Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Procedure
2.4. Assessments
2.5. Statistical Analyzis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Siegel, R.L.; Miller, K.D.; Wagle, N.S.; Jemal, A. Cancer Statistics, 2023. CA Cancer J. Clin. 2023, 73, 17–48. [Google Scholar] [CrossRef] [PubMed]
- Miller, K.D.; Nogueira, L.; Devasia, T.; Mariotto, A.B.; Yabroff, K.R.; Jemal, A.; Kramer, J.; Siegel, R.L. Cancer Treatment and Survivorship Statistics, 2022. CA Cancer J. Clin. 2022, 72, 409–436. [Google Scholar] [CrossRef] [PubMed]
- Pierrisnard, C.; Baciuchka, M.; Mancini, J.; Rathelot, P.; Vanelle, P.; Montana, M. Body Image and Psychological Distress in Women with Breast Cancer: A French Online Survey on Patients’ Perceptions and Expectations. Breast Cancer 2018, 25, 303–308. [Google Scholar] [CrossRef] [PubMed]
- Brederecke, J.; Heise, A.; Zimmermann, T. Body Image in Patients with Different Types of Cancer. PLoS ONE 2021, 16, e0260602. [Google Scholar] [CrossRef] [PubMed]
- Erturhan Turk, K.; Yilmaz, M. The Effect on Quality of Life and Body Image of Mastectomy Among Breast Cancer Survivors. Eur. J. Breast Health 2018, 14, 205–210. [Google Scholar] [CrossRef]
- Ding, Y.; Tong, Z.; Jin, L.; Ye, B.; Zhou, J.; Sun, Z.; Yang, H.; Hong, L.; Huang, F.; Wang, W.; et al. An NIR Discrete Metallacycle Constructed from Perylene Bisimide and Tetraphenylethylene Fluorophores for Imaging-Guided Cancer Radio-Chemotherapy. Adv. Mater. 2022, 34, 2106388. [Google Scholar] [CrossRef]
- Yan, M.; Zhou, J. Suprasomes: An Emerging Platform for Cancer Theranostics. Sci. China Chem. 2023, 66, 613–614. [Google Scholar] [CrossRef]
- Fiser, C.; Crystal, J.S.; Tevis, S.E.; Kesmodel, S.; Rojas, K.E. Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors. Breast Cancer Targets Ther. 2021, 13, 701–709. [Google Scholar] [CrossRef]
- Gargantini, A.C.G.; Martín Casari, L. Imagen Corporal y su Influencia en la Calidad de Vida en mujeres con mastectomía. Comparación entre mujeres con reconstrucción inmediata, reconstrucción diferida o sin reconstrucción. Psicooncología 1970, 16, 43–60. [Google Scholar] [CrossRef] [Green Version]
- Jáuregui-Lobera, I.; Ríos, P.B. Body Image and Quality of Life in a Spanish Population. Int. J. Gen. Med. 2011, 4, 63–72. [Google Scholar] [CrossRef] [Green Version]
- Fernández-Bustos, J.-G.; González-Martí, I.; Contreras, O.; Cuevas, R. Relación entre imagen corporal y autoconcepto físico en mujeres adolescentes. Rev. Latinoam. Psicol. 2015, 47, 25–33. [Google Scholar] [CrossRef] [Green Version]
- Rosenberg, M. Society and the Adolescent Self-Image; Princeton University Press: Princeton, NJ, USA, 1965; 326p. [Google Scholar]
- Montt, M.E.; Ulloa Chavez, F. Autoestima y Salud Mental En Los Adolescentes. Salud Ment. 1996, 19, 30–35. [Google Scholar]
- Kolodziejczyk, A.; Pawłowski, T. Negative Body Image in Breast Cancer Patients. Adv. Clin. Exp. Med. 2019, 28, 1137–1142. [Google Scholar] [CrossRef]
- Rezaei, M.; Elyasi, F.; Janbabai, G.; Moosazadeh, M.; Hamzehgardeshi, Z. Factors Influencing Body Image in Women with Breast Cancer: A Comprehensive Literature Review. Iran. Red Crescent Med. J. 2016, 18, e39465. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liu, Y.; Liu, W.; Ma, Y.; Yang, X.; Zhou, H.; Zhang, T.; Shao, S. Research on Body Image Cognition, Social Support and Illness Perception in Breast Cancer Patients with Different Surgical Methods. Front. Psychol. 2022, 13, 931679. [Google Scholar] [CrossRef]
