Both obesity and breast cancer incidence increased dramatically during two recent decades in a rapidly changing society in northern Iran. In this study, we examined the ability of body mass index (BMI) and waist circumference (WC) as predictor biomarkers of breast cancer risk in Iranian women. In a case-control study of 100 new cases of histological confirmed breast cancer and 200 age-matched controls, in Babol, we measured weight, height, waist and hip circumference at time of diagnosis with standard methods. The data of demographic, characteristics, reproductive and lifestyle factors were collected by interview. We used both regression and receiver operator characteristics (ROC) analysis to estimate the predictive ability of BMI and WC for breast cancer as estimated by area under the curve (AUC). The results showed a significant difference in the mean of weight, BMI and WC between patients and controls in pre- and postmenopausal women (P<0.001). While after adjusting for BMI, no longer an association between WC and breast cancer was found. The overall accuracy of observed BMI and WC were 0.79 (95% CI: 0.74-0.84) and 0.68 (95% CI: 0.61-0.74), respectively. The accuracy of BMI and WC were 0.82 (95% CI: 0.76-0.89), 0.75(0.67-0.83) for premenopausal and 0.77(0.68-0.85), 0.60 (0.50-0.71) for postmenopausal women, respectively. BMI and WC are predictor biomarkers of breast cancer risk in both pre- and postmenopausal Iranian women while after adjusting for BMI, no longer an association between WC and breast cancer was observed. These findings imply to perform breast cancer screening program in women with a higher BMI and WC.

The inverse association of educational level with breast cancer risk observed in this study is not in accordance with education inequalities found in breast cancer risk in Western countries. The present findings provide a rationale for earlier screening in Iranian women with low education.

Introduction: Anxiety and depression are significant concerns in breast cancer patients, and it may remain for a long term after primary treatments. The hospital anxiety and depression scale (HADS) is widely used to measure depressive and anxiety symptoms in clinical practices. The purpose of this study was to assess the psychometric properties of the Persian version of this scale in Iranian breast cancer survivors. Methods: A total of 305 patients with breast cancer, refered to Cancer Hospital in northen Iran and completed the primary treatments were enrolled in. All patients responded to a 14-item HADS. We performed confirmatory factor analysis (CFA) to examine the factor structure of HADS and the item-scale analysis in order to estimate the item reliability and consider the Cronbach's alpha as a measure of internal consistency. Results: With a threshold of ≥8, the prevalence of anxiety and depression symptoms (moderate/severe) was 78.9 and 66.9%, respectively. The Cronbach's alpha coefficients for anxiety and depression were 0.81 and 0.78, respectively. The CFA confirmed the two-factor structure model for HADS, indicating a good fitting summary indexes (χ2/df = 2.83, NFI = 0.88, RFI = 0.82, IFI = 0.92, CFI = 0.92, and RMSEA = 0.078). Conclusion:The CFA and item reliability analysis have indicated an excellent psychometric property of the Persian version of HADS to measure depressive and anxiety symptoms in breast cancer survivors. Thus, HADS is a useful screening tool to identify post-breast cancer anxiety and depressive disorders.

Breast cancer is the most common malignancy among women worldwide and is also known as the 2nd cause of mortality due to cancer in the United States (WHO, 2017). It was estimated annually 252,710 new cases of breast cancer and about 40,610 deaths in United States in 2017 (Siegel et al., 2017). In the two recent decades, the incidence of breast cancer has increased dramatically in Iranian women with a high risk of mortality (Mousavi et al., 2007). This increased risk may be linked with changing the pattern of obesity and reproductive characteristics of Iranian women (Delavar & Hajian-Tilaki, 2008;Hajian-Tilaki et al., 2011). Additional to demographic characteristics, reproductive behaviours and obesity, the psychological distress has been recognized as risk factor of breast cancer (Metcalfe et al., 2007). However, the breast cancer itself, in addition to physical problems, may have an influence on mental