Development and Psychometric Validation of the Breast Cancer Stigma Assessment Scale for Women with Breast Cancer and Its Survivors

Abstract

Background: The increase in breast cancer cases and breast cancer survival makes it advisable to quantify the impact of the health-related stigma of this disease.

Purpose/objectives: To develop and validate a breast cancer stigma scale in Spanish.

Methods: Women diagnosed with, or survivors of, breast cancer were included. The development of the Breast Cancer Stigma Assessment Scale (BCSAS) involved both a literature review and personal interviews. Content validity was assessed using a Delphi study and a pilot test; construct validity was evaluated using an exploratory factor analysis; and convergent validity was assessed using six scales. Cronbach's α internal consistency and test-retest reliability were used to determine the reliability of the scales.

Results: 231 women responded to the 28-item scale. The BCSAS showed good reliability, with α = 0.897. Seven factors emerged: concealment (α = 0.765), disturbance (α = 0.772), internalized stigma (α = 0.750), aesthetics (α = 0.779), course (α = 0.599), danger (α = 0.502), and origin (α = 0.350). The test-retest reliability was 0.830 (p < 0.001). Significant correlation was observed with event centrality (r = 0.701), anxiety-depression (r = 0.668), shame (r = 0.645), guilt (r = 0.524), and quality of life (r = -0.545).

Conclusions: The BCSAS is a reliable and valid measure of stigma in women with breast cancer and its survivors. It could be useful for detecting stigma risk and establishing psychotherapeutic and care priorities.

Keywords: breast neoplasm; cancer; cancer survivors; patients; social stigma; validation study.

Figure 1

Fujisawa and Hagiwara’s conceptual model of cancer stigma [15]. A: The presence of cancer in itself is not always considered as a stigma, particularly when it does not convey a deviation from the norm and/or is not associated with undesirable qualities. B: The presence of cancer, once labeled as a stigma, can induce negative reactions among the general population toward the patients. C: Negative reactions from others can impact patient health status as well as health-related behaviors.