Breast Cancer incidence rate has risen consistently as the leading female cancer in Sri Lanka among rural population. Hence this study focused to identify the reflexive responses of Sri Lankan rural women living with breast cancer to Emotional challenges under three themes; Stress and depression, feeling solation and spiritual directions. Qualitative research approach was adopted for this study and the data collected through semi-structured, in-depth interviews from twenty-four respondents. Research themes have been derived from First-level analytical coding approach and thematic analysis was used in analysis of collected data. Most of the women in the unit of analysis are stressed and feared more at the very first beginning of the breast cancer diagnosis. As a positive note no one could identify with depression conditions. Feeling isolation could identify with reduced social interaction mostly in younger women rather than elder. Finally, a greater extent of spiritual directions could reveal after the diagnosis of breast cancer as a coping mechanism of this illness and psychological well-being. Findings of this research can be applied to real world context when dealing with rural women who are living with breast cancer by everyone in the society. Application of identified reflexive responses may significantly contribute in building up coping strategies in counselling and psychology for breast cancer patients. There seemed to be no a considerable number of research studies in line with breast cancer and its challenges and responses in Sri Lankan rural context. Thus, along with these research findings, future researchers can investigate more depth in to this study including women in urban areas, different races, different religions, professionals and workers in variety of occupations also under many other research themes.

1. World Health Organization. (2012) World health statistics 2012. [Online]. Available: https://bit.ly/3lfWpyK
2. J. R. Schubart, M. Emerich, M. Farnan, J. S. Smith, G. L. Kauffman, and R. B. Kass, “Screening for psychological distress in surgical breast cancer patients,” Annals of Surgical Oncology, vol. 21, no. 10, pp. 3348–3353, 2014. doi: https://doi.org/10.1245/s10434-014-3919-8
3. A. Fernando, U. Jayarajah, S. Prabashani, E. A. Fernando, and S. A. Seneviratne, “Incidence trends and patterns of breast cancer in Sri Lanka: An analysis of the national cancer database,” BMC Cancer, vol. 18, no. 1, pp. 1–6, 2018. doi: https://doi.org/10.1186/s12885-018-4408-4
4. F. ̇Izci, A. S. ̇Ilgün, E. Fındıklı, and V. Özmen, “Psychiatric symptoms and psychosocial problems in patients with breast cancer,” The Journal of Breast Health, vol. 12, no. 3, pp. 94–101, 2016. doi: https://doi.org/10.5152/tjbh.2016.3041
5. R. F. Obeidat, R. M. Lally, and S. S. Dickerson, “Arab American women’s lived experience with early-stage breast cancer diagnosis and surgical treatment,” Cancer Nursing, vol. 35, no. 4, pp. 302–311, 2012. doi: https://doi.org/10.1097/NCC.0b013e318231db09
6. A. Holst-Hansson, E. Idvall, I. Bolmsjö, and A. Wennick, “Hoping to reach a safe haven-Swedish families’ lived experience when a family member is diagnosed with breast cancer,” European Journal of Oncology Nursing, vol. 31, pp. 52–58, 2017. doi: https://doi.org/10.1016/j.ejon.2017.10.003
7. E. Mehrabi, S. Hajian, M. Simbar, M. Hoshyari, and F. Zayeri, “The lived experience of Iranian women confronting breast cancer diagnosis,” Journal of Caring Sciences, vol. 5, no. 1, pp. 43–55, 2016. doi: https://doi.org/10.15171/jcs.2016.005
8. H. P. N. I. Kumarasinghe and U. K. Thalgaspitiya, “Living with breast cancer; Sri Lankan rural women’s reflexive responses emotional challenges,” in 8th International Conference in the series of youth 2025, Jaipuriya, India, 2021.
9. H. P. N. I. Kumarasinghe and U. K. Thalgaspitiya, “Living with breast cancer; Sri Lankan rural women’s reflexive responses to social and emotional challenges,” in 16th International Conference on Business Management (ICBM), Colombo, Sri Lanka, 2019.
10. J. van Wyk and C. Carbonatto, “The social functioning of women with breast cancer in the context of the life world: A social work perspective,” Social Work, vol. 52, no. 3, pp. 439–458, 2016. doi: http://dx.doi.org/10.15270/52-2-518
11. M. Banning, M. Hassan, H. Hafeez, S. Faisal, and A. Zafar, “The impact of culture, sociological and psychological issues on Muslim breast cancer patients in Pakistan,” Cancer Nursing, vol. 34, no. 4, pp. 317–24, 2009. doi: https://doi.org/10.1097/NCC.0b013e31819b240f
12. E. M. Sawin, “‘my husband would not help me, so i was driving over there’: Older rural women experiencing breast cancer with a non-supportive intimate partner,” Rural and Remote Health, vol. 10, no. 4, pp. 1–13, 2010.
