Skip to main content
NCBI home page
Asian Pacific Journal of Cancer Prevention : APJCP logoLink to Asian Pacific Journal of Cancer Prevention : APJCP
. 2017;18(12):3187–3194. doi: 10.22034/APJCP.2017.18.12.3187

Cancer Screening Awareness and Practice in a Middle Income Country; A Systematic Review from Iran

Azam Majidi 1, Somayye Majidi 2, Somayye Salimzadeh 1, Maryam Khazaee-Pool 3, Alireza Sadjadi 1, Hamideh Salimzadeh 1,*, Alireza Delavari 1
PMCID: PMC5980869  PMID: 29281865

Abstract

Objective:

Ageing population and noticeable changes in lifestyle in developing countries like Iran caused an increase in cancer incidence. This requires organized cancer prevention and screening programs in population level, but most importantly community should be aware of these programs and willing to use them. This study explored existing evidence on public awareness and practice, as well as, adherence to cancer screening in Iranian population.

Methods:

Major English databases including Web of Science, PubMed, Scopus, and domestic Persian databases i.e., SID, Magiran, and Barakat search engines were searched. All publications with focus on Iranian public awareness about cancer prevention, screening, and early detection programs which were published until August 2015, were explored in this systematic review. For this purpose, we used sensitive Persian phrases/key terms and English keywords which were extracted from medical subject headings (MeSH). Taking PRISMA guidelines into considerations eligible documents, were evaluated and abstracted by two separate reviewers.

Results:

We found 72 articles relevant to this topic. Screening tests were known to, or being utilized by only a limited number of Iranians. Most Iranian women relied on physical examination particularly self-examination, instead of taking mammogram, as the most standard test to find breast tumors. Less than half of the average-risk adult populations were familiar with colorectal cancer risk factors and its screening tests, and only very limited number of studies reported taking at least one time colonoscopy or FOBT, at most 5.0% and 15.0%, respectively. Around half of women were familiar with cervical cancer and Pap-smear test with less than 45% having completed at least one lifetime test. The lack of health insurance coverage was a barrier to participate in screening tests. Furthermore some people would not select to be screened only because they do not know how or where they can receive these services.

Conclusion:

Low awareness and suboptimal use of screening tests in Iran calls for effective programs to enhance intention and compliance to screening, improving the patient-physician communication, identifying barriers for screening and providing tailored public awareness and screening programs.

Keywords: Screening, early detection, screening awareness, knowledge, attitude and practice, primary prevention-Iran

Introduction

Most developing countries face with an increase in the incidence of Noncommunicable diseases NCDs, including cancers (Ahmadi et al., 2016) mostly due to epidemiologic transitions and perceptible shift in lifestyle towards unhealthy habits (Chan, 2007; WHO, 2015). Based on GLOBOCAN estimates, by 2030 there will be 26 million deaths due to cancer, of which 60% will occur in low and middle income countries (LMICs). In order to combat the increasing burden of cancer, cancer control programs have been systemized throughout the world on rising public awareness and implementing screening or early detection (Petersen, 2009; WHO, 2006). Data of developed countries suggest that national cancer screening programs have been effective in increasing survival rates in cancer patients (Berry et al., 2005; Le Galès-Camus et al., 2007; López-Gómez et al., 2013; Torre et al., 2015; Trevena, 2009).

As a middle income country in West Asia, in Iran cancer is the 3rd major cause of mortality and disability behind cardiovascular diseases and traffic injuries (Ferlay, et al., 2013). Similar to most LMICs currently there is no mass screening program in Iran for early detection of cancers and the policy for cancer screening in Iran is opportunistic. Therefore, only people who are well-informed about the importance of these tests include cancer screening in their health schedules (Adab, et al., 2004).

To date, scattered data have been published on public knowledge level and their attitude and practice (KAP) towards cancer screening and prevention in Iran. Yet, the overall status on public awareness or preventive behaviors about cancer, and the applicability of these data in policy making has not been studied.

The objective of this study, therefore, is to review the publications on cancer awareness and screening practice in Iran addressing the following topics: general awareness; cancer specific knowledge; health knowledge about cancer; interventions to enhance adherence to screening tests; prevalence of preventive and early detection behaviors e.g., rate of use of screening tests; predictors or correlates of adherence to screening tests; and barriers to/or reasons for non-adherence to screening tests.

Material and Methods

Search strategy and inclusion criteria: Major English databases including Web of Science (WOS), PubMed, Scopus, and domestic Persian databases including SID, Magiran, and Barakat search engines were searched. Using a sensitive Persian phrases key terms and English keyword list, extracted from medical subject headings (MeSH) all publications with focus on Iranian public awareness about cancer prevention and early detection programs were explored in this systematic review. Eligible articles were extracted based on our inclusion/exclusion criteria. The end date of search was determined as the end of August 2015 (Appendix 1).

Data extraction

Only, records which had investigated the awareness and practice toward cancer screening and prevention in general population were extracted and those targeting specific groups like health professionals or medical students, teachers, university or school students and so on, were excluded from further analysis. This study is limited to review publications pertaining to four cancers i.e., (CRC), breast, cervical, and oral cancers, as recommended by World Health Organization (WHO) for screening in developing countries (Le Galès-Camus et al., 2007). Following PRISMA guideline for data extraction (Moher et al., 2009), we included information on title, study type, sampling frame, age-groups, gender, publication date, sample size, and a brief description demonstrating the knowledge, attitude and practice toward cancer prevention or screening.

Regarding sampling methods and the quality of information reported by different articles data reflecting descriptive information of studies and their main findings were extracted. Meta-analysis was taken into consideration.

Results

Overall, this search strategy found 72 articles from which 45 were attributed to breast cancer and the other 16, 6 and, 5 records respectively were about cervical cancer, CRC and cancers of oral cavity (see Flow diagram).

Knowledge about cancers risk factors, symptoms and screening tests

Among all extracted documents 21 studies had addressed population awareness regarding cancer risk factors, 55 reported awareness status for existing cancer screening tests, and finally 25 studies had evaluated awareness about warning signs of cancer and their known symptoms. Also two studies had provided a general report regarding overall knowledge about cancer risk factors, related warning signs or symptoms and screening behavior (Supplementary Table 1).

Table 1.

