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In Iran, breast cancer is the most common cancer among women, with an age-standardized incidence rate of 43.02 per 100,000 in 2017. The descriptive-analytical study was conducted on 354 women aged 40 and older referred to comprehensive health service centers in Gonabad city (Eastern Iran) in 2023. To determine the stages of decision-making, a researcher-made questionnaire based on the PAPM was used, and people were classified in the stages of unaware, unengaged, deciding to act, decided not to act, decided to act, acting and maintenance. The data was collected by telephone interview and analyzed by statistical tests. The mean age of women was 53.55\u2009\u00b1\u20097.8 years. In terms of decision-making stages, 19.8%, 39.5%, 9.9%, 21.5%, 9.3% in the unaware stage, unengaged, decided not to act, decided to act, acting and maintenance of mammography screening behavior. Statistical tests showed that the variables of disease history (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), family history of disease (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), education level (<jats:italic>p<\/jats:italic>\u2009=\u20090.021) and BMI (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) with the stages of intention to perform mammography had a significant relationship. The findings showed that most of the women were in the stage of unaware and deciding to act, and a small percentage were in the stage of decided to act acting and maintenance. Therefore, it seems necessary to carry out educational interventions based on decision-making processes in order to improve mammography screening behavior and early diagnosis of breast cancer.<\/jats:p>","DOI":"10.1038\/s41598-025-08511-3","type":"journal-article","created":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T12:52:41Z","timestamp":1752411161000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mammography screening status of women aged 40 and older in eastern Iran using the precaution adoption process model (PAPM)"],"prefix":"10.1038","volume":"15","author":[{"given":"Mahbobe Sadat","family":"Sahebi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gholamreza","family":"Sharifzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitra","family":"Moodi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"8511_CR1","doi-asserted-by":"publisher","first-page":"15274","DOI":"10.1038\/s41598-024-66342-0","volume":"14","author":"E Seyedkanani","year":"2024","unstructured":"Seyedkanani, E., Hosseinzadeh, M., Mirghafourvand, M. & Sheikhnezhad, L. 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