{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T01:05:13Z","timestamp":1780880713548,"version":"3.54.1"},"reference-count":53,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background and Objectives: Female breast cancer (FBC) is an increasing public health concern in Iran, with notable geographic disparities that necessitate comprehensive burden assessments at national and provincial levels. This study presented the national and subnational burden and changes in FBC burden from 2010 to 2021 in Iran in comparison with global data. Materials and Methods: The GBD (2021) data on female BC were extracted from the Global Health Data Exchange (GHDx) query tool. Age-standardized incidence, deaths, prevalence, and adjusted years of life with disabilities (DALYs) rates (per 100,000) of FBC were extracted. Data were extracted globally, by continents, for Iran and its provinces, from 2010 to 2021. Results: Although the global FBC burden indicators remained almost stable, in Iran, there was a nearly twofold rise in incidence and prevalence and notable rises in mortality and DALYs. This study showed significant variation at the provincial level; Tehran, Qom, and Alborz consistently had the highest incidence, prevalence, mortality, and DALY rates, whereas Sistan and Baluchistan, Chahar Mahaal and Bakhtiari, Kohgiluyeh and Boyer-Ahmad, and Zanjan had the lowest rates. During 2010\u20132021, the provinces of Golestan, Ardebil, Sistan and Baluchistan, West Azarbayejan, Kohgiluyeh and Boyer-Ahmad, and North Khorasan experienced the most increasing trend in BC burden, while Yazd and Semnan showed smaller increases or modest decreases. Conclusions: The rising FBC burden in Iran underscores the urgent need to strengthen cancer registries, expand screening programs, ensure equitable resource distribution, and implement targeted regional interventions focused on modifiable risk factors and early detection to reduce health disparities nationwide.<\/jats:p>","DOI":"10.3390\/diseases14010015","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:08:11Z","timestamp":1767190091000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["National and Subnational Burden of Female Breast Cancer in Iran from 2010 to 2021"],"prefix":"10.3390","volume":"14","author":[{"given":"Zahra","family":"Pasokh","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz 8433471946, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrooz","family":"Mazidimoradi","sequence":"additional","affiliation":[{"name":"Department of Health Assistant, Shiraz University of Medical Sciences, Shiraz 8433471946, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Hamidian","sequence":"additional","affiliation":[{"name":"Clinical Research Development Unit, Amir Al Momineen Hospital, Zabol University of Medical Sciences, Zabol 9861615881, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Shahabinia","sequence":"additional","affiliation":[{"name":"Geriatric Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohaddeseh","family":"Kiani","sequence":"additional","affiliation":[{"name":"Birjand University of Medical Sciences, Birjand 9717853577, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Salehiniya","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.breast.2022.08.010","article-title":"Current and future burden of breast cancer: Global statistics for 2020 and 2040","volume":"66","author":"Arnold","year":"2022","journal-title":"Breast"},{"key":"ref_2","unstructured":"WHO (2021). Fact Sheets, Breast Cancer, World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9347","DOI":"10.1038\/s41598-025-93883-9","article-title":"The global burden of breast cancer among women of reproductive age: A comprehensive analysis","volume":"15","author":"Cai","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_4","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103835","DOI":"10.1016\/j.breast.2024.103835","article-title":"Current and future burden of breast cancer in Asia: A GLOBOCAN data analysis for 2022 and 2050","volume":"79","author":"Fu","year":"2025","journal-title":"Breast"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"422","DOI":"10.30699\/jogcr.8.5.422","article-title":"Molecular Epidemiology of Breast Cancer in Iran: A Review Article","volume":"8","author":"Dolatkhah","year":"2023","journal-title":"J. Obstet. Gynecol. Cancer Res."},{"key":"ref_7","first-page":"748","article-title":"The Direct Medical Costs of Breast Cancer in Iran: Analyzing the Patient\u2019s Level Data from a Cancer Specific Hospital in Isfahan","volume":"4","author":"Davari","year":"2013","journal-title":"Int. J. Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"360","DOI":"10.26719\/2018.24.4.360","article-title":"Incidence pattern and spatial analysis of breast cancer in Iranian women: Geographical Information System applications","volume":"24","author":"Ahmadi","year":"2018","journal-title":"East. Mediterr. Health J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"471","DOI":"10.2217\/pme-2018-0047","article-title":"The Shiraz Breast Cancer Registry (SBCR): Study design and primary reports","volume":"15","author":"Talei","year":"2018","journal-title":"Pers. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.7314\/APJCP.2016.17.S3.59","article-title":"Spatial Analysis of Breast Cancer Incidence in Iran","volume":"17","author":"Mahdavifar","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hirko, K.A., Rocque, G., Reasor, E., Taye, A., Daly, A., Cutress, R.I., Copson, E.R., Lee, D.W., Lee, K.H., and Im, S.A. (2022). The impact of race and ethnicity in breast cancer-disparities and implications for precision oncology. BMC Med., 20.","DOI":"10.1186\/s12916-022-02260-0"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Marmot, M., and Wilkinson, R. (2005). Social Determinants of Health, Oxford University Press.","DOI":"10.1093\/acprof:oso\/9780198565895.001.0001"},{"key":"ref_13","unstructured":"Solar, O., and Irwin, A. (2010). A Conceptual Framework for Action on the Social Determinants of Health, WHO Document Production Services."