Facilitators and Barriers of Participation in Cancer Screening Programs

Cancer type Facilitators Barriers
Colon Doing annual health controls and recommendation of health providers (Javadzade, et al., 2012) Having no symptoms (Salimzadeh, et al., 2012)
Fear of finding positive result (Javadzade, et al., 2012; Salimzadeh, et al., 2012)
High cost (Salimzadeh, et al., 2012)
No recommendation of health providers (Javadzade, et al., 2012; Salimzadeh, et al., 2012)
Feeling embarrassed (Javadzade, et al., 2012)
Time limits (Javadzade, et al., 2012)
No knowledge about where they should go for screening (Javadzade, et al., 2012)
Negative family history of cancer (Salimzadeh, et al., 2012)
Lack of awareness about the necessity of screening (Javadzade, et al., 2012; Salimzadeh, et al., 2012)
Breast Educational level (Ahmadian, et al., 2012)
Being married (Ahmadian, et al., 2012; Godazandeh, et al., 2006; Montazeri, et al., 2008; Noroozi and Tahmasebi, 2011)
Having health insurance (Ahmadian, et al., 2012)
Husband’s higher education level (Charkazi, et al., 2013)
Using modern birth control devices (Noroozi and Tahmasebi, 2011)
Awareness about cancer (Soltanahmadi, et al., 2010)
Recommendation of health providers (Soltanahmadi, et al., 2010; Yadollahie, et al., 2011)
Higher socioeconomic status (Farshbaf-Khalili, et al., 2015; Soltanahmadi, et al., 2010)
Previous breast benign diseases (Allahverdipour, et al., 2011; Banaeian, et al., 2006; Farshbaf-Khalili, et al., 2015; Soltanahmadi, et al., 2010)
Number of children (Banaeian, et al., 2006; Farshbaf-Khalili, et al., 2015)
Positive attitudes (Banaeian, et al., 2006; Salimi, et al., 2010)
History of hormone therapy (Banaeian, et al., 2006)
Experience of breastfeeding (Farshbaf-Khalili, et al., 2015)		 Having no symptoms (Ghazdehi, et al., 2013)
Fear of finding cancer (Farshbaf-Khalili, et al., 2015; Nojomi, et al., 2014) (Pilehvarzadeh, et al., 2015)
High cost (Farshbaf-Khalili, et al., 2015)
Negative attitudes (Ghazdehi, et al., 2013)
Time limits (Farshbaf-Khalili, et al., 2015; Laluie and Kashanizadeh, 2006)
Older age (Ahmadian, et al., 2012; Allahverdipour, et al., 2011; Berdi-Ghourchaei, et al., 2013; Farshbaf-Khalili, et al., 2015; Godazandeh, et al., 2006; Montazeri, et al., 2008; Ramezani, et al., 2001)
Unfamiliarity with mammography (Ghazdehi, et al., 2013)
No health insurance (Allahverdipour, et al., 2011)
Negative family history for breast cancer (Allahverdipour, et al., 2011; Farshbaf-Khalili, et al., 2015; Ghazdehi, et al., 2013; Godazandeh, et al., 2006)
No recommendation of health providers (Farshbaf-Khalili, et al., 2015; Nojomi, et al., 2014; Sakkaki, et al., 2015)
No awareness about the necessity of screening (Banaeian, et al., 2006; Charkazi, et al., 2013; Ghazdehi, et al., 2013; Godazandeh, et al., 2006; Heidari, et al., 2007; Ramezani, et al., 2001; Salimi, et al., 2010; Simi, et al., 2009; Soltanahmadi, et al., 2010)
No experience of mammography among friends (Ghazdehi, et al., 2013)
Cervix Ethnicity (Khojasteh, 2004)
Recommendation of friends (Khojasteh, 2004)
Living in urban areas vs. Rural (Hadi and Azimirad, 2010)
Awareness about cancer (Hadi and Azimirad, 2010; Soltanahmadi, et al., 2010)
Older age (Hadi and Azimirad, 2010)
Socioeconomic status (Khojasteh, 2004; Soltanahmadi, et al., 2010)
Educational level (Khojasteh, 2004)
Using modern birth control devices (Khojasteh, 2004)
Self-efficacy through employment (Soltanahmadi, et al., 2010)
Recommendation of health providers (Khojasteh, 2004)		 Having no symptoms (Soltanahmadi, et al., 2010)
Feeling embarrassed (Soltanahmadi, et al., 2010)
Negative family history for breast cancer (Soltanahmadi, et al., 2010)
Open in a new tab

Noticeably poor awareness about CRC risk factors and screening were reported, that is, the necessity of CRC screening among average-risk adults above 50 years was stated only by 20% of investigated participants. On the other hand, FOBT and colonoscopy, as CRC screening tests were respectively known by around 40.0% and 50.0% of the studied population.

A small part of people were familiar with oral cancer risk factors. Few people knew the importance of oral hygiene and taking care of dentures as preventive methods for cancer in mouth cavity. Also almost less than half of people were aware of the carcinogenesis effect of eating/drinking hot foods/beverages. None of studies documented individuals’ awareness regarding oral screening.

Half of Iranian women were not familiar with breast cancer risk factors and related screening tests. Most studies had focused on breast physical examination, either performed by women themselves or by their clinicians. Mammography, which currently is the most reliable test for early detection was hardly known as a breast screening test in most regions (with awareness level varying from 3.4% to 64.0%).

Only few records had reported Iranian women’s knowledge about cervical cancer risk factors. Around half of studied women knew the early signs and symptoms of cervical cancer. Although more than one test is available for cervical cancer screening in Iran’s laboratories, Pap-smear test has been taken into considerations more frequently by the investigators. Around half of studied women had an average to good level of knowledge about cervical cancer risk factors and screening tests.

graphic file with name APJCP-18-3187-g001.jpg

Open in a new tab

Flow diagram. Literature Selection Flow Diagram According PRISMA Guideline

Attitudes toward cancer screening

Out of total documents, 13 studies had evaluated people’s attitudes toward cancer screening and prevention. In a study, only 29.0% of participants believed that CRC screening decrease the chance of CRC related mortality. The majority of studied women were interested in learning about cervical and breast cancer screening and prevention methods. Most women were concerned with breast cancer and less than 10.0% considered breast cancer as a preventable cancer. While more positive beliefs were reported regarding the effectiveness of screening tests in the case of breast and cervical cancers, only few people believed that early detection of CRC and cancer of mouth cavity provides better prognosis. Some people did not intend to take screening tests due to fear of being diagnosed with cancer (Supplementary Table 2).