- Brunet, J.; Price, J.; Harris, C. Body Image in Women Diagnosed with Breast Cancer: A Grounded Theory Study. Body Image 2022, 41, 417–431. [Google Scholar] [CrossRef] [PubMed]
- An, J.; Zhou, K.; Li, M.; Li, X. Assessing the Relationship between Body Image and Quality of Life among Rural and Urban Breast Cancer Survivors in China. BMC Womens Health 2022, 22, 61. [Google Scholar] [CrossRef]
- Davis, C.; Tami, P.; Ramsay, D.; Melanson, L.; MacLean, L.; Nersesian, S.; Ramjeesingh, R. Body Image in Older Breast Cancer Survivors: A Systematic Review. Psychooncology 2020, 29, 823–832. [Google Scholar] [CrossRef]
- Lewis-Smith, H.; Diedrichs, P.C.; Harcourt, D. A Pilot Study of a Body Image Intervention for Breast Cancer Survivors. Body Image 2018, 27, 21–31. [Google Scholar] [CrossRef]
- Ganz, P.A.; Desmond, K.A.; Belin, T.R.; Meyerowitz, B.E.; Rowland, J.H. Predictors of Sexual Health in Women After a Breast Cancer Diagnosis. J. Clin. Oncol. 1999, 17, 2371. [Google Scholar] [CrossRef]
- Miaja, M.; Platas, A.; Martinez-Cannon, B.A. Psychological Impact of Alterations in Sexuality, Fertility, and Body Image in Young Breast Cancer Patients and Their Partners. Rev. Investig. Clin. 2017, 69, 111. [Google Scholar] [CrossRef] [PubMed]
- Tsai, H.-Y.; Kuo, R.N.-C.; Chung, K. Quality of Life of Breast Cancer Survivors Following Breast-Conserving Therapy versus Mastectomy: A Multicenter Study in Taiwan. Jpn. J. Clin. Oncol. 2017, 47, 909–918. [Google Scholar] [CrossRef] [Green Version]
- Landero, R.; González, M.-T. Variables psicosociales como predictoras de la salud en mujeres. Rev. Psicol. Soc. 2004, 19, 255–264. [Google Scholar] [CrossRef]
- Gómez-Campelo, P.; Bragado-Álvarez, C.; Hernández-Lloreda, M.J.; Sánchez-Bernardos, M.L. The Spanish Version of the Body Image Scale (S-BIS): Psychometric Properties in a Sample of Breast and Gynaecological Cancer Patients. Support. Care Cancer 2015, 23, 473–481. [Google Scholar] [CrossRef]
- Hopwood, P.; Fletcher, I.; Lee, A.; Al Ghazal, S. A Body Image Scale for Use with Cancer Patients. Eur. J. Cancer 2001, 37, 189–197. [Google Scholar] [CrossRef] [PubMed]
- Rhondali, W.; Chisholm, G.B.; Filbet, M.; Kang, D.-H.; Hui, D.; Cororve Fingeret, M.; Bruera, E. Screening for Body Image Dissatisfaction in Patients with Advanced Cancer: A Pilot Study. J. Palliat. Med. 2015, 18, 151–156. [Google Scholar] [CrossRef] [Green Version]
- Morone, G.; Iosa, M.; Fusco, A.; Scappaticci, A.; Alcuri, M.R.; Saraceni, V.M.; Paolucci, S.; Paolucci, T. Effects of a Multidisciplinary Educational Rehabilitative Intervention in Breast Cancer Survivors: The Role of Body Image on Quality of Life Outcomes. Sci. World J. 2014, 2014, 451935. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moreira, H.; Canavarro, M.C. A Longitudinal Study about the Body Image and Psychosocial Adjustment of Breast Cancer Patients during the Course of the Disease. Eur. J. Oncol. Nurs. 2010, 14, 263–270. [Google Scholar] [CrossRef]