},{"key":"ref_14","first-page":"e157981","article-title":"Incidence, Prevalence, Mortality, and Direct Costs of Breast Cancer in Iran: Using the Iran Health Insurance Organization Database","volume":"18","author":"Effatpanah","year":"2025","journal-title":"Int. J. Cancer Manag."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zeng, X., Wang, J., Liu, N., Chen, L., Liang, L., Zhuo, L., Zhang, X., and Lin, M. (2025). Global, regional and national burden of colorectal cancer and its risk factors, 1990\u20132021: A systematic analysis for the GBD 2021. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1673341"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e936","DOI":"10.1002\/hsr2.936","article-title":"The global, regional and national epidemiology, incidence, mortality, and burden of ovarian cancer","volume":"5","author":"Mazidimoradi","year":"2022","journal-title":"Health Sci. Rep."},{"key":"ref_17","unstructured":"Global Burden of Disease Collaborative Network (2024). Global Burden of Disease Study 2021 (GBD 2021) Cause-Specific Mortality 1990\u20132021, Institute for Health Metrics and Evaluation (IHME)."},{"key":"ref_18","first-page":"e1967","article-title":"Cancer incidence in Iran in 2016: A study based on the Iranian National Cancer Registry","volume":"7","author":"Hadavandsiri","year":"2024","journal-title":"Cancer Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Allahqoli, L., Mazidimoradi, A., Momenimovahed, Z., Rahmani, A., Hakimi, S., Tiznobaik, A., Gharacheh, M., Salehiniya, H., Babaey, F., and Alkatout, I. (2022). The Global Incidence, Mortality, and Burden of Breast Cancer in 2019: Correlation with Smoking, Drinking, and Drug Use. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.921015"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s40944-023-00714-8","article-title":"Temporal Trends of Ovarian Cancer Between 1990 and 2019, in Asian Countries by Geographical Region and SDI, Comparison with Global Data","volume":"21","author":"Momenimovahed","year":"2023","journal-title":"Indian J. Gynecol. Oncol."},{"key":"ref_21","unstructured":"Murray, C. (2023). Protocol for the Global Burden Of Diseases, Injuries, And Risk Factors Study (GBD), Institute for Health Metrics and Evaluation (IHME)."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5748","DOI":"10.18632\/aging.202502","article-title":"Global incidence and mortality of breast cancer: A trend analysis","volume":"13","author":"Huang","year":"2021","journal-title":"Aging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6081","DOI":"10.7314\/APJCP.2015.16.14.6081","article-title":"Incidence and Mortality of Breast Cancer and their Relationship to Development in Asia","volume":"16","author":"Ghoncheh","year":"2015","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Schliemann, D., Hoe, W.M.K., Mohan, D., Allotey, P., Reidpath, D.D., Tan, M.M., Taib, N.A.M., Donnelly, M., and Su, T.T. (2022). Challenges and opportunities for breast cancer early detection among rural dwelling women in Segamat District, Malaysia: A qualitative study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0267308"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/S1470-2045(21)00071-1","article-title":"The Global Breast Cancer Initiative: A strategic collaboration to strengthen health care for non-communicable diseases","volume":"22","author":"Anderson","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13058-023-01633-4","article-title":"National and subnational burden of female and male breast cancer and risk factors in Iran from 1990 to 2019: Results from the Global Burden of Disease study 2019","volume":"25","author":"Aryannejad","year":"2023","journal-title":"Breast Cancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Shoorabeh, F.F., Goodarzi, E., Shafeai, F., Pordanjani, S.R., and Abbasi, M. (2024). Pattern of burden cancer breast and relationshipin to human development index in Iran 2009 to 2019: An observational study based on the Global Burden of Diseases. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03378-4"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Rahimzadeh, S., Burczynska, B., Ahmadvand, A., Sheidaei, A., Khademioureh, S., Pazhuheian, F., Saeedi Moghaddam, S., Bentham, J., Farzadfar, F., and Di Cesare, M. (2021). Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248723"},{"key":"ref_29","first-page":"1705","article-title":"Trends in Leading Cancer Incidence among Iranian Women: Annual Cancer Registry Reports, 2003\u20132015","volume":"50","author":"Panahi","year":"2021","journal-title":"Iran. J. Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ghiasvand, R., Bahmanyar, S., Zendehdel, K., Tahmasebi, S., Talei, A., Adami, H.O., and Cnattingius, S. (2012). Postmenopausal breast cancer in Iran; risk factors and their population attributable fractions. BMC Cancer, 12.","DOI":"10.1186\/1471-2407-12-414"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"9543","DOI":"10.7314\/APJCP.2014.15.21.9543","article-title":"Dietary habits contributing to breast cancer risk among Iranian women","volume":"15","author":"Mobarakeh","year":"2014","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.clbc.2018.10.011","article-title":"Dietary Habits and Physical Activity are Associated with the Risk of Breast Cancer Among Young Iranian Women: A Case-control Study on 1010 Premenopausal Women","volume":"19","author":"Fararouei","year":"2019","journal-title":"Clin. Breast Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.nut.2017.06.011","article-title":"The association between the Index of Nutritional Quality (INQ) and breast cancer and the evaluation of nutrient intake of breast cancer patients: A case-control study","volume":"45","author":"Vahid","year":"2018","journal-title":"Nutrition"},{"key":"ref_34","first-page":"51","article-title":"Health equity in Iran: A systematic review","volume":"35","author":"Ghiasvand","year":"2021","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e109801","DOI":"10.5812\/ijcm.109801","article-title":"Association of Urban Liveability with Cancer Incidence in Iran: A Nationwide Ecological Study","volume":"14","author":"Khorrami","year":"2021","journal-title":"Int. J. Cancer Manag."