Screening practice

Detailed information about utilization of different screening tests is brought in Table 3. Among average-risk people, only 5.0% had colonoscopy experience and less than 15% at least a prior fecal occult blood test (FOBT).

Mammography was infrequently used by Iranian women with only 6.4% having at least one lifetime mammogram. Mammography practice was poorest in the North of Iran and highest in Hamadan a city in the West of Iran. Adherence to regular cervical screening is still sub-optional among Iranian women, with an estimated 17.0-36.0% participation rate for regular screening.

Few studies had reported facilitating and hindering factors of public cancer screening behavior (Table 1). Accordingly socioeconomic status, adherence to regular health check-ups and awareness about cancer signs and symptoms, as well as, existing screening programs were defined as influential factors on screening practice among Iranians.

Intervention studies

Application of health promotion models, resulted a significant difference in utilization of pap-smear, 97.1% vs. 2.9% (Pirzadeh and Mazaheri, 2012), FOBT, 26.0% vs. 2.8% (Salimzadeh et al., 2014) and 83.1% vs. 14.1% (Moattari et al., 2009), as well as, BSE 76.7% vs. 2.9% (Aghamolaei et al., 2011) among intervention group compared to control group. Nonetheless, after health-educational consults regarding screening colonoscopy only 5.0% of participants underwent colonoscopy, while none of the participants in the control group, accepted to take colonoscopy (Salimzadeh, et al., 2014).

Discussion

This systematic review revealed that there is suboptimal awareness about cancer risk factors and known symptoms among Iranian population. Cancer screening tests are known to, or being utilized by a very limited number of people in Iran. In case of breast cancer screening, most Iranian women relied on physical examination particularly self-examination instead of taking mammogram, known as the most valid screening test. Less than half of average-risk adult men and women above 50 were familiar with CRC screening tests and only very limited number of studies reported taking at least one time colonoscopy or FOBT, at most 5.0% and 15.0%, respectively. Around half of women were familiar with the current cervical screening method, i.e., pap-smear test and less than 45% at least had once pap-smear test. There was a scarce of KAP studies about cancer of mouth cavity. The lack of health insurance coverage was a barrier to participation in screening tests; that is economic independency would have facilitated individuals’ participation in screening tests particularly in women. Furthermore, in Iran some people may not select to be screened only because they do not know how or where they can receive these services.

Iran, as an example of middle-income countries, had conservable achievements in delivering basic health care to low-income rural residents during past decades (Hsiao, 2007). Currently in rural and low-population cities, primary health care services and family physician program provide primary prevention targeting common risk factors of NCDs (Bonita, et al., 2013; Jannati et al., 2014; Naghavi 2006; WHO, 2013; WHO, 2014). In practice, most of the preventive care services such as screening tests and dental care are not covered by current health insurance policies, while they cover almost all therapeutic facilities like cancer treatment and surgeries (Jannati et al., 2014). In the absence of national cancer screening programs, people do not look for screening and preventive services; rather they are utilizing curative and rehabilitative services (Jannati et al., 2014).

Studies to date poorly support the effectiveness of BSE educational programs in decreasing mortality related to breast cancer (Long et al., 2010; Thomas et al., 2002). Recent guidelines emphasize on the importance of breast self-awareness instead of BSE, to encourage women to know their body and report any changes that may be related to breast cancer (Bevers et al., 2015; Oeffinger et al., 2015). During six decades breast cancer survival increased considerably in USA, which is mainly attributable to mammography and effective surgical procedures (Shulman et al., 2010). Yet, as brought in results many women in Iran are not familiar with existing breast screening facilities. Our review showed marital status as a positive moderator for participation in breast screening which is comparable with the results from other studies (Selvin and Brett, 2003; Sutton et al., 1994). In most eastern cultures gynecological controls, including BCE, are mainly utilized by married (or ever married) women. This means that never married women are less likely to comply with screening guidelines and they might lose the chance of being diagnosed in early stages. Therefore in order to enhance participation and adherence to breast screening programs, health providers should make efforts targeting all eligible women, i.e., both married and single women.

At least for CRC screening and mammography test, physicians had key role in encouraging their patients to undertake screening tests (Farshbaf-Khalili et al., 2015; Javadzade et al., 2012; Nojomi et al., 2014; Sakkaki et al., 2015; Salimzadeh et al., 2012). Currently there is no national guidelines for cancer screening in Iran. Therefore, expert physicians routinely follow guidelines and instructions issued for other populations in their clinical practice (Delavari et al., 2014a; Delavari et al., 2014b; Delavari et al., 2015; Majidi et al., 2015). Although, physicians’ adherence to these guidelines in making sound advice to their healthy clients remains unclear.

Cancer screening tests are offered to healthy or apparently healthy individuals. In most developing countries there is limited access to early detection and primary care (Breen et al., 2001). While participation in the current opportunistic screening programs initially requires adequate public awareness (Adab et al., 2004; Denny et al., 2006; Trevena, 2009), only limited number of awareness rise programs had been successful in increasing participation in cervical screening, BSE and fecal-based CRC screening tests. On the other hand, some studies have shown that awareness rise is necessary but not the only influential factor on the participation rate in screening colonoscopy (Farshbaf-Khalili et al., 2015; Javadzade et al., 2012; Nojomi et al., 2014; Sakkaki et al., 2015; Salimzadeh et al., 2012).

Some studies had mentioned economic barriers, such as the lack of health insurance, or partial support of current health insurance, as the hindering factors for taking screening tests or adherence to repeated screenings (Ahmadian et al., 2012; Allahverdipour et al., 2011; Farshbaf-Khalili et al., 2015; Khojasteh 2004; Salimzadeh et al., 2012; Soltanahmadi et al., 2010). On the other hand, insufficient or even inaccurate information about screening tests have been mentioned as possible causes for poor intention to screening programs, even among people with higher economic status (Allahverdipour et al., 2011; Banaeian et al., 2006; Charkazi et al., 2013; Farshbaf-Khalili et al., 2015; Ghazdehi et al., 2013; Godazandeh et al., 2006; Heidari et al., 2007; Javadzade et al., 2012; Nojomi et al., 2014; Ramezani et al., 2001; Sakkaki et al., 2015; Salimi et al., 2010; Salimzadeh et al., 2014; Simi et al., 2009; Soltanahmadiet al., 2010). A major reason for failure of cancer screening programs is the insufficient resources devoted by health systems which may be due to scarce resources, lack of information and difficulties in the advertising of screening programs (2002).

