Barriers to breast cancer screening in Iranian females: a review article

Main Article Content

Nazanin Masoudi
Saeed Dastgiri
Zohreh Sanaat
Zhila Abbasi
Roya Dolatkhah


Breast cancer is one of the most common malignancies among females in Iran. Screening and detection in the early stages can increase the likelihood of breast cancer treatment and prognosis, thereby decreasing the mortality rate and promoting patient survival. However, mass screening programs for breast cancer are still confronted by predominant barriers in Iran. We tried to review and recognize the barriers to breast cancer screening and early detection in Iranian females as the main research question. We searched all available databases, and screened manuscripts for eligibility according to our inclusion/exclusion criteria. The search strategy was based on the following keywords: Breast, Malignancy, Cancer, Screening, Early Detection, Mammography, Iran, and Barrier. Responsible authors performed a literature review and compiled the results into a report. Various perceived barriers at different levels (individual, intrapersonal, health systems, and community) play influential and pivotal roles in women’s decisions to participate in breast cancer screening programs to facilitate early detection. Lack of awareness, neglect, procrastination, embarrassment, religious beliefs, and lack of primary health workers awareness and recommendation were cited as perceived barriers in screening procedures in Iran. There are still barriers in performing mammography at population levels in five major dimensions including availability, accessibility, cost, fears, and acceptability. However, the rate of regular mammography utilization in Iran is low compared with other countries and needs increasing through informing women. Many perceived barriers can affect women’s willingness and self-efficacy in screening procedures and one of the most effective ways of overcoming these barriers is to increase women’s awareness.

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How to Cite
Masoudi, N., Dastgiri , S., Sanaat, Z., Abbasi, Z., & Dolatkhah, R. (2022). Barriers to breast cancer screening in Iranian females: a review article. Universa Medicina, 41(1), 79–89.
Review Article


Global Burden of Disease Cancer , Fitzmaurice C, Abate D, Abbasi N, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol 2019;5:1749-68. doi: 10.1001/jamaoncol.2019.2996.

Chen Z, Xu L, Shi W, et al. Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990-2017. Breast Cancer Res Treat 2020;180:481-90. doi: 10.1007/s10549-020-05561-1.

Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. doi: 10.3322/caac.21660.

Zendehdel K. Cancer statistics in I.R. Iran in 2018. Basic Clin Cancer Res 2019;11:1-4.

Roshandel G, Ghanbari-Motlagh A, Partovipour E, et al. Cancer incidence in Iran in 2014: results of the Iranian National Population-based Cancer Registry. Cancer Epidemiol 2019;61:50-8. doi: 10.1016/j.canep.2019.05.009.

Ginsburg O, Bray F, Coleman MP, et al. The global burden of women's cancers: a grand challenge in global health. Lancet 2017;389:847-60. doi: 10.1016/S0140-6736(16)31392-7.

Mazarei M, Abedini S, Montaseri M. Knowledge and behavior among women referring to health careiInstitutions screening for breast cancer in the South of Iran. Int Electron J Med 2020;9:1-6. doi 10.34172/iejm.2020.01.

Dolatkhah R, Somi MH, Jafarabadi MA, et al. Breast cancer survival and incidence: 10 years cancer registry data in the Northwest, Iran. Int J Breast Cancer 2020;2020:1963814. doi: 10.1155/2020/1963814.

Foroozani E, Ghiasvand R, Mohammadianpanah M, et al. Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study. Sci Rep 2020;10:21477. doi: 10.1038/s41598-020-78517-6.

Nikpour M, Hajian-Tilaki K, Bakhtiari A. Risk assessment for breast cancer development and its clinical impact on screening performance in Iranian women. Cancer Manag Res 2019;11:10073-82. doi: 10.2147/CMAR.S311176.

Koh D, Song S, Moon SE, et al. Adherence to the American Cancer Society Guidelines for Cancer Survivors and health-Related quality of life among breast cancer survivors. Nutrients 2019;11:2924. DOI: 10.3390/nu11122924.

Mehta JM, MacLaughlin KL, Millstine DM, et al. Breast cancer screening: women's attitudes and beliefs in light of updated United States Preventive Services Task Force and American Cancer Society Guidelines. J Womens Health (Larchmt) 2019;28:302-13. doi: 10.1089/jwh.2017.6885.

Monticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021;18:1280-8. doi: 10.1016/j.jacr.2021.04.021.

Agirrezabal I, Bunting C, Brooks-Rooney C. Analysing the effects of a disinvestment decision in breast cancer screening programmes in Asia-Pacific countries: a modelling approach. Value Health 2014;17:A735. DOI: 10.1016/j.jval.2014.08.106.