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Jabbari, A., Najafpour, Z., Ourang, S., Loveimi, S., Bohrani, R., and Baymani, M. (2025). Implementation and performance barriers in Iran\u2019s breast cancer screening program: A qualitative case study. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1490191"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1524-4741.2007.00446.x","article-title":"Breast cancer in Iran: An epidemiological review","volume":"13","author":"Mousavi","year":"2007","journal-title":"Breast J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1002\/ijc.33574","article-title":"Cancer in Iran 2008 to 2025: Recent incidence trends and short-term predictions of the future burden","volume":"149","author":"Roshandel","year":"2021","journal-title":"Int. J. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.1111\/tbj.14011","article-title":"Impact of COVID-19 on breast imaging case volumes in South Florida: A multicenter study","volume":"26","author":"Kaplan","year":"2020","journal-title":"Breast J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rcl.2020.09.008","article-title":"The Impact of the COVID-19 Pandemic on Breast Imaging","volume":"59","author":"Freer","year":"2021","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"7","DOI":"10.30699\/ijbd.14.1.7","article-title":"COVID-19 and Breast Cancer. Iran","volume":"14","author":"Haghighat","year":"2021","journal-title":"J. Breast Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"108373","DOI":"10.1016\/j.cmpb.2024.108373","article-title":"ViT-MAENB7: An innovative breast cancer diagnosis model from 3D mammograms using advanced segmentation and classification process","volume":"257","author":"Umamaheswari","year":"2024","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1007\/s12282-025-01783-7","article-title":"Global mapping of artificial intelligence applications in breast cancer from 1988\u20132024: A machine learning approach","volume":"32","author":"Nguyen","year":"2025","journal-title":"Breast Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13058-025-02024-7","article-title":"Advances in CTC and ctDNA detection techniques: Opportunities for improving breast cancer care","volume":"27","author":"Zhong","year":"2025","journal-title":"Breast Cancer Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3","DOI":"10.21037\/tbcr-24-27","article-title":"Recent advances and updated highlights in breast cancer pathologic diagnosis: A narrative review","volume":"6","author":"Liu","year":"2025","journal-title":"Transl. Breast Cancer Res. J. Focus. Transl. Res. Breast Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"104103","DOI":"10.1016\/j.esmoop.2024.104103","article-title":"Comparative overall survival of CDK4\/6 inhibitors plus an aromatase inhibitor in HR+\/HER2- metastatic breast cancer in the US real-world setting","volume":"10","author":"Rugo","year":"2025","journal-title":"ESMO Open"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Mansour, R., Abunasser, M., Sharaf, B., and Abdel-Razeq, H. (2025). Update in the clinical utilization of chemoprevention for breast cancer: A narrative review. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1435253"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"103862","DOI":"10.1016\/j.breast.2024.103862","article-title":"Survival feature and trend of female breast cancer: A comprehensive review of survival analysis from cancer registration data","volume":"79","author":"Tang","year":"2025","journal-title":"Breast"},{"key":"ref_49","first-page":"10","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_50","first-page":"84","article-title":"A silence full of words: Sociocultural beliefs behind the sexual health of Iranian women undergoing breast cancer treatment, a qualitative study","volume":"31","author":"Zangeneh","year":"2022","journal-title":"Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Soleimani, M., Ayyoubzadeh, S.M., Jalilvand, A., and Ghazisaeedi, M. (2023). Exploring the geospatial epidemiology of breast cancer in Iran: Identifying significant risk factors and spatial patterns for evidence-based prevention strategies. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11555-1"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mehrabizadeh, M., Zaremohzzabieh, Z., Zarean, M., Ahrari, S., and Ahmadi, A.-R. (2024). Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03383-7"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e081839","DOI":"10.1136\/bmjopen-2023-081839","article-title":"Risk perception regarding social determinants of health among women with breast cancer in Iran: A qualitative study","volume":"14","author":"Ashari","year":"2024","journal-title":"BMJ Open"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:23:59Z","timestamp":1767191039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diseases14010015"],"URL":"https:\/\/doi.org\/10.3390\/diseases14010015","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]}}}