- McDermott, E.; Moloney, J.; Rafter, N.; Keegan, D.; Byrne, K.; Doherty, G.A.; Cullen, G.; Malone, K.; Mulcahy, H.E. The Body Image Scale: A Simple and Valid Tool for Assessing Body Image Dissatisfaction in Inflammatory Bowel Disease. Inflamm. Bowel Dis. 2014, 20, 286–290. [Google Scholar] [CrossRef] [PubMed]
- Morejón, A.J.V.; García-Bóveda, R.J.; Jiménez, R.V.-M. Escala de autoestima de Rosenberg: Fiabilidad y validez en población clínica española. Apunt. Psicol. 2004, 22, 10. [Google Scholar]
- Tinakon, W.; Nahathai, W. A Comparison of Reliability and Construct Validity between the Original and Revised Versions of the Rosenberg Self-Esteem Scale. Psychiatry Investig. 2012, 9, 54. [Google Scholar] [CrossRef] [Green Version]
- Alvarez-Pardo, S.; Romero-Pérez, E.M.; Camberos-Castañeda, N.; de Paz, J.A.; Horta-Gim, M.A.; González-Bernal, J.J.; Mielgo-Ayuso, J.; Simón-Vicente, L.; Fernández-Solana, J.; González-Santos, J. Quality of Life in Breast Cancer Survivors in Relation to Age, Type of Surgery and Length of Time since First Treatment. Int. J. Environ. Res. Public Health 2022, 19, 16229. [Google Scholar] [CrossRef]
- Álvarez-Pardo, S.; de Paz, J.A.; Romero-Pérez, E.M.; Tánori-Tapia, J.M.; Rendón-Delcid, P.A.; González-Bernal, J.J.; Fernández-Solana, J.; Simón-Vicente, L.; Mielgo-Ayuso, J.; González-Santos, J. Related Factors with Depression and Anxiety in Mastectomized Women Breast Cancer Survivors. Int. J. Environ. Res. Public Health 2023, 20, 2881. [Google Scholar] [CrossRef]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; L. Erlbaum Associates: Hillsdale, NJ, USA, 1988; ISBN 978-0-8058-0283-2. [Google Scholar]
- Izydorczyk, B.; Kwapniewska, A.; Lizinczyk, S.; Sitnik-Warchulska, K. Psychological Resilience as a Protective Factor for the Body Image in Post-Mastectomy Women with Breast Cancer. Int. J. Environ. Res. Public Health 2018, 15, 1181. [Google Scholar] [CrossRef] [Green Version]
- Sebastián, J.; Manos, D.; Bueno, M.J.; Mateos, N. Imagen Corporal y Autoestima en Mujeres con Cáncer de Mama Participantes en un Programa de Intervención Psicosocial. Clínica Salud 2007, 18, 137–161. [Google Scholar]
- Rosenberg, S.M.; Dominici, L.S.; Gelber, S.; Poorvu, P.D.; Ruddy, K.J.; Wong, J.S.; Tamimi, R.M.; Schapira, L.; Come, S.; Peppercorn, J.M.; et al. Association of Breast Cancer Surgery with Quality of Life and Psychosocial Well-Being in Young Breast Cancer Survivors. JAMA Surg. 2020, 155, 1035. [Google Scholar] [CrossRef] [PubMed]
- Al-Ghazal, S.; Sully, L.; Fallowfield, L.; Blamey, R. The Psychological Impact of Immediate Rather than Delayed Breast Reconstruction. Eur. J. Surg. Oncol. EJSO 2000, 26, 17–19. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wu, T.-Y.; Chang, T.-W.; Chang, S.-M.; Lin, Y.-Y.; Wang, J.-D.; Kuo, Y.-L. Dynamic Changes of Body Image and Quality of Life in Breast Cancer Patients. Cancer Manag. Res. 2019, 11, 10563–10571. [Google Scholar] [CrossRef] [Green Version]
- Fernández, A.I. Alteraciones Psicológicas Asociadas a los Cambios en la Apariencia Física en Pacientes Oncológicos. Psicooncología 2004, 1, 12. [Google Scholar]
