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Published on: August 19, 2025
Factors influencing stigma in Chinese postoperative breast cancer patients: a systematic review and meta-analysis
Wenjuan Yan1, Hongjuan Zhou2, Yinying Huang1
1Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Objective:
To systematically evaluate stigma levels and its influencing factors among Chinese postoperative breast cancer patients, providing evidence for culturally adapted interventions.
Methods:
Chinese and English databases, such as China Biology Medicine Disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (WangFang), China Science and Technology Journal Database (The VIP), Cochrane Library, PubMed, Embase, Scopus, Medline, Web of Science, and grey literature from the National Institute for Health Research (NIHR), were searched. The time limit of the search for literature on the factors affecting the level of stigma in Chinese postoperative breast cancer patients was from the establishment of the databases to 14 July 2025. Two researchers independently screened studies, extracted data, and assessed quality using AHRQ criteria. Meta-analyses were performed using Stata 18.0.
Results:
Fourteen cross-sectional studies (total n = 2,873 patients) revealed a high stigma burden among Chinese postoperative breast cancer patients, with pooled Social Impact Scale (SIS) scores of 58.22 (95%CI: 55.30-61.15)-significantly exceeding rates in comparable populations. Meta-analysis identified seven culturally embedded predictors (p < 0.05): higher stigma was associated with unmarried/divorced/widowed status (SMD = 1.754), rural residence (SMD = 1.337), negative body image (SMD = 0.467), and yielding coping styles (SMD = 1.276); conversely, lower stigma correlated with occupational engagement (SMD = -0.568), breast reconstruction (SMD = -2.116), and self-payment status (SMD = -0.747). Paradoxically, spousal support intensified stigma (β = 1.336), while broader social support showed no significant association (p = 0.680).
Conclusion:
Chinese breast cancer survivors face severe stigma shaped by Confucian familial norms, economic pressures, and healthcare disparities. Interventions must prioritize marital counseling, occupational reintegration, accessible reconstruction, and rural mental health services. Longitudinal studies are needed to establish causality.
Systematic Review Registration:
CRD42024502898, https://www.crd.york.ac.uk/PROSPERO/recorddashboard.