{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:32:06Z","timestamp":1777984326829,"version":"3.51.4"},"reference-count":27,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns7:p>Background Body image disturbances in breast and gynecological cancer survivors involve complex interrelationships between physical changes, sexuality, and self-esteem. Existing tools inadequately capture these multidimensional, cancer-specific concerns. This study developed and validated a Four-Dimensional Body Image Score for women with breast and gynecological Cancers (4D-BISC). Methods A cross-sectional study was conducted (March\u2013April 2025) across six Tunisian healthcare facilities. Women presenting with gynecological or breast cancers were included. Participants completed the 16-item questionnaire (5-point Likert scale) derived from validated scales (the Female Sexual Function Index (FSFI) and the Body Esteem Scale for Adolescents and Adults (BESAA)) and cancer-specific items. Psychometric properties were assessed via exploratory\/confirmatory factor analyses (EFA\/CFA), Cronbach\u2019s alpha (\u03b1), and correlations with established scales (FSFI, BESAA). Results In total, 101 participants were included. CFA confirmed a robust 4-factor structure: Appearance Concerns (\u03b1=0.704), Social Exposure (\u03b1=0.737), Sexual Desirability (\u03b1=0.918) and Self-Esteem (\u03b1=0.786). The global score demonstrated excellent reliability. Strong correlations emerged between body image factors and sexual function (e.g., Sexual Desirability and sexual desire: p=0.706 and p&lt;0.001 respectively). Breast cancer patients reported significantly worse body image globally (p=0.003), particularly in social exposure (median=26.7) and sexual desirability (median=30). Marital status and socioeconomic status significantly influenced sexuality-related concerns and self-esteem (p&lt;0.05). Conclusion The 4D-BISC is a psychometrically valid tool capturing cancer-specific body image dimensions. It highlights critical vulnerabilities among breast and gynecological cancers cancer patients- and provides a foundation for targeted psychosocial interventions.<\/ns7:p>","DOI":"10.12688\/f1000research.169080.1","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T10:00:06Z","timestamp":1756893606000},"page":"863","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Scars: Development and Validation of a Four-Dimensional Body Image Score for Women with Breast and Gynecological Cancers - A Tunisian Multicenter Study"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9101-7849","authenticated-orcid":false,"given":"Narjes","family":"karmous","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdennour","family":"Karmous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Refka","family":"Bouslimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wided","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"579-594","DOI":"10.1002\/pon.991","article-title":"Body image and sexual problems in young women with breast cancer.","volume":"15","author":"P Fobair","year":"2006 Jul","journal-title":"Psycho Oncol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"253-267","DOI":"10.1007\/s11195-014-9367-3","article-title":"Validating the Sexual Adjustment and Body Image Scale (Sabis) with Breast Cancer Patients.","volume":"33","author":"E \u00d6zalp","year":"2015 Jun 1","journal-title":"Sex. 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We are particularly grateful for your constructive comments and thoughtful suggestions regarding the methodology, presentation of results, and ethical considerations. We fully agree that the proposed clarifications - including those related to potential confounders, the role of interpreters, refinement of sociodemographic variables, and the consent process- will further enhance the clarity, methodological rigor, and reproducibility of the manuscript. We would like to confirm that all the points you raised will be carefully addressed and incorporated in the revised version. At this stage, we are awaiting the feedback from the second reviewer, after which we will proceed with a consolidated revision to ensure coherence and completeness across all sections of the manuscript. Once again, we sincerely appreciate your time, expertise, and valuable contribution to improving the quality of our work. Kind regards, Narjes","URL":"https:\/\/f1000research.com\/articles\/14-863\/v1#referee-comment-15209","order":1,"name":"referee-comment-15209","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.186365.r470867, Amayra Tannoubi, High Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 28 Mar 2026, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-863\/v1#referee-response-470867","order":2,"name":"referee-response-470867","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.186365.r470864, Massimo Tusconi, University of Cagliari, Cagliari, 01 Apr 2026, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-863\/v1#referee-response-470864","order":3,"name":"referee-response-470864","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}