Exploring Effective Contextual Factors for Regular Cervical Cancer Screening in Iranian Women: A Qualitative Study

Background: Adherence to regular screening programs for cervical cancer in Iranian women is not common.The aim of this study was to explore contextual factors influencing behavior and compliance with guidelines.Methods: This qualitative content analysis study was conducted in 2016-2017 in Hamadan city, Iran. Semi-structuredin-depth interviews were conducted with 31 participants who were selected purposefully on referring to health centers.Twenty-three were women with various experiences of cervical cancer screening and 8 were health care providers(4 midwives, 1 gynecologist, 1 general practitioner and 1 family health expert). Guba and Lincoln criteria were usedfor tustworthiness. MAXQDA10 software was employed for data analysis. Results: Four themes were extracted fromthe data: an opportunity maker system, opportunities to become acquainted, concerns for healthy living, and perceptionof cancer. Conclusion: The results showed sensitivity of health care providers and their appropriate performancein relation to regular screening behavior of women is very important. Women’s perception of cancer and its curabilityis another factor with a major effect on screening behavior. Opportunities for people to become acquainted with thePap smear in a variety of ways and concern for healthy living and the need to have a healthy life to ensure qualityof life were also found to be important.     

Knowledge,Attitudes, and Practices Regarding Cervical Cancer Screening among Omani Women Attending Primary Healthcare Centers in Oman: A Cross-Sectional

Background: This study aimed to assess knowledge, attitudes, and practices regarding cervical cancer, cervical cancer screening, and Papanicolaou (Pap) smear testing among Omani women attending primary healthcare centers in Oman, and to establish a correlation with various sociodemographic characteristics. Methods: A multi-center cross-sectional survey was carried out from August 2019 to January 2020 and included 805 women attending 18 primary healthcare centers. A pre-tested questionnaire was utilized to assess the participants’ sociodemographic characteristics, cervical cancer risk factors, knowledge, attitudes, and practices related to cervical cancer, cervical cancer screening, and Pap smear testing. Results: All 805 women participated in the study (response rate: 100%). Overall, 67.5% and 50.9% had heard of cervical cancer and Pap smear testing, respectively; however, only 13.4% and 10.9% demonstrated high levels of knowledge concerning these topics. Knowledge was significantly associated with educational level, type of educational qualification (i.e. if their degree was related to healthcare), monthly income, and employment status (p ≤ 0.05 each). Only 15.7% of the participants had previously undergone Pap smear testing, although 42.7% were willing to undertake such screening in future. No associations were noted between Pap smear practice or willingness and sociodemographic characteristics, family history of cervical cancer or personal history of cervical cancer or related risk factors. Conclusions: Knowledge regarding cervical cancer and Pap smear testing was suboptimal among a cohort of Omani women attending primary healthcare centers in Oman. This may be a factor behind the increased number of cervical cancer cases in Oman; as such, a well-structured awareness and educational program is needed to address this issue.     

Cervical Cancer Screening Among Adult Women in China, 2010

Introduction.

Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China.

Methods.

We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders.

Results.

Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30–39 years (30.1%, 95% confidence interval, 26.8%–33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30–49 years, higher education, being married, and having urban health insurance.

Conclusion.

Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women.

Implications for Practice:

This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.     

Factors Associated with Breast Cancer Mammographic Screening Behavior among Iranian Women

Breast cancer is one of the most common diseases of women, which can increase the survival of patients with its early diagnosis. Despite the existence of relatively sensitive methods of early detection of breast cancer, such as mammography, statistics show that a small number of women perform mammography according to the recommended clinical guidelines. Using the health belief model, this study aims to determine the factors affecting mammography among women teachers in Hamedan. Methods: This study was conducted on 458 female teachers aged 40 years and older of Hamadan city, in western part of Iran, during October to December of 2019. The participants were asked about the factors affecting mammography based on the health belief model. Questionnaires were completed by self-reported method and analyzed by SPSS software at 95% confidence interval. Results: The average age of the study participants was 46±4.1 years. Among the participants, about 41.5% had performed mammography at least once. In univariate analysis, the constructs of the health belief model generally predicts performing mammography between 35 and 49 percent. In multivariate analysis, age 46 to 50 years, having supplementary insurance, history of breast disease, perceived barriers with odds ratio of 3.4, 3.4, 10.6 and .89, respectively, were significantly related to mammography. Conclusions: Female teachers over 45 years of age with a history of breast disease, if they do not have financial or other barriers to do mammography, perform breast cancer screening.     