Overall, considering the very low prevalence of oral hygiene behaviors (Asgari et al., 2011) and obvious burden of complications related to tobacco use among Iranian populations including cancers of oral cavity (Meysamie et al., 2010), high incidence and proportionately lower survival rates of breast cancer, increasing incidence of CRC, as well as, the high mortality to incidence ratio of cervical cancer in the nation (Majidi et al., 2015), establishment of national screening programs as suggested by WHO, are recommended (Ferlay et al., 2013; Majidi et al., 2015; Pourhoseingholi and Zali 2012; Rezaianzadeh et al., 2009; Vahdaninia and Montazeri, 2004). In order to enhance cancer screening rates and ensure community adherence to these programs, economic obstacles should be considered besides investment on health education (Majidi et al., 2015; Soltanahmadi et al., 2010). Providing access to cost-effective screening tests and prevention methods with higher acceptance rates also providing simple periodical oral visual inspection by trained health providers may result in higher screening rates and more lifesaving benefits (Majidi et al., 2015; Subramanian et al., 2010). Studies underlined the importance of universal health coverage in provision of equal access to cancer screening by enhancing the adherence to these tests among unprivileged groups (Breen et al., 2001). With this regard, the experience of limited-resource and developed countries revealed the important impact of engaging non-governmental organizations NGOs and civil activists in disease control programs (Anderson et al., 2006; Azenha et al., 2011; Domingo et al., 2008; Gómez-Jauregui, 2004; Klugman, 2000). Establishment and development of similar societies is suggestible to Iranian communities.

Precise cancer registries in developed countries verified the effectiveness of screening tests (Long et al., 2010). Use of screening tests increased the chances of detecting cancer in primary stages. Accordingly, it causes apparent increase in cancer incidence rates, leading to good prognosis of the disease and higher survival rates (Long et al., 2010; Shulman et al., 2010). In order to promote the current health status and provide more successful cancer prevention programs in our region we will need the baseline and follow-up registry data to define future goals and objectives. National objectives and monitoring systems are critical factors in health promotion programs. Like many developed countries it is time for developing countries too, to set organized objectives for health promotion and disease prevention (Koh, 2010). The results of this study would be utilized as the baseline data regarding the status of cancer screening in the country.

To our knowledge this is the first study that focused on exploring information related to Iranian population awareness about cancer screening and cancer prevention also their screening practice. Inclusion of population-based studies in this systematic review may provide a general view for cancer screening in Iran. All studies included in this review had reported quantitative measures consisting of sample size, proportions or rates with sufficient descriptive information. The main limitation of this study was the limited number of publications with population-based samples. Most of these studies were focused on breast cancer screening, while awareness and preventive practices towards other cancers was the concern of only a few studies.

It seems that with appropriate knowledge about cancer and related screening tests, people are more likely to participate in screening tests. This systematic review underlines the low awareness and poor performance towards cancer screening programs among Iranian population. This calls for targeted public awareness campaigns, as well as development of screening guidelines targeting both high-risk and average-risk groups.

List of Abbreviations

CRC, Colorectal cancer; BSE, Breast self-examination; CBE, Clinical breast examination; NCDs, Noncommunicable diseases; WHO, World Health Organization; KAP, Knowledge, Attitude, Practice; FOBT, Fecal Occult Blood Test; MMG, Mammogram; COL, Colonoscopy

Statement conflict of Interest

Authors specify no conflict of interest in this study.

Supplementary

APJCP-18-3187_suppl.pdf (265.1KB, pdf)

Acknowledgements

This study was supported by the Digestive Diseases Research Institute at Tehran University of Medical Sciences.