Suwankhong D, Liamputtong P. Early detection of breast cancer and barrier to screening programmes amongst Thai migrant women in Australia: a qualitative study. Asian Pac J Cancer Prev 2018;19:1089-97. doi: 10.22034/APJCP.2018.19.4.1089.

Yuniar P, Robinson S, Moorin R, Norman R. Economic evaluation of breast cancer early detection strategies in Asia: a systematic review. Value Health Reg Issues 2020;21:252-63. doi: 10.1016/j.vhri.2020.01.003.

Alizadeh-Sabeg P, Mehrabi E, Nourizadeh R, Hakimi S, Mousavi S. The effect of motivational interviewing on the change of breast cancer screening behaviors among rural Iranian women. Patient Educ Couns 2020; 104:369-74. doi: 10.1016/j.pec.2020.08.011.

Safizade H, Amirzadeh N, Mangolian Shahrbabaki P. Motivational factors for breast cancer screening behaviors in Iranian women: a qualitative study. Asian Pac J Cancer Prev 2020;21:3109-14. doi: 10.31557/APJCP.2020.21.10.3109.

Salmani F, Moodi M, Yousefi A, Norozi E. Healthy beliefs regarding breast cancer screening in Iranian women health volunteers: a path analysis. Korean J Fam Med 2020;42:132-9. doi: 10.4082/kjfm.20.0001.

Kulkarni SV, Mishra GA, Dusane RR. Determinants of compliance to breast cancer screening and referral in low socio-economic regions of urban India. Int J Prev Med 2019;10:84. doi: 10.4103/ijpvm.IJPVM_335_17.

Wu TY, Lee J. Promoting breast cancer awareness and screening practices for early detection in low-resource settings. Eur J Breast Health 2019;15:18-25. doi: 10.5152/ejbh.2018.4305.

Izanloo A, Ghaffarzadehgan K, Khoshroo F, et al. Knowledge and attitude of women regarding breast cancer screening tests in Eastern Iran. Ecancermedicalscience 2018;12:806. doi: 10.3332/ecancer.2018.806.

Tabrizi MF, Vahdati S, Khanahmadi S, Barjasteh S. Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran. Asian Pac J Cancer Prev 2018;19:997-1003. doi: 10.22034/APJCP.2018.19.4.997.

Farzaneh E, Heydari H, Shekarchi AA, Kamran A. Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study. Onco Targets Ther 2017;10:985-92. doi: 10.2147/OTT.S125344.

Sabermahani A, Mohammad Taghizade S, Goodarzi R. A Comparative study on willingness to pay for breast cancer and osteoporosis screening in Kerman, Southeastern Iran. Iran J Public Health 2017;46:693-8.

Ivanova A, Kvalem IL. Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model. BMC Womens Health 2021;21:67. doi: 10.1186/s12905-021-01201-y.

Bond M, Pavey T, Welch K, et al. Systematic review of the psychological consequences of false-positive screening mammograms. Health Technol Assess 2013;17:1-170, v-vi. doi: 10.3310/hta17130.

Yousefi Kashi AS. Overall survival and related prognostic factors for familial breast cancer patients: A single institution study in Iran. Breast J 2020;26:2103-5. doi: 10.1111/tbj.13942.

Salek R, Shahidsales S, Mozafari V. Changing pattern in the clinical presentation of breast cancer in the absence of a screening program over a period of thirty-three years in Iran. Breast 2016;28:95-9. doi: 10.1016/j.breast.2016.05.003.

Ahmadipour H, Sheikhizade S. Breast and cervical cancer screening in women referred to urban healthcare centers in Kerman, Iran, 2015. Asian Pac J Cancer Prev 2016;17:143-7. doi: 10.7314/apjcp.2016.17.s3.143.

Aminisani N, Fattahpour R, Dastgiri S, Asghari-Jafarabadi M, Allahverdipour H. Determinants of breast cancer screening uptake in Kurdish women of Iran. Health Promot Perspect 2016;6:42-6. doi: 10.15171/hpp.2016.07.

Ghahramanian A, Rahmani A, Aghazadeh AM, Mehr LE. Relationships of Fear of Breast Cancer and Fatalism with Screening Behavior in Women Referred to Health Centers of Tabriz in Iran. Asian Pac J Cancer Prev 2016;17:4427-32.

Hoseini ZS, Tavakoli Ghouchani H, Mohaddes Hakak HR, et al. Effect of awareness and perceived self-efficacy on breast cancer preventive behaviors in women; a case study of Neyshabur city. J Edu Comm Health 2019;6:33-9. DOI: 10.21859/jech.6.1.33.