Breast and Cervical Cancer Screening and Associated Factors among Older Adult Women in South Africa

Background: Little is known about the cancer screening prevalence and correlates in older adults fromdifferent racial backgrounds. In the context of heightened efforts for prevention and early diagnosis, we collectedinformation on screening for two major types of cancers: cervical and breast cancer in order to establish theirprevalence estimates and correlates among older South African women who participated in the Study of GlobalAgeing and Adults Health (SAGE) in 2008. Materials and Methods: We conducted a national population-basedcross-sectional study with a multi-stage stratified cluster sample of 3,840 individuals aged 50 years or older inSouth Africa in 2008. In this analysis, we only considered the female subsample of (n=2202). The measures usedincluded socio-demographic characteristics, health variables, anthropometric and blood pressure measurements.Multivariable regression analysis was performed to assess the association of socio-demographic factors,health variables and cancer screening. Results: Overall, regarding cervical cancer screening, 24.3% ever hada Papanicolaou (PAP) smear test, and regarding breast cancer screening, 15.5% ever had a mammography.In multivariate logistic regression analysis, younger age, higher education, being from the White or Colouredpopulation group, urban residence, greater wealth, and suffering from two or more chronic conditions wereassociated with cervical cancer screening, and higher education, being from the White or Indian/Asian populationgroup, greater wealth, having a health insurance, and suffering from two or more chronic condtions wereassociated with breast cancer screening. Conclusions: Cancer screening coverage remains low among elderlywomen in South Africa in spite of the national guideline recommendations for regular screening in order toreduce the risk of dying from these cancers if not detected early. There is a need to improve accessibility andaffordability of early cervical and breast cancer screening for all women to ensure effective prevention andmanagement of cervical and breast cancer.     

Development of In-House Multiplex Real Time PCR for Human Papillomavirus Genotyping in Iranian Women with Cervical Cancer and Cervical Intraepithelial Neoplasia

Background: HPV related cervical cancer as one of the most common women cancers in developing countries. Regarding accessibility of commercial vaccines, any long or short term modality for integrating preventive immunization against HPV in a national program needs comprehensive information about HPV prevalence and its genotypes. The important role of selecting most accurate diagnostic technologies for obtaining relevant data is underlined by different assays proposed in the literature. The main objective of the present study wasto introduce an in-house HPV typing assay using multiplex real time PCR with reliable results and affordable cost for molecular epidemiology surveys and diagnosis. Materials and Methods: 112 samples of formalin fixed paraffin embedded tissues and liquid based cytology specimens from patients with known different grades of cervical dysplasia and invasive cancer, were examined by this method and the result were verified by WHO HPV LabNet proficiency program in 2013. Results: HPV was detected in 105 (93.7%) out of 112 samples. The dominant types were HPV 18 (61.6%) and HPV 16 (42.9%). Among the mixed genotypes, HPV 16 and 18 in combination were seen in 12.4% of specimens. Conclusions: According to acceptable performance, easy access to primers, probes and other consumables, affordable cost per test, this method can be used as a diagnostic assay in molecular laboratories and for further planning of cervical carcinoma prevention programs.     

Personal and Socio-Cultural Barriers to Cervical Cancer Screening in Iran,Patient and Provider Perceptions: a Qualitative Study

Background: Although cervical cancer is preventable and early screening might decrease the associatedmortality, challenges faced by the women and health care providers can postpone early detection. This qualitativestudy aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervicalcancer screening in Mashhad, Iran. Materials and Methods: In the present study, which was conducted in 2012,eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structuredinterviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis andAtlas-Ti software. Results: One theme and two categories were derived from data including: cognitive/behavioralfactors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lackof health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition,modernity and religious, extra marital relationships and cultural taboos). Conclusions: Providing communitybased approach education programs and employing social policy are needed for preventing of cervical cancerin Iran.     

Prevalence of Abnormal Papanicolaou Test Results and Related Factors among Women Living in Zanjan,Iran

Background: Currently, a comprehensive program for screening and early detection of cervical cancer doesnot exist in Iran. This study aimed to determine the prevalence of abnormal Papanicolaou (Pap) smears andsome related factors among women living in Zanjan, Iran. Materials and Methods: This cross-sectional studywas conducted in 2012 in Zanjan on 4274 married women aged 20-65 years. The study participants were selectedthrough two-stage cluster sampling. After obtaining written consent, demographic and fertility questionnaireswere completed. Samples from cervix were obtained through a standard method using the Rover Cervex-Brush. Evaluation and interpretation of the samples were reported using the Bethesda 2001 method. Data werestatistically analyzed using chi-square and logistic regression models. Results: Most inflammatory changes in thesamples were mild (37.4%). Abnormal atypical changes in the epithelial cells were found in 4.04%. The highestpercentage of abnormal changes in the epithelial cells was atypical squamous cells of undetermined significance(ASCUS) (1.9%). Abnormal results of Pap smear was significantly and independently associated with age,papillomavirus infection, and lack of awareness about Pap smear tests. Conclusions: Given the high prevalenceof inflammatory and precancerous changes in this study, compared to other studies in Iran and other Muslimcountries, and the effect of demographic variables and individual factors on abnormal results, increasing theawareness of women and their families regarding the risk factors for cervical cancer, preventive measures suchas screening, and timely treatment seem necessary.     