References

  1. Abedian Z, Dormohamadi M. Investigating awareness, attitude and practice of women who referred to health centers of mashhad city toward pop smear. Iran J Obstet Gynaecol Fertil. 2013;15:22–8. [Google Scholar]
  2. Abedzadeh M, Sadat Z, Saberi F. tests Knowledge, attitude, and performance of women referring health care centers in Kashan towards breast cancer and its screening. J Kashan Univ Med Sci (FEYZ) 2003;7:85–92. [Google Scholar]
  3. Adab P, McGhee SM, Yanova J, et al. Effectiveness and efficiency of opportunistic cervical cancer screening:comparison with organized screening. Med Care. 2004;42:600–9. doi: 10.1097/01.mlr.0000128007.04494.29. [DOI] [PubMed] [Google Scholar]
  4. Aghamolaei T, Hasani L, Tavafian SS, et al. Improving breast self-examination:An educational intervention based on health belief model. Iran J Cancer Prev. 2011;4:82–7. [Google Scholar]
  5. Ahmadi B, Alimohammadian M, Yaseri M, et al. Multimorbidity:epidemiology and risk factors in the Golestan cohort study, Iran:A cross-sectional analysis. Medicine. 2016;95:e2756. doi: 10.1097/MD.0000000000002756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ahmadian M, Samah AA, Redzuan M, et al. Predictors of mammography screening among Iranian women attending outpatient clinics in Tehran, Iran. Asian Pac J Cancer Prev. 2012;13:969–74. doi: 10.7314/apjcp.2012.13.3.969. [DOI] [PubMed] [Google Scholar]
  7. Akhtari-Zavare M, Ghanbari-Baghestan A, Latiff LA, et al. Knowledge of breast cancer and breast self-examination practice among Iranian women in Hamedan, Iran. Asian Pac J Cancer Prev. 2014;15:6531–4. doi: 10.7314/apjcp.2014.15.16.6531. [DOI] [PubMed] [Google Scholar]
  8. Allahverdipour H, Asghari-Jafarabadi M, Emami A. Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women. Women Health. 2011;51:204–19. doi: 10.1080/03630242.2011.564273. [DOI] [PubMed] [Google Scholar]
  9. Allahverdipour H, Emami A. Perceptions of cervical cancer threat, benefits, and barriers of Papanicolaou smear screening programs for women in Iran. Women Health. 2008;47:23–37. doi: 10.1080/03630240802132302. [DOI] [PubMed] [Google Scholar]
  10. Anderson BO, Yip C-H, Ramsey SD, et al. Breast cancer in limited-resource countries:Health care systems and public policy. Breast J. 2006;12:54–69. doi: 10.1111/j.1075-122X.2006.00203.x. [DOI] [PubMed] [Google Scholar]
  11. Asgari F, Majidi A, Koohpayehzadeh J, et al. Oral hygiene Status in a general population of Iran 2011:A key lifestyle marker in relation to common risk factors of non-communicable diseases. Int J Health Policy Manag. 2011;8:343–52. doi: 10.15171/ijhpm.2015.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Asgharnia M, Faraji R, Zahiri Z, et al. A study of knowledge and practice of woman about breast cancer and its screening, in the case of women who referred to Alzahra hospital in Rasht during 2010-2011. Iran J Surg. 2013;21:50–8. [Google Scholar]
  13. Azenha G, Bass LP, Caleffi M, et al. The role of breast cancer civil society in different resource settings. Breast. 2011;20:81–7. doi: 10.1016/j.breast.2011.02.005. [DOI] [PubMed] [Google Scholar]
  14. Baghiani-Moghadam M. Survey on knowledge, attitude and practice of 15-49 years age group married women related to Pap smear test in Yazd city in 2001. J Mazandarn Univ Med Sci. 2003;40:79–85. [Google Scholar]
  15. Bahri N, Jajvandian R, Bolandhemmat M, et al. Knowledge, attitudes and practice about pap smear test among women living in Bojnourd, North East of Iran:A population-based study. Asian Pac J Cancer Prev. 2015;16:2013–8. doi: 10.7314/apjcp.2015.16.5.2013. [DOI] [PubMed] [Google Scholar]
  16. Banaeian S, Kazemian A, Kheiri S. Knowledge, attitude and practice about breast cancer screening and related factors among women referred to health care centers in Boroujen in 2005. J Shahrekord Univ Med Sci. 2006;7:28–34. [Google Scholar]
  17. Berdi-Ghourchaei A, Charkazi A, Razzaq-Nejad A. Knowledge, practice and perceived threat toward breast cancer in the women living in Gorgan, Iran. J Res Dev Nurs Midwifery. 2013;1:25–32. [Google Scholar]
  18. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784–92. doi: 10.1056/NEJMoa050518. [DOI] [PubMed] [Google Scholar]
  19. Bevers TB, Ward JH, Arun BK, et al. Breast cancer Risk reduction, Version 2.2015. J Natl Compr Canc Netw. 2015;13:880–915. doi: 10.6004/jnccn.2015.0105. [DOI] [PubMed] [Google Scholar]
  20. Bidouei F, Abdolhosseini S, Jafarzadeh N, et al. Knowledge and perception toward colorectal cancer screening in east of Iran. Int J Health Policy Manag. 2014;3:11–5. doi: 10.15171/ijhpm.2014.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Bonita R, Magnusson R, Bovet P, et al. Country actions to meet UN commitments on non-communicable diseases:a stepwise approach. Lancet. 2013;381:575–84. doi: 10.1016/S0140-6736(12)61993-X. [DOI] [PubMed] [Google Scholar]
  22. Breen N, Wagener DK, Brown ML, et al. Progress in cancer screening over a decade:results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst. 2001;93:1704–13. doi: 10.1093/jnci/93.22.1704. [DOI] [PubMed] [Google Scholar]
  23. Chan M. Trade, foreign policy, diplomacy and health (Health Transition) [Online] World Health Organization. 2007. [Accessed Access date:30 Oct. 2017, 2017]. Available: http://www.who.int/trade/en/
  24. Charkazi A, Samimi A, Razzaghi K, et al. Adherence to recommended breast cancer screening in Iranian turkmen women:the role of knowledge and beliefs. ISRN Prev Med. 2013;2013:581027. doi: 10.5402/2013/581027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Dadkhah B, Mohammadi M. Knowledge, attitude and practice of women in Ardabil about breast self-examination, 2000. J Ardabil Univ Med Sci. 2002;2:14–20. [Google Scholar]
  26. Delavari A, Bishehsari F, Salimzadeh H, et al. Adenoma detection rates in an opportunistic screening colonoscopy program in Iran, a country with rising colorectal cancer incidence. BMC Gastroenterol. 2014a;14:196. doi: 10.1186/s12876-014-0196-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Delavari A, Mardan F, Salimzadeh H, et al. Characteristics of colorectal polyps and cancer;a retrospective review of colonoscopy data in iran. Middle East J Dig Dis. 2014b;6:144. [PMC free article] [PubMed] [Google Scholar]