13. F. Bray, J. Ferlay, I. Soerjomataram, R. L. Siegel, L. A. Torre, and A. Jemal, “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,” CA: A Cancer Journal for Clinicians, vol. 68, no. 6, pp. 394–424, 2018. doi: https://doi.org/10.3322/caac.21492
14. P. Kanavos, “The rising burden of cancer in the developing world,” Annals of Oncology, vol. 17, pp. 15–23, 2006. doi: https://doi.org/10.1093/annonc/mdl983
15. American Cancer Society. (2013) Cancer facts & figures. [Online]. Available: https://bit.ly/3ahTfEc
16. S. Seneviratne, “Dr. RL Spittel oration: A breast cancer registry to improve quality and reduce disparities in breast cancer care-lessons learnt,” Sri Lanka Journal of Surgery, vol. 34, no. 4, pp. 16–20, 2016. doi: http://doi.org/10.4038/sljs.v34i4.8316
17. National Cancer Control Programme. (2014) Cancer incidence data in Sri Lanka. [Online]. Available: https://bit.ly/3iFoTAp
18. C. Rogers-Clark, “Living with breast cancer: Theinfluence of rurality on women’s suffering and resilience. a postmodern feminist inquiry,” Australian Journal of Advanced Nursing, The, vol. 20, no. 2, pp. 34–39, 2002.
19. S. J. Coakes and G. J. Kelly, “Community competence and empowerment: Strategies for rural change in women’s health service planning and delivery,” Australian Journal of Rural Health, vol. 5, no. 1, pp. 26–30, 1997. doi: https://doi.org/10.1111/j.1440-1584.1997.tb00231.x
20. S. M. S. Baqutayan, “The effect of anxiety on breast cancer patients,” Indian Journal of Psychological Medicine, vol. 34, no. 2, pp. 119–123, 2012. doi: https://doi.org/10.4103/0253-7176.101774
21. M.-L. Luoma and L. Hakamies-Blomqvist, “The meaning of quality of life in patients being treated for advanced breast cancer: A qualitative study,” Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, vol. 13, no. 10, pp. 729–739, 2004. doi: https://doi.org/10.1002/pon.788
22. C. Pierrisnard, M. Baciuchka, J. Mancini, P. Rathelot, P. Vanelle, and M. Montana, “Body image and psychological distress in women with breast cancer: A French online survey on patients’ perceptions and expectations,” Breast Cancer, vol. 25, no. 3, pp. 303–308, 2018. doi: https://doi.org/10.1007/s12282-017-0828-2
23. A. A. Malik and T. Kiran, “Psychological problems in breast cancer patients: A review,” Chemotherapy, vol. 2, no. 2, pp. 1–6, 2013. doi: https://doi.org/10.4172/2167-7700.1000115
24. R. E. Gray, P. James, J. Manthorne, J. Gould, and M. I. Fitch, “A consultation with Canadian rural women with breast cancer,” Health Expectations, vol. 7, no. 1, pp. 40–50, 2004. doi: https://doi.org/10.1046/j.1369-6513.2003.00248.x
25. B. R. Sprung, B. L. Janotha, and A. J. Steckel, “The lived experience of breast cancer patients and couple distress,” Journal of the American
    Academy of Nurse Practitioners, vol. 23, no. 11, pp. 619–627, 2011. doi: https://doi.org/10.1111/j.1745-7599.2011.00653.x
26. A. Girgis, A. Boyes, R. W. Sanson-Fisher, and S. Burrows, “Perceived needs of women diagnosed with breast cancer: Rural versus urban location,” Australian and New Zealand Journal of Public Health, vol. 24, no. 2, pp. 166–173, 2000. doi: https://doi.org/10.1111/j.1467-842x.2000.tb00137.x
27. M. C. Katapodi, N. C. Facione, C. Miaskowski, M. J. Dodd, C. Waters et al., “The influence of social support on breast cancer screening in a multi-cultural community sample,” in Oncology Nursing Forum, vol. 29, no. 5. Oncology Nursing Society, 2002. doi: https://doi.org/10.1188/02.ONF.845-852 pp. 845–852.
28. F. Taleghani, Z. P. Yekta, and A. N. Nasrabadi, “Coping with breast cancer in newly diagnosed Iranian women,” Journal of Advanced Nursing, vol. 54, no. 3, pp. 265–272, 2006. doi: https://doi.org/10.1111/j.1365-2648.2006.03808_1.x

H. P. N. I. Kumarasinghe, and U. K. Thalgaspitiya, “Living with breast cancer; Sri Lankan rural women’s reflexive responses to emotional challenges,” International Journal of Health and Medical Sciences, vol. 7, pp. 40-48, 2021. doi: https://dx.doi.org/10.20469/ijhms.7.30006