Situation analysis of breast cancer screening in Iran: a mixed-methods study

Breast cancer is the leading cause of cancer death among Iranian women, yet national screening remains opportunistic and unevenly implemented. This study assessed Iran’s breast cancer screening system to identify gaps and opportunities for establishing an organized, population-based program. We performed a convergent mixed methods study comprising (i) a literature review of 953 records (7 retained) to develop a checklist, (ii) a two round Delphi panel ( n = 6) to complete and validate the checklist, and (iii) after finalizing the checklist; the data that were collected from the literature review and from six semi structured interviews with policy makers, oncologists and frontline providers were used to assess the breast cancer screening program in Iran according to the checklist that was developed in the previous stage. Despite the existence of a national guideline and a broad network of screening centers, implementation remains inconsistent, with significant disparities in access, resource allocation, and program reach across provinces. Screening is primarily opportunistic, and manual data management, insufficient dedicated funding, and limited proactive outreach constrain effectiveness. Key performance indicators, such as early detection and follow-up rates, are not systematically monitored. However, the established infrastructure, trained personnel, and ongoing awareness campaigns provide a strong foundation for future improvements. Iran has made notable progress in establishing the foundations of a national breast cancer screening program, but critical gaps persist. Advancing toward an organized, population-based approach will require integrated electronic systems, sustainable funding, workforce development, and robust monitoring frameworks. Piloting an invitation-based model in selected provinces or catchment areas may provide a feasible pathway for gradual national scale-up.