  28. Delavari A, Salimzadeh H, Rakhshankhah ES, et al. Mean Polyp per patient is an accurate and readily obtainable surrogate for adenoma detection rate:results from an opportunistic screening colonoscopy program. Middle East J Dig Dis. 2015;7:214–9. [PMC free article] [PubMed] [Google Scholar]
  29. Denny L, Quinn M, Sankaranarayanan R. Screening for cervical cancer in developing countries. Vaccine. 2006;24:71–7. doi: 10.1016/j.vaccine.2006.05.121. [DOI] [PubMed] [Google Scholar]
  30. Domingo EJ, Noviani R, Noor MRM, et al. Epidemiology and prevention of cervical cancer in Indonesia, Malaysia, the Philippines, Thailand and Vietnam. Vaccine. 2008;26:71–9. doi: 10.1016/j.vaccine.2008.05.039. [DOI] [PubMed] [Google Scholar]
  31. Farajzadehgan Z, Nourbakhsh SF, Mostajeran M, et al. Cervical cancer screening status in 35 to 60 year-old women in Isfahan, Iran. J Isfahan Univ Med Sci. 2012;30:1542–9. [Google Scholar]
  32. Farshbaf-Khalili A, Salehi-Pourmehr H, Shahnazi M, et al. Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran. Niger Med J. 2015;56:28–34. doi: 10.4103/0300-1652.149167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Farzaneh F, Shirvani HE, Barouti E, et al. Knowledge and attitude of women regarding the human papillomavirus (HPV) infection, its relationship to cervical cancer and prevention methods. Med J Malaysia. 2011;66:468–73. [PubMed] [Google Scholar]
  34. Fazel N, Akbarzadeh R, Estaji Z, et al. Breast self-examination:knowledge, and performance among upper 20 year old women in medical-health centers in sabzevar-Iran in 2010. Iran J Breast Dis. 2010;3:49–54. [Google Scholar]
  35. Feizi A, Kazemnejad A, Hosseini M, et al. Assessing awareness level about warning signs of cancer and its determinants in an Iranian general population. J Health Popul Nutr. 2011;29:656–9. doi: 10.3329/jhpn.v29i6.9904. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v10, cancer incidence and mortality worldwide:IARC CancerBase No. 11 [internet] [accessed 10 October, 2014];International Agency for Research on Cancer, Lyon. globocan. iarc. fr. 2013 [Google Scholar]
  37. Fouladi N, Pourfarzi F, Mazaheri E, et al. Beliefs and behaviors of breast cancer screening in women referring to health care centers in northwest Iran according to the champion health belief model scale. Asian Pac J Cancer Prev. 2013;14:6857–62. doi: 10.7314/apjcp.2013.14.11.6857. [DOI] [PubMed] [Google Scholar]
  38. Ghazdehi MR, Amini L, Parvizi S, et al. Attitudinal barriers to mammography screening among women in Tehran. J Mazandaran Univ Med Sci. 2013;23:68–75. [Google Scholar]
  39. Ghodsi Z, Hojjatoleslami S. Breast self examination and mammography in cancer screening:women health protective behavior. J Prev Med Hyg. 2014;55:46–9. [PMC free article] [PubMed] [Google Scholar]
  40. Godazandeh G, Khani H, Khalilian A, et al. Knowledge and practice of above 15 years old females towards breast cancer prevention in Sari township, 2004. J Mazandaran Univ Med Sci. 2006;6:64–76. [Google Scholar]
  41. Gómez-Jauregui J. The Feasibility of Government Partnerships with NGOs in the Reproductive Health Field in Mexico. Reprod Health Matters. 2004;12:42–55. doi: 10.1016/s0968-8080(04)24146-5. [DOI] [PubMed] [Google Scholar]
  42. Hadi N, Azimirad A. Knowledge attitude and practice of women in Shiraz about cervical cancer and Pap smear 2009. Iran J Cancer Prev. 2010;3:117–26. [Google Scholar]
  43. Hajializadeh K, Ahadi H, Jomehri F, et al. Psychosocial predictors of barriers to cervical cancer screening among Iranian women:the role of attachment style and social demographic factors. J Prev Med Hyg. 2013;54:218–22. [PMC free article] [PubMed] [Google Scholar]
  44. Hajian-Tilaki K, Auladi S. Health belief model and practice of breast self-examination and breast cancer screening in Iranian women. Breast Cancer. 2014;21:429–34. doi: 10.1007/s12282-012-0409-3. [DOI] [PubMed] [Google Scholar]
  45. Hajian Tilaki K, Auladi S. Awareness, attitude, and practice of breast cancer screening women, and the associated socio-demographic characteristics, in Northern Iran. Iran J Cancer Prev. 2015;8:e3429. doi: 10.17795/ijcp.3429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Harirchi I, Azary S, Montazeri A, et al. Literacy and breast cancer prevention:A population-based study from Iran. Asian Pac J Cancer Prev. 2012;13:3927–30. doi: 10.7314/apjcp.2012.13.8.3927. [DOI] [PubMed] [Google Scholar]
  47. Heidari Z, Mahmoudzadeh-Sagheb HR, Sakhavar N. Breast cancer screening knowledge and practice among women in southeast of Iran. Acta Medica Iranica. 2007;46:321–8. [Google Scholar]
  48. Hsiao WC. Why is a systemic view of health financing necessary? Health Affairs. 2007;26:950–61. doi: 10.1377/hlthaff.26.4.950. [DOI] [PubMed] [Google Scholar]
  49. Jalalvandi M, Khodadoostan M. Married women and pap-smear, what they know?How they do? Iran J Nurs. 2005;18:139–44. [Google Scholar]
  50. Jalilian F, Emdadi S. Factors related to regular undergoing pap-smear test:Application of theory of planned behavior. J Res Health Sci. 2011;11:103–8. [PubMed] [Google Scholar]
  51. Javadzade SH, Reisi M, Mostafavi F, et al. Factors associated with the fecal occult blood testing for colorectal cancer screening based on health belief model structures in moderate risk individuals, Isfahan, 2011. J Educ Health Promot. 2012;1:18. doi: 10.4103/2277-9531.99218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Kakoei S, Rad M, Mahmoudvand N, et al. A survey of the Kerman adults'knowledge about the signs and risk factor of oral carcinoma. J Dent. 2009;10:234–40. [Google Scholar]
  53. Karimian Z, Mehran N, Haddad Z. The assessment of knowledge, attitude and behavior of women in qom toward breast cancer screening methods 2009. Res J Med Sci. 2010;4:116–8. [Google Scholar]
  54. Keshavarzian K, Barzegari Z. The Knowledge of Herisian female about the cervical cancer and pap smear in. J Tabriz Univ Med Sci. 2014;36:70–3. [Google Scholar]
  55. Kharameh Z, Foroozanfar S, Zamanian H. Psychometric properties of the persian version of Champion's health belief model scale for colorectal cancer screening. Asian Pac J Cancer Prev. 2014;15:4595–9. doi: 10.7314/apjcp.2014.15.11.4595. [DOI] [PubMed] [Google Scholar]
  56. Khojasteh F. Women's knowledge, attitude and practice on pap smear test and prevention of cervix cancer in Zahedan, 2004. J Ahvaz Univ Med Sci. 2004;41:1–9. [Google Scholar]