- Paterson, C.L.; Lengacher, C.A.; Donovan, K.A.; Kip, K.E.; Tofthagen, C.S. Body Image in Younger Breast Cancer Survivors: A Systematic Review. Cancer Nurs. 2016, 39, E39–E58. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hubbeling, H.G.; Rosenberg, S.M.; González-Robledo, M.C.; Cohn, J.G.; Villarreal-Garza, C.; Partridge, A.H.; Knaul, F.M. Psychosocial Needs of Young Breast Cancer Survivors in Mexico City, Mexico. PLoS ONE 2018, 13, e0197931. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Thornton, M.; Lewis-Smith, H. “I Listen to My Body Now”: A Qualitative Exploration of Positive Body Image in Breast Cancer Survivors. Psychol. Health 2021, 38, 249–268. [Google Scholar] [CrossRef] [PubMed]
- Spatuzzi, R.; Vespa, A.; Lorenzi, P.; Miccinesi, G.; Ricciuti, M.; Cifarelli, W.; Susi, M.; Fabrizio, T.; Ferrari, M.G.; Ottaviani, M.; et al. Evaluation of Social Support, Quality of Life, and Body Image in Women with Breast Cancer. Breast Care 2016, 11, 28–32. [Google Scholar] [CrossRef] [Green Version]
- Pons-Rodríguez, A.; Martínez-Alonso, M.; Perestelo-Pérez, L.; Garcia, M.; Sala, M.; Rué, M.; Cardona, À.; Codern, N.; Àrea, Q.; Perestelo-Pérez, L.; et al. Elección informada en el cribado del cáncer de mama: El papel del nivel educativo. Gac. Sanit. 2021, 35, 243–249. [Google Scholar] [CrossRef]
- Solikhah, S.; Promthet, S.; Hurst, C. Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women. Asian Pac. J. Cancer Prev. 2019, 20, 877–884. [Google Scholar] [CrossRef]
- Coughlin, S.S. Social Determinants of Breast Cancer Risk, Stage, and Survival. Breast Cancer Res. Treat. 2019, 177, 537–548. [Google Scholar] [CrossRef]
- Casellas-Grau, A.; Font, A.; Vives, J. Positive Psychology Interventions in Breast Cancer. A Systematic Review: Positive Interventions in Breast Cancer. Psychooncology 2014, 23, 9–19. [Google Scholar] [CrossRef] [PubMed]
- Frank, C.; Land, W.M.; Schack, T. Mental Representation and Learning: The Influence of Practice on the Development of Mental Representation Structure in Complex Action. Psychol. Sport Exerc. 2013, 14, 353–361. [Google Scholar] [CrossRef]
- Mellalieu, S.D.; Neil, R.; Hanton, S.; Fletcher, D. Competition Stress in Sport Performers: Stressors Experienced in the Competition Environment. J. Sports Sci. 2009, 27, 729–744. [Google Scholar] [CrossRef]
- Hanin, Y. From Anxiety to Performance-Related Emotions in Top-Level Sport. Kalokagathia 2009, 2, 59–76. [Google Scholar]
- John, D.S.; Verma, D.S.K.; Khanna, D.G.L. The Effect of Mindfulness Meditation on HPA-Axis in Pre-Competition Stress in Sports Performance of Elite Shooters. Natl. J. Integr. Res. Med. 2011, 2, 15–21. [Google Scholar]
- Sherman, K.A.; Przezdziecki, A.; Alcorso, J.; Kilby, C.J.; Elder, E.; Boyages, J.; Koelmeyer, L.; Mackie, H. Reducing Body Image–Related Distress in Women with Breast Cancer Using a Structured Online Writing Exercise: Results from the My Changed Body Randomized Controlled Trial. J. Clin. Oncol. 2018, 36, 1930–1940. [Google Scholar] [CrossRef] [PubMed]
- Kowalczyk, R.; Nowosielski, K.; Cedrych, I.; Krzystanek, M.; Glogowska, I.; Streb, J.; Kucharz, J.; Lew-Starowicz, Z. Factors Affecting Sexual Function and Body Image of Early-Stage Breast Cancer Survivors in Poland: A Short-Term Observation. Clin. Breast Cancer 2019, 19, e30–e39. [Google Scholar] [CrossRef] [Green Version]
