Breast cancer screening and early detection programs in Iran: A health policy analysis and recommendations

Screening and early detection programs for breast cancer (BC) have significantly reduced mortality rates and enhanced survival rates globally. Breast cancer screening programs in low- and middle-income countries like Iran need improvement. This study examines Iran's breast cancer screening and early detection (BCSED) policies, employing the Policy Triangle Model in two phases: a review of 27 documents including various related sources related of policies and strategies, followed by 20 semi-structured interviews across four distinct levels: policy, regional, clinical, and community levels. Content analysis for documents and MAXQDA(2020) software for the second phase were used, and findings integrated. In our analysis of 27 national documents and 20 interviews, we found 10 themes, 19 sub-themes, and 42 specific codes across four dimensions of the mentioned framework. Main themes in the context dimension covered deficient interactions, deficiency in knowledge management, cultural challenges, and socioeconomic challenges. From the analysis of 27 national documents, we recognized service excellence schemes, personal health encouragement, and service levels. Policy formulation and monitoring and evaluation emerged as central themes for the process dimension, while stakeholder challenges were prominent in the actors' dimension. BCSED programs are multifactorial issues. Proposed strategies to address these issues include the dedicated funds for BC prevention programs, strengthening the Ministry of Health's stewardship role, elevating public awareness, and conducting systematic screening trials in select cities to provide valuable national evidence for future policymaking.