Effect of an Educational Intervention Based on Protection Motivation Theory on Preventing Cervical Cancer among Marginalized Women in West Iran

Objective: This study aimed to determine the effectiveness of an educational intervention to prevent cervical canceramong marginalized Iranianwomen based on the Protection Motivation Theory (PMT) as a theoretical framework.Methods: This quasi-experimental study was carried out on 143 women of Kermanshah City in western Iran during2017. Participants were recruited through cluster and simple random sampling and randomly divided into experimental(n=72) and control groups (n=71). All completed a self-administered questionnaire including PMT constructs anddemographic variables. An intervention over six sessions was then applied to the experimental group. Reassessmentwas conducted three months after the intervention, with data was analyzed with SPSS-16 using chi-square, McNemar,paired T- and independent T-tests. Results: The mean scores for the constructs of PMT, and cervical cancer screeningbehavior showed no significant differences between the two groups before the intervention (P>0.05). The educationalmanipulation had significant effects on the experimental groups’ average response for perceived vulnerability, perceivedseverity, perceived reward, self-efficacy, response efficacy, response cost and protection motivation (all p < 0.001).Also, the prevalence of regular Pap smear testing and referral to health centers were significantly increased after 3months in the experimental (P=0.048), but notthe control group (P>0.05). Conclusions: The results show that applyingan educational intervention based on PMT might help prevent cervical cancer and improve regular Pap smear testing.     

Breast Cancer Risk Factors in Women Participating in a Breast Screening Program: a Study on 11,850 Iranian Females

The incidence rate of breast cancer in developed countries is almost three-fold higher than in developingcountries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the recentdecades a marked increase has been seen. The purpose of this study was to investigate some established riskfactors of breast cancer in Iranian women. A study of 11,850 women participating in abreast screening programwas conducted. The 197 women diagnosed with breast cancer and 11,653 healthy women were compared. Logisticregression was performed to investigate associations of reproductive and anthropometric factors with breastcancer risk. Family history of breast cancer (OR=1.94 , 95%CI=1.35-2.78), occupation (OR= 1.65,95%CI=1.20-2.25), education level (OR=0.50,95%CI=0.28-0.91), parity (OR=0.27, 95%CI=0.12-0.59), menopausal status(OR=3.15, 95%CI=2.35-4.21), age at menarche (OR=0.33, 95%CI=0.15-0.70), and age at the first pregnancy(OR=4.10 , 95%CI=1.13-14.77) were related to the risk of breast cancer. Decrease in parity may to some extentexplain the rising trend of incidence of breast cancer incidence in Iranian women.     

Burden of Breast Cancer in Iranian Women is Increasing

Background: Breast cancer (BC) is the leading cause of oncological death for women, in both developed anddeveloping countries. In Iran, breast cancer ranks first among cancers diagnosed in women. The aim of this studywas to present the burden of this cancer including incidence, mortality and years life lost (YLL) due to breastcancer in Iranian women. Materials and Methods: National incidence data from the Iranian annual NationalCancer Registration reports from 2003 to 2009 and national death statistics reported by the Ministry of Healthand Medical Education from 1995 to 2010, stratified by age group, were included in this analysis. Also calculatedYLLs provided by the Institute for Health Metrics and Evaluation (IHME) for the years 1990, 1995, 2000, 2005and 2010 were employed to express the years lost due to BC for Iranian women. Results: The general mortalityrate of breast cancer increased during these years from 0.96 to 4.33 per 100,000 and incidence increased from 16.0to 28.3 per 100,000 for the years under study. YLLs calculated by IHME showed both increasing and decreasingpatterns, with a tendency for stabilization. Conclusions: The burden of breast cancer for Iranian women is stillincreasing. Thus, health education programs to inform women regarding the signs and risk factors, and nationalscreening to facilitate early diagnosis are needed for the female community in Iran.     