Taleghani F, Kianpour M, Tabatabaiyan M. Barriers to breast self-examination among Iranian women. Iran J Nurs Midwifery Res 2019;24:108-12.

Shirzadi S, Allahverdipour H, Sharma M, Hasankhani H. Perceived barriers to mammography adoption among women in Iran: a qualitative study. Korean J Fam Med 2020;41:20-7. doi: 10.4082/kjfm.18.0054.

Bouya S, Balouchi A, Ahmadidarehsima S, Badakhsh M. Knowledge and source of information about early detection techniques of breast cancer among women in Iran: a systematic review. J Cancer Prev 2018;23:51-60. doi: 10.15430/JCP.2018.23.1.51.

Kardan-Souraki M, Moosazadeh M, Khani S, Hamzehgardeshi Z. Factors related to breast cancer screening in women in the Northern Part of Iran: a cross-sectional study. Open Access Maced J Med Sci 2019;7:637-42. doi: 10.3889/oamjms.2019.045.

Safizadeh H, Hafezpour S, Mangolian Shahrbabaki P. Health damaged context: barriers to breast cancer screening from viewpoint of Iranian health volunteers. Asian Pac J Cancer Prev 2018;19:1941-9. doi: 10.22034/APJCP.2018.19.7.1941.

Badakhsh M, Balouchi A, Taheri S, Bouya S, Ahmadidarehsima S, Aminifard M. Attitude and practice regarding breast cancer early detection among Iranian women: a systematic review. Asian Pac J Cancer Prev 2018;19:9-16. doi: 10.22034/APJCP.2018.19.1.9.

Hossaini F, Akbari ME, Soori H, Ramezankhani A. Perceived barriers to early detection of breast cancer in Iranian women: a qualitative content analysis. Int J Cancer Manag 2020;13:e101467. doi: 10.5812/ijcm.101467.

Homan SG, Yun S, et al. Breast cancer population screening program results in early detection and reduced treatment and health care costs for medicaid. J Public Health Manag Pract 2021;27:70-9. doi: 10.1097/PHH.0000000000001041.

Al-Mousa DS, Alakhras M, Hossain SZ,et al. Knowledge, attitude and practice around breast cancer and mammography screening among Jordanian women. Breast Cancer (Dove Med Press) 2020;12:231-42. doi: 10.2147/BCTT.S275445.

Canelo-Aybar C, Ferreira DS, Ballesteros M, et al. Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer. J Med Screen 2021:969141321993866. doi: 10.1177/0969141321993866.

Emami L, Ghahramanian A, Rahmani A, Mirza Aghazadeh A, Onyeka TC, Nabighadim A. Beliefs, fear and awareness of women about breast cancer: effects on mammography screening practices. Nurs Open 2021;8:890-9. doi:10.1002/nop2.696..

Rundle A, Iles S, Matheson K, et al. Women's views about breast cancer prevention at mammography screening units and well women's clinics. Curr Oncol 2020;27:e336-42. doi: 10.3747/co.27.5755.

Bonsu AB, Ncama BP. Evidence of promoting prevention and the early detection of breast cancer among women, a hospital-based education and screening interventions in low- and middle-income countries: a systematic review protocol. Syst Rev 2018;7:234. doi: 10.1186/s13643-018-0889-0.

Hsieh HM, Chang WC, Shen CT, Liu Y, Chen FM, Kang YT. Mediation effect of health beliefs in the relationship between health knowledge and uptake of mammography in a National Breast Cancer Screening Program in Taiwan. J Cancer Educ 2021;36:832-43. doi: 10.1007/s13187-020-01711-7.

Shen CT, Chen FM, Hsieh HM. Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan. Health Policy 2020;124:478-85. doi: 10.1016/j.healthpol.2020.02.006.

Islam RM, Billah B, Oldroyd J. Barriers to cervical cancer and breast cancer screening uptake in low-income and middle-income countries: a systematic review. Asian Pac J Cancer Prev 2017;18:1751-63. doi: 10.22034/APJCP.2017.18.7.1751.

Wagh B, Chaluvarayaswamy R, Pal D.. Assessment of adaptive breast cancer screening policies for improved mortality reduction in low to middle income countries. Asian Pac J Cancer Prev 2017;18:2375-80. doi: 10.22034/APJCP.2017.18.9.2375.

Pippin MM, Boyd R. Breast self examination. StatPearls: Treasure Island (FL);2020.