  57. Klugman B. The role of NGOs as agents for change. Dev Dialog. 2000;40:95–120. [Google Scholar]
  58. Koh HK. A 2020 vision for healthy people. N Engl J Med. 2010;362:1653–6. doi: 10.1056/NEJMp1001601. [DOI] [PubMed] [Google Scholar]
  59. Laluie A, Kashanizadeh N. Rate of women's awareness about breast self- examination in Najmieh and Baqiyatollah hospitals referrers. J Rehabil. 2006;7:66–9. [Google Scholar]
  60. Long N, Moore M, Chen W, et al. Cancer epidemiology and control in north-East Asia-past, present and future. Asian Pac J Cancer Prev. 2010;11:107–48. [PubMed] [Google Scholar]
  61. López-Gómez M, Malmierca E, de Górgolas M, et al. Cancer in developing countries:the next most preventable pandemic. The global problem of cancer. Crit Rev Oncol Hematol. 2013;88:117–22. doi: 10.1016/j.critrevonc.2013.03.011. [DOI] [PubMed] [Google Scholar]
  62. Mahmoodi A, Ramazani A. Study of knowledge, attitude, and practice of presenting women to Zabol health centers with regard to breast self examination by using health belief model (in 2009) Modern Care J. 2011;8:65–72. [Google Scholar]
  63. Majidi A, Ghiasvand R, Hadji M, et al. Priority setting for improvement of cervical cancer prevention in Iran. Int J Health Policy Manag. 2015;5:1–8. doi: 10.15171/ijhpm.2015.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Mazloomy MS, Zeynolabedini M, Noorbala M, et al. Knowledge, attitude, and performance of people toward skin cancer in Yazd. Toloo-E-Behdasht. 2012;11:125–37. [Google Scholar]
  65. Meysamie A, Ghaletaki R, Haghazali M, et al. Pattern of tobacco use among the Iranian adult population:results of the national survey of risk factors of non-communicable diseases (SuRFNCD-2007) Tobacco Control. 2010;19:125–8. doi: 10.1136/tc.2009.030759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Moattari M, Rouzitala M, Saberfirouzi M, et al. Effect of education based on health belief model on knowledge and participation of average risk people in colorectal cancer screening. Res Med Sci. 2009;33:47–54. [Google Scholar]
  67. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. Ann Int Med. 2009;151:264–9. doi: 10.7326/0003-4819-151-4-200908180-00135. [DOI] [PubMed] [Google Scholar]
  68. Montazeri A, Vahdaninia M, Harirchi I, et al. Breast cancer in Iran:need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med. 2008;7:6. doi: 10.1186/1447-056X-7-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Motallebnejad MM, Khanian M, Alizadeh R, et al. Community survey of knowledge about oral cancer in Babol:effect of an education intervention. East Mediterr Health J. 2009;15:1489–95. [PubMed] [Google Scholar]
  70. Motevalli R, Mousazadeh T. Women's Knowledge and attitude towards breast cancer screening tests. Health Care J. 2011;13:22–8. [Google Scholar]
  71. Nafissi N, Saghafinia M, Motamedi MH, et al. A survey of breast cancer knowledge and attitude in Iranian women. J Cancer Res Ther. 2012;8:46–9. doi: 10.4103/0973-1482.95173. [DOI] [PubMed] [Google Scholar]
  72. Naghavi M. Transition in health status in the Islamic republic of Iran. Iran J Epidemiol. 2006;2:45–57. [Google Scholar]
  73. Nojomi M, Namiranian N, Myers RE, et al. Factors Associated with breast cancer screening decision stage among women in Tehran, Iran. Int J Prev Med. 2014;5:196–202. [PMC free article] [PubMed] [Google Scholar]
  74. Noroozi A, Tahmasebi R. Factors influencing breast cancer screening behavior among Iranian women. Asian Pac J Cancer Prev. 2011;12:1239–44. [PubMed] [Google Scholar]
  75. Nourizadeh R, Bakhtariagdam F, Sahebi L. Knowledge, health beliefs and breast cancer screening behaviors of women referring to health centers of Tabriz, 2010. Iran J Breast Dis. 2011;3:43–51. [Google Scholar]
  76. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk:2015 guideline update from the American cancer society. JAMA. 2015;314:1599–614. doi: 10.1001/jama.2015.12783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Pakfetrat A, Falaki F, Esmaily HO, et al. Oral cancer knowledge among patients referred to Mashhad dental school, Iran. Arch Iran Med. 2010;13:543–8. [PubMed] [Google Scholar]
  78. Parhizgar A. A KAP study about breast cancer in Sanandaj. J Kordestan Univ Med Sci. 1998;3:17–20. [Google Scholar]
  79. Petersen PE. Oral cancer prevention and control–the approach of the world health organization. Oral oncol. 2009;45:454–60. doi: 10.1016/j.oraloncology.2008.05.023. [DOI] [PubMed] [Google Scholar]
  80. Pilehvarzadeh M, Rezie HH, Aflatoonian MR, et al. Knowledge and attitude of women about breast self-examination. Biosci Biotechnol Res Asia. 2015;12:209–15. [Google Scholar]
  81. Pirzadeh A, Mazaheri MA. The effect of education on women's practice based on the health belief model about pap smear test. Int J Prev Med. 2012;3:585–90. [PMC free article] [PubMed] [Google Scholar]
  82. Pourhaji F, Vahedian-Shahroudi M, Esmaeili H, et al. Knowledge, attitudes and health behaviors regarding breast cancer among health volunteers in Mashhad, 2012. Iran J Breast Dis. 2013;5:44–52. [Google Scholar]
  83. Pourhoseingholi MA, Zali MR. Colorectal cancer screening:Time for action in Iran. World J Gastrointest Oncol. 2012;4:82–3. doi: 10.4251/wjgo.v4.i4.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  84. Ramezani F, Mohammad K, Rahgozar M, et al. Knowledge, attitude, and practice of 20-49 years old Iranian women about breast cancer. Teb Va Tazkieh. 2001a;42:30–7. [Google Scholar]
  85. Ramezani F, Mohammad KA, Rahgozar M, et al. Kenowlege and practice of Iranian women toward cervical cancer. J Reprod Infertil. 2001b;2:50–6. [Google Scholar]
  86. Rastad H, Shokohi L, Dehghani SL, et al. Assessment of the Awareness and Practice of Women vis-à-vis Breast Self-Examination in Fasa in 2011. J Fasa Univ Med Sci. 2013;3:75–80. [Google Scholar]
  87. Razavi SM, Tahani B, Nouri S, et al. Oral cancer knowledge and practice among dental patients and their attitude towards tobacco cessation in Iran. Asian Pac J Cancer Prev. 2015;16:5439–44. doi: 10.7314/apjcp.2015.16.13.5439. [DOI] [PubMed] [Google Scholar]
  88. Rezaee Ghazdehi M, Amini L, Parvizi S, et al. Attitudinal barriers to mammography screening among women in Tehran, 2010. J Mazandaran Univ Med Sci. 2013;23:67–74. [Google Scholar]
