit different rates of exposure to certain risks, different patterns in the quest for treatment or differential impacts of the social and economic determinants of health. The study shows the results of a qualitative methodology with nine women aged 48 to 74 years with varying levels of schooling and socioeconomic status, who had breast cancer at some stage of adult life and who regularly attend a nongovernmental organization (NGO) to support women with breast cancer, in the city of Niterói (Rio de Janeiro, Brazil). The participants’ discourses evidenced the idea of the primacy of the caregiving, the idealized image of the warrior woman and their self-neglect and State’s care as elements of the potential impact on the choices of these women concerning self-care, and consequently in their experiences of illness.