Key Determinants Shaping Cancer Prevention Policy Governance in Iran

OBJECTIVE: Cancer prevention policy (CPP) plays a vital role in reducing the cancer burden, but it poses considerable challenges in health systems with limited resources and disparities in service access. Understanding the drivers, processes, and barriers influencing CPP governance is critical to designing equitable and effective interventions, particularly in low- and middle-income countries, such as Iran. METHODS: This qualitative study employed a case study approach to investigate the complex social and systemic factors shaping cancer prevention policy (CPP) governance in Iran. Data were collected through 25 semi-structured interviews with key stakeholders and an extensive review of 47 relevant documents. Participants were purposively selected from government agencies, academic institutions, NGOs, and cancer specialty centers. Data analysis combined deductive and inductive content analysis, facilitated by ATLAS.ti, to identify themes related to actors, processes, and contextual influences. RESULTS: Findings revealed that CPP governance is influenced by a network of domestically and internationally trained specialists, institutional leadership from the Ministry of Health, academic bodies, and civil society. Political, economic, and socio-cultural contexts significantly affected policy priorities and resource allocation. Challenges included insufficient needs assessments, fragmented stakeholder collaboration, and tensions between the growth of specialization and equitable access. Public demand for cancer prevention services remained low due to limited awareness and accessibility. Workforce shortages and cost constraints further complicated program implementation. CONCLUSION: Successful CPP governance requires inclusive participation, evidence-informed decision-making, and the adaptive integration of international expertise with local realities.