Cancer Screening Profile of the Iranian Population: Findings from STEPS 2021 survey

Background Cancer is a pressing global health concern, making effective cancer control planning crucial. This is emphasized by the objectives in target 3.4 of the Sustainable Development Goals and the CanScreen 5 project from the International Agency for Research on Cancer (IARC). The objective of this study was to provide a comprehensive overview of breast, cervix, prostate, colorectal cancer screening practices within the Iranian adult population in the year 2021. Methods Using nationally and sub-nationally representative STEPS 2021 data, this study included 27,874 participants aged 18 and above from urban and rural Iran. Participants were asked if they had ever undergone screening for breast, cervical, colorectal, or prostate cancer. Socio-demographic factors such as age, sex, employment, marriage status, education, and wealth index were included. Weighted prevalence, mean, SD, and 95% CIs were reported. The 2016 National Population and Housing Census was used for direct age standardization. Univariate and multiple logistic regression estimated crude and adjusted ORs with 95% CIs for cancer screening participation. Results The age standardized prevalence of participating in cancer screening programs is as follows: breast cancer (24.99%, 95% CI: 24.22–25.76), cervical cancer (42.16%, 41.29–43.02), colorectal cancer in females (7.50%, 7.03–7.98), colorectal cancer in males (6.16%, 5.69–6.63), and prostate cancer (12.29%, 11.64–12.95). For all cancers, complementary health insurance coverage was associated with higher cancer screening participation. Additionally, for all cancers except breast cancer, basic health insurance was also linked to higher screening participation. In cervical cancer screening, human papillomavirus vaccination and urban residency were associated with higher participation, while for colon cancer in both men and women, rural residency was linked to higher participation, based on the adjusted model. Conclusion Cancer screening participation rates in Iran fall below expectations, particularly in meeting targets set by the World Health Organization Cervical Cancer Elimination Initiative for 2030 emphasizing to screen at least 70% of women between the age of 35 and 45. Implementing best-buy interventions from the Global Action Plan for Noncommunicable Diseases, scaling up prevention, prioritizing screening and early diagnosis, and strengthening cancer services are essential for improving coverage and participation in cancer screening programs.