- Sebri, V.; Durosini, I.; Triberti, S.; Pravettoni, G. The Efficacy of Psychological Intervention on Body Image in Breast Cancer Patients and Survivors: A Systematic-Review and Meta-Analysis. Front. Psychol. 2021, 12, 611954. [Google Scholar] [CrossRef] [PubMed]
- Morales-Sánchez, L.; Luque-Ribelles, V.; Gil-Olarte, P.; Ruiz-González, P.; Guil, R. Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 1640. [Google Scholar] [CrossRef]
- Ussher, J.M.; Perz, J.; Gilbert, E. Changes to Sexual Well-Being and Intimacy After Breast Cancer. Cancer Nurs. 2012, 35, 456–465. [Google Scholar] [CrossRef]
- Awick, E.A.; Phillips, S.M.; Lloyd, G.R.; McAuley, E. Physical Activity, Self-Efficacy and Self-Esteem in Breast Cancer Survivors: A Panel Model: Physical Activity and Self-Esteem in Breast Cancer Survivors. Psychooncology 2017, 26, 1625–1631. [Google Scholar] [CrossRef] [PubMed]
Variable | Group | p | Cohen’s d | 95% (CI) | |
---|---|---|---|---|---|
Age | <50 years (n = 86) | ≥50 years (n = 112) | |||
5.82 ± 6.20 | 4.25 ± 4.76 | 0.046 | −0.289 | −0.572 to −0.007 | |
Elapsed years | <5 years (n = 145) | ≥5 years (n = 53) | |||
5.09 ± 5.59 | 4.50 ± 5.20 | 0.506 | −0.107 | −0.422 to 0.207 | |
Type of surgery | Mastectomy (n = 72) | Breast-conserving therapy (n = 126) | |||
4.43 ± 5.94 | 5.23 ± 5.20 | 0.325 | 0.146 | −0.144 to 0.436 | |
Receiving treatment | Without receiving treatment (n = 103) | Receiving treatment (n = 95) | |||
4.99 ± 5.08 | 4.88 ± 5.91 | 0.892 | −0.020 | −0.299 to 0.259 | |
Reconstruction | Without reconstruction (n= 185) | With reconstruction (n = 13) | |||
4.91 ± 5.51 | 5.23 ± 5.15 | 0.843 | 0.058 | −0.504 to 0.621 | |
Family history | Without medical history (n = 49) | With medical history (n = 149) | |||
3.87 ± 4.75 | 5.28 ± 5.67 | 0.118 | 0.258 | −0.065 to 0.582 | |
Marital status | Without partner (n = 46) | With partner (n = 152) | |||
5.13 ± 6.01 | 4.88 ± 5.32 | 0.788 | −0.046 | −0.375 to 0.284 | |
Employment situation | Unemployed (n = 141) | Employee (n = 57) | |||
4.99 ± 5.57 | 4.80 ± 5.27 | 0.830 | −0.035 | −0.342 to 0.273 | |
Level of education | Up to secondary school (n = 117) | From secondary school (n = 81) | |||
4.15 ± 4.97 | 6.07 ± 5.99 | 0.015 | 0.355 | 0.069 to 0.640 | |
Knowledge of diagnosis | No or slightly (n = 77) | Yes with knowledge (n = 121) | |||
5.07 ± 5.40 | 4.85 ± 5.54 | 0.777 | −0.040 | −0.326 to 0.246 | |
Sense of humor | Without sense of humor (n = 21) | With sense of humor (n = 177) | |||
7.61 ± 6.26 | 4.62 ± 5.31 | 0.017 | −0.552 | −1.008 to −0.097 | |
Psychological support | Without psychological support (n = 120) | With psychological support (n = 78) | |||
4.80 ± 5.69 | 5.15 ± 5.15 | 0.658 | 0.064 | −0.221 to 0.349 |
Variable | Group | p | Cohen’s d | 95% (CI) | |
---|---|---|---|---|---|
Age | <50 years (n = 86) | ≥50 years (n = 112) | |||
35.19 ± 5.73 | 36.64 ± 3.91 | 0.517 | 0.303 | 0.020 to 0.586 | |
Elapsed years | <5 years (n = 145) | ≥5 years (n = 53) | |||
35.20 ± 5.05 | 36.13 ± 3.89 | 0.225 | 0.195 | −0.120 to 0.510 | |
Type of surgery | Mastectomy (n = 72) | Breast-conserving therapy (n = 126) | |||
35.61 ± 3.97 | 35.35 ± 5.19 | 0.720 | −0.054 | −0.344 to 0.235 | |
Treatment | Without treatment (n = 103) | With treatment (n = 95) | |||