  89. Rezaianzadeh A, Peacock J, Reidpath D, et al. Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC Cancer. 2009;9:168. doi: 10.1186/1471-2407-9-168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Sahraee A, Noroozi A, Tahmasebi R. Predicting factors of breast self-examination based on health belief model and locus of control among women aged 20-50 years. Hayat. 2013;19:27–39. [Google Scholar]
  91. Sakkaki M, Gozaliyan Z, Hajimiri K, et al. Women's knowledge and beliefs about mammography based on HBM constructs. Health Sys Res J. 2015;10:729–38. [Google Scholar]
  92. Salimi PS, Kariman N, Sheykhan Z, et al. Investigation of breast cancer screening tests performance and affecting factors in women referred to Ardebil's health and medical centers, 2009. J Ardabil Univ Med Sci. 2010;10:310–8. [Google Scholar]
  93. Salimzadeh H, Delavari A, Montazeri A, et al. Knowledge and practice of iranians toward colorectal cancer, and barriers to screening. Int J Prev Med. 2012;3:29–35. [PMC free article] [PubMed] [Google Scholar]
  94. Salimzadeh H, Eftekhar H, Delavari A, et al. Psycho-social determinants of colorectal cancer screening in Iran. Int J Prev Med. 2014a;5:185–90. [PMC free article] [PubMed] [Google Scholar]
  95. Salimzadeh H, Eftekhar H, Majdzadeh R, et al. Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members:a randomized trial. J Behav Med. 2014b;37:1019–29. doi: 10.1007/s10865-013-9533-6. [DOI] [PubMed] [Google Scholar]
  96. Selvin E, Brett KM. Breast and cervical cancer screening:sociodemographic predictors among White, Black, and Hispanic women. Am J Public Health. 2003;93:618–23. doi: 10.2105/ajph.93.4.618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  97. Shamani A, Reshadmanesh N. Knowledge evaluation of above 15 years old women in breast self-examination and breast disease, Sanandaj 1997. J Kordestan Univ Med Sci. 1999;3:6–11. [Google Scholar]
  98. Shulman LN, Willett W, Sievers A, et al. Breast cancer in developing countries:opportunities for improved survival. J Oncol. 2010;2010:1–6. doi: 10.1155/2010/595167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  99. Simi A, Yadollahie M, Habibzadeh F. Knowledge and attitudes of breast self examination in a group of women in Shiraz, southern Iran. Postgrad Med J. 2009;85:283–7. doi: 10.1136/pgmj.2008.072678. [DOI] [PubMed] [Google Scholar]
  100. Soltanahmadi J, Abbaszadeh A, Tirgari B. A survey on the rate and causes of women's participation or nonparticipation in breast and cervical cancers screening programs. Iran J Obstet Gynaecol Fertil. 2010;13:37–46. [Google Scholar]
  101. Subramanian S, Bobashev G, Morris RJ. When budgets are tight, there are better options than colonoscopies for colorectal cancer screening. Health Aff. 2010;29:1734–40. doi: 10.1377/hlthaff.2008.0898. [DOI] [PubMed] [Google Scholar]
  102. Sutton S, Bickler G, Sancho-Aldridge J, et al. Prospective study of predictors of attendance for breast screening in inner London. J Epidemiol Community Health. 1994;48:65–73. doi: 10.1136/jech.48.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  103. Tadbir AA, Ebrahimi H, Pourshahidi S, et al. Evaluation of levels of knowledge about etiology and symptoms of oral cancer in southern Iran. Asian Pac J Cancer Prev. 2013;14:2217–20. doi: 10.7314/apjcp.2013.14.4.2217. [DOI] [PubMed] [Google Scholar]
  104. Talaiezadeh A, Sarmast-Shoshtari M, Ansari-Asefeh N. Knowledge about breast self-examination among women older than 18 years in Ahvaz. Sci Med J. 2009;7:503–12. [Google Scholar]
  105. Tavafian SS, Hasani L, Aghamolaei T, et al. Prediction of breast self-examination in a sample of Iranian women:an application of the health belief model. BMC Womens Health. 2009;9:37. doi: 10.1186/1472-6874-9-37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  106. Tazhibi M, Feizi A. Awareness levels about breast cancer risk factors, early warning signs, and screening and therapeutic approaches among Iranian adult women:a large population based study using latent class analysis. Biomed Res Int. 2014;2014:306352. doi: 10.1155/2014/306352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  107. Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai:final results. J Natl Cancer Inst. 2002;94:1445–57. doi: 10.1093/jnci/94.19.1445. [DOI] [PubMed] [Google Scholar]
  108. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. doi: 10.3322/caac.21262. [DOI] [PubMed] [Google Scholar]
  109. Trevena L. Cancer screening:Pros, cons, choice, and the patient. Aust Fam Physician. 2009;38:188. [PubMed] [Google Scholar]
  110. Vahdaninia M, Montazeri A. Breast cancer in Iran:a survival analysis. Asian Pac J Cancer Prev. 2004;5:223–5. [PubMed] [Google Scholar]
  111. WHO. Cervical cancer screening in developing countries- Report of a WHO consultation, world health organization-Genava, world health organization. 2002 [Google Scholar]
  112. WHO. Comprehensive cervical cancer control:a guide to essential practice, world health organization. 2006 [PubMed] [Google Scholar]
  113. WHO. Global action plan for the prevention and control of oncommunicable diseases 2013-2020. In Eds world health organization. 2013 [Google Scholar]
  114. Yadollahie M, Simi A, Habibzadeh F, et al. Knowledge of and attitudes toward breast self-examination in Iranian women:a multi-center study. Asian Pac J Cancer Prev. 2011;12:1917–24. [PubMed] [Google Scholar]
  115. Zare Marzouni H, Lavasani Z, Shalilian M, et al. Women's awareness and atitude toward breast self-examination in Dezful City, Iran, 2013. Iran Red Crescent Med J. 2015;17:e17829. doi: 10.5812/ircmj.17829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  116. Zareai M. Women's knowledge and practice of Pap smear test and barriers to performing it in Jahrom. J Jahrom Univ Med Sci. 2014;12:40. [Google Scholar]
  117. Zolfaghari M, Parsa-Yehta Z, Bahramnejad F, et al. Knowledge about seven warning signs of cancer and protective measures of cancer among people in Tehran, Iran. Payesh. 2010;9:317–24. [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

APJCP-18-3187_suppl.pdf (265.1KB, pdf)

Articles from Asian Pacific Journal of Cancer Prevention : APJCP are provided here courtesy of West Asia Organization for Cancer Prevention

RESOURCES