Delayed Presentation of Self-discovered Breast Cancer Symptoms in Iranian Women: A Qualitative Study

Background: Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making amajor contribution to low survival. Despite the importance of this problem, current knowledge is insufficient toinform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delayin Iranian women with self-discovered breast cancer symptom. Materials and Methods: This qualitative studywas conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discoveredsymptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran,Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed andanalyzed using conventional content analysis with MAXqda software version 10. Findings: Content analysis of thedata revealed four main themes related to the delay in seeking medical help including: 1) attributing symptomsto the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers toaccess to health care systems. Conclusions: These results suggest that patient delay is influenced by complexand multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed byfocusing on improvement of women’s medical knowledge, managing patients’ emotional expression and reformof the referral system.     

Cervical Cancer Screening: Recommendations for Muslim Societies

Background: The overall cervical cancer incidence rate is low in Iran; however, because of a higher risk of death for cervical cancer, a disease that kills women in middle age, a cervical cancer control program is needed. The aim of this study was to provide consensus recommendation for cervical cancer prevention in Iran and other Muslim societies with low incidences of cervical cancer. Materials and Methods: Through a practical guideline development cycle, we developed six questions that were relevant to produce the recommendation. We reviewed 190 full text records of cervical cancer in Iran (1971 to 2013) of which 13 articles were related to the data needed to answer the recommendation questions. We also reviewed World Health Organization, IARC, GLOBOCAN report, Iran Ministry of Health cancer registry report and 8 available foreign countries guidelines. Lastly, we also evaluated the Pap smear results of 825 women who participated in the Iranian HPV survey, of whom 328 were followed-up after a 5-year interval. Results: The obtained data highlighted the burden of HPV and cervical cancer situation in Iran. Experts emphasized the necessity of a cervical cancer screening program for Iranian women, and recommended an organized screening program with a cytological evaluation (Pap smear) that would start at the age of 30 years, repeated every 5 years, and end at the age of 69 years. Meanwhile, there is no need for screening among women with a hysterectomy, and screening should be postponed to post-partum among pregnant women. Conclusions: An organized cervical cancer screening is a necessity for Iran as more than 500-900 women in middle age diagnosed with an invasive cervical cancer every year cannot be ignored. This recommendation should be taken into account by the National Health System of Iran and Muslim countries with shared culture and behavior patterns. CUBA HPV test could be consideration in countries Muslim country with appropriate budget, resources and facility.     

Development of a Colorectal Cancer Screening Intervention for Iranian Adults: Appling Intervention Mapping

Background: While the incidence rate of the colorectal cancer (CRC) has been increasing over the last three decades in Iran, very limited interventions to increase CRC screening have been developed for Iranian population. The purpose of this study was to describe the use of Intervention Mapping (IM) for applying theory and evidence and considering local contexts to develop a CRC screening program among adults in Iran. Materials and Methods: From April 2014 to July 2016 following the IM process, six steps were formulated and implemented. First a need assessment was conducted involving relevant stakeholders and using focus groups discussions (n=10), individual interviews (n=20), and a household survey (n= 480). Then a matrix of change objectives was developed for each behavioral outcome and theoretical methods and their practical applications were identified to guide intervention development and implementation. A multi-component intervention was developed and piloted. Decision on suitable parts of intervention was made based on feedback of pilot study. Finally, evaluation plan including process and outcome evaluation was generated and conducted to inform future scale up. Results: The needs assessment highlighted factors affecting CRC screening including knowledge, self efficacy, social support and perceived benefit and barriers (financial problems, fear of detection of cancer and etc). Results of needs assessment were used to develop next steps IM. The program utilized methods like information delivery, modeling, and persuasion. Practical applications included video presentation, group discussion, role playing and postcards.This program was assessed through a cluster-randomized controlled trial. Results showed that there were significant differences in CRC screening uptake between intervention groups and control (P<0.001). Conclusions: IM is a useful process in the design of a theory-based intervention addressing CRC screening among Iranian population.     

新疆维吾尔族妇女宫颈癌筛查方法横断面比较研究

[目的]探讨适合新疆维吾尔族妇女宫颈癌的筛查方法。[方法]于2006～2007年采用整群抽样方法,选择新疆维吾尔族妇女883名,采用自我采样HPV检测,液基细胞学检查,医生采样HPV检测,肉眼筛查(VIA)进行宫颈癌筛查。分析和比较不同筛查方法的灵敏度、特异度、阳性预测值、阴性预测值。[结果]医师采样HPV检测的灵敏度和特异度均为最高(P<0.01),自我采样的灵敏度与细胞学检查相似(P>0.05),但自我采样HPV检测的特异度高于细胞学检查(P<0.01),与医生采样HPV检测相似(P>0.05)。肉眼筛查的灵敏度和特异度为最低。[结论]新疆维吾尔族妇女的宫颈癌筛查方案应首选医生采样HPV检测,自我采样HPV检测是比较适合于新疆民族地区妇女的方案,在偏远和缺少设备的地区,肉眼筛查也是一种可行的筛查方法。     