35.01 ± 5.45 | 35.91 ± 3.90 | 0.188 | 0.189 | −0.091 to 0.468 | |
Reconstruction | Without reconstruction (n= 185) | With reconstruction (n = 13) | |||
35.29 ± 4.88 | 37.69 ± 1.84 | 0.080 | 0.505 | −0.059 to 1.070 | |
Family history | Without medical history (n = 49) | With medical history (n = 149) | |||
36.89 ± 3.03 | 34.97 ± 5.14 | 0.014 | −0.408 | −0.733 to −0.083 | |
Marital status | Without partner (n = 46) | With partner (n = 152) | |||
36.00 ± 3.27 | 35.28 ± 5.14 | 0.374 | −0.151 | −0.481 to 0.179 | |
Employment situation | Unemployed (n = 141) | Employee (n = 57) | |||
35.14 ± 5.06 | 36.19 ± 3.92 | 0.165 | 0.220 | −0.088 to 0.529 | |
Level of education | Up to secondary school (n = 117) | From secondary school (n = 81) | |||
35.35 ± 5.11 | 35.59 ± 4.28 | 0.727 | 0.050 | −0.233 to 0.333 | |
Knowledge of diagnosis | No or slightly (n = 77) | Yes with knowledge (n = 121) | |||
34.64 ± 5.82 | 35.95 ± 3.91 | 0.060 | 0.276 | −0.011 to 0.563 | |
Sense of humor | Without sense of humor (n = 21) | With sense of humor (n = 177) | |||
32.14 ± 5.35 | 35.84 ± 4.56 | 0.001 | 0.796 | 0.337 to 1.255 | |
Psychological support | Without psychological support (n = 120) | With psychological support (n = 78) | |||
35.35 ± 4.19 | 35.60 ± 5.58 | 0.717 | 0.052 | −0.233 to 0.337 |
Unstandardized | Standardized Coefficients | ||||
---|---|---|---|---|---|
Model | B | Std. Error | Beta | t | Sig. |
(Constant) | 4.905 | 1.664 | 2.948 | 0.004 | |
Educational level | 1.781 | 0.777 | 0.160 | 2.292 | 0.023 |
Sense of humor | −2.769 | 1.241 | −0.156 | −2.232 | 0.027 |
Dependent variable Body image R2 = 0.044 | |||||
Unstandardized | Standardized Coefficients | ||||
Model | B | Std. Error | Beta | t | Sig. |
(Constant) | 35.581 | 1.689 | 21.072 | 0.000 | |
Sense of humor | 3.520 | 1.055 | 0.227 | 3.337 | 0.001 |
Family history | −1.970 | 0.757 | −0.178 | −2.604 | 0.010 |
Reconstruction | 2.650 | 1.317 | 0.138 | 2.012 | 0.046 |
Dependent variable Self Esteem R2 = 0.019 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Álvarez-Pardo, S.; De Paz, J.A.; Montserrat Romero-Pérez, E.; Portilla-Cueto, K.M.; Horta-Gim, M.A.; González-Bernal, J.J.; Fernández-Solana, J.; Mielgo-Ayuso, J.; García-Valverde, A.; González-Santos, J. Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors. Int. J. Environ. Res. Public Health 2023, 20, 5154. https://doi.org/10.3390/ijerph20065154
Álvarez-Pardo S, De Paz JA, Montserrat Romero-Pérez E, Portilla-Cueto KM, Horta-Gim MA, González-Bernal JJ, Fernández-Solana J, Mielgo-Ayuso J, García-Valverde A, González-Santos J. Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors. International Journal of Environmental Research and Public Health. 2023; 20(6):5154. https://doi.org/10.3390/ijerph20065154
Chicago/Turabian StyleÁlvarez-Pardo, Sergio, José Antonio De Paz, Ena Montserrat Romero-Pérez, Kora Mónica Portilla-Cueto, Mario A. Horta-Gim, Jerónimo J. González-Bernal, Jessica Fernández-Solana, Juan Mielgo-Ayuso, Adrián García-Valverde, and Josefa González-Santos. 2023. "Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors" International Journal of Environmental Research and Public Health 20, no. 6: 5154. https://doi.org/10.3390/ijerph20065154