Jabbari Arezoo, Najafpour Zhila, Ourang Sima, Loveimi Somayeh, Bohrani Reyhane, Baymani Mahsa
Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Health Care Management, School of Public Health, Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Front Public Health. 2025 May 9;13:1490191. doi: 10.3389/fpubh.2025.1490191. eCollection 2025.
Cancer screening programs (CSPs) are essential for early detection and improving survival rates; however, they often encounter barriers to effective implementation. This study aims to identify the key challenges faced in implementing the Breast Cancer Screening Program (BCSP) in Iran, with the goal of providing insights to enhance the program's effectiveness and accessibility.
This study was conducted as an observational and qualitative research to assess the implementation status and identify barriers within the Breast Cancer Screening Program (BCSP). Data were collected through a combination of interviews, process observations, and document reviews. A purposive sample of 37 participants was interviewed, including individuals involved in the management, implementation, or evaluation of the screening program. Thematic content analysis was employed to analyze the data, with saturation achieved to ensure comprehensive coverage of the study's objectives.
The study identified several key barriers to the effective implementation of breast cancer screening programs, which were categorized into three main dimensions: infrastructural, managerial, and healthcare service delivery. The most critical issues in infrastructural category were a lack of trained healthcare personnel, insufficient screening facilities, inaccurate registration systems, fragmented databases, and poor data quality control. Key barriers in the managerial dimension include the absence of a mechanism for identifying and inviting women eligible for cancer screening, as well as inadequate monitoring of non-responders to follow-up. Overcrowding during peak times, long waiting periods, inaccurate triage, and lack of general practitioners (GPs) at the primary level of public healthcare were the identified barriers in service delivery in cancer screening. Additionally, interviews with women revealed several barriers, such as low perceived risk, fear and anxiety, lack of family support, and cultural or religious objections, all of which further hindered participation in breast cancer screening.
This study highlights the critical barriers to the implementation of breast cancer screening programs in Iran, most of which appear to stem from systemic failures. Addressing these challenges requires a comprehensive, strategic approach that targets the identified obstacles at multiple levels. Overcoming these barriers is crucial to improving the accessibility, efficiency, and overall effectiveness of breast cancer screening programs, ultimately enhancing early detection and patient outcomes.
癌症筛查项目对于早期发现和提高生存率至关重要；然而，它们在有效实施过程中常常遇到障碍。本研究旨在确定伊朗实施乳腺癌筛查项目（BCSP）所面临的关键挑战，以便为提高该项目的有效性和可及性提供见解。
本研究作为一项观察性定性研究，旨在评估乳腺癌筛查项目（BCSP）的实施状况并确定其中的障碍。通过访谈、过程观察和文件审查相结合的方式收集数据。对37名参与者进行了有目的抽样访谈，其中包括参与筛查项目管理、实施或评估的人员。采用主题内容分析法对数据进行分析，并达到饱和状态以确保全面涵盖研究目标。
该研究确定了乳腺癌筛查项目有效实施的几个关键障碍，这些障碍可分为三个主要方面：基础设施、管理和医疗服务提供。基础设施方面最关键的问题是缺乏训练有素的医护人员、筛查设施不足、登记系统不准确、数据库分散以及数据质量控制不佳。管理方面的主要障碍包括缺乏识别和邀请符合癌症筛查条件女性的机制，以及对未响应后续跟进者的监测不足。癌症筛查服务提供方面的障碍包括高峰时段过度拥挤、等待时间长、分诊不准确以及公共医疗基层缺乏全科医生（GP）。此外，对女性的访谈揭示了一些障碍，如感知风险低、恐惧和焦虑、缺乏家庭支持以及文化或宗教方面的反对意见，所有这些都进一步阻碍了参与乳腺癌筛查。
本研究突出了伊朗实施乳腺癌筛查项目的关键障碍，其中大多数似乎源于系统性失灵。应对这些挑战需要一种全面的战略方法，在多个层面针对已确定的障碍。克服这些障碍对于提高乳腺癌筛查项目的可及性、效率和整体有效性至关重要，最终可提高早期发现率和患者治疗效果。