Self-Disclosure of Breast Cancer Diagnosis by Iranian Women to Friends and Colleagues

Background: Breast cancer (BC) is the most common form of cancer in Iranian women, and it remains a majorhealth problem. An increasing number of young women are being diagnosed with BC, and therefore, there is anincreasing likelihood that more women will survive breast cancer for many years. Many opine that self-disclosureof BC diagnosis is important because talking about cancer helps people to make sense of their experiences; infact, self-disclosure appears to play an important role in many health outcomes. However, this has not yet beenstudied in BC patients in Iran. Therefore, this study aimed to explore the status of self-disclosure of BC diagnosisby Iranian women to friends and colleagues. Materials and Methods: All BC records for 2001-2011 of employedwomen were studied at five hospitals in Mashhad. Data about the self-disclosure of BC diagnosis were gatheredthrough telephone interviews, and the participants filled out a questionnaire about their status of self-disclosureof BC diagnosis to various groups of people. Results: The mean age of employed women at the time of diagnosiswas 44.3±6.7 years. Over 60% self-disclosed to work colleagues and over 90% to bosses/managers. Seventy percent reported that they had support from their family and husband’s family, while 95% reported that they hadsupport from parents, siblings, children and friends. Conclusions: Most employed women self-disclosed freelyto family, friends, colleagues and bosses/managers. Apparently, self-disclosure of breast cancer diagnosis mayhave negative effects at work. About half of patients reported that they had support from family, managers andcolleagues; however, for nearly 28% of employed women, disclosure had less positive effects. In particular, italtered their perception of others, produced difficulties with work and family and diminished closeness with thepeople who were told. However, the stigma of BC is far less than it once was.     

Ovarian Cancer in Iranian Women,a Trend Analysis of Mortality and Incidence

Background: Ovarian cancer is an important cause of mortality in women. The aim of this study was toevaluate the incidence and mortality rates and trends in the Iranian population and make predictions. Materialsand Methods: National incidence from Iranian annual of National Cancer Registration report from 2003 to 2009and National Death Statistics reported by the Ministry of Health and Medical Education from 1999 to 2004 wereincluded in this study. A time series model (autoregressive) was used to predict the mortality for the years 2007,2008, 2012 and 2013, with results expressed as annual mortality rates per 100,000. Results: The general mortalityrate of ovarian cancer slightly increased during the years under study from 0.01 to 0.75 and reaching plateauaccording to the prediction model. Mortality was higher for older age. The incidence also increased during theperiod of the study. Conclusions: Our study indicated remarkable increasing trends in ovarian cancer mortalityand incidence. Therefore, attention to high risk groups and setting awareness programs for women are neededto reduce the associated burden in the future.     

Quality of Actions to Control Cervical Cancer in Bahia,Brazil

Objective: To assess the quality of the actions to control cervical cancer (CC) and its correlates. Methods: This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- “Performance of educational, promotion, prevention, and monitoring actions” (D1); “Access to diagnostic tests” (D2); “Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)” (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. Results: The following prevalence rates were found: D1  39.8% (95% CI: 33.8-46.2); D2  73.9% (95% CI: 67.9-79.1); and D3  46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. Conclusion: Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC.     

Factors Influencing Breast Cancer Screening Behavior among Iranian Women

Background: Early detection of breast cancer is of great importance to improve women’s health and to decreasethe cost related to cancer death. Therefore, recognition of variables related to breast cancer screening behaviorsis necessary. Objectives of this study were to identify the rates of breast self-examination (BSE) performance andmammography use in Iranian women, and to characterize the demographic and cognitive factors associated withtheir breast cancer screening behavior. Method: Data were collected from a convenience sample of 388 females,using an adapted version of Champion’s revised Health Belief Model Scale. Results: The results showed that7.5% of the participants performed BSE on a regular monthly basis, and among the women aged 40 and older,14.3% reported having had at least one mammography in their lifetime. Perceived self-efficacy and perceivedbarriers to BSE were significant predictors for BSE performance. For having mammography, health motivationwas the main predictor. Conclusion: Eliminating barriers and increasing perceived self-efficacy with an emphasisto make the women acquainted with BSE performance; as well as increasing health motivation of women andpersuading of physicians for clinical breast examination (CBE) performance with low cost and free access tom ammography, are important to promote BSE and mammography.