Facilitating Factors and Barriers of Women’s Cancer Screening in Iran: A Systematic Review

Sulmaz Ghahramani, Hengameh Kasraei, Saeed Shahabi, Kamran Bagheri Lankarani

Abstract


Low uptake of women’s cancer screening and its facilitating factors and barriers in Iran has been studied so far but no consensus on factors affecting this low uptake has been stated previously. Nevertheless, facilitating factors and barriers of breast cancer and cervical cancer have been reviewed. In this systematic review, Web of Science, PubMed, EMBASE, Scopus, and Google Scholar were the preferred search engines. In addition, the Persian database of Magiran and SIDs and ISC indexed journals were searched with different combinations of Persian keywords compatible with English search. A hand search of key Iranian journals was also accomplished. Through 964 primarily searched articles, finally, after duplicates being removed, the screen of records, and full‑text articles assessed for eligibility, only 12 articles were included in the review. Barriers observed mostly were screening not advised by a physician, having no relevant problems or disease, having no knowledge about the procedure, fear from pain or cancer detection, shame from the procedure, and forget to have screening. Facilitators were less focused than barriers and frequently were identified as advised by healthcare professionals, the perceived necessity for screening, and the important identified risk of cancer acquire. Almost all studies focused on individual and interpersonal barriers and facilitators for screening instead of a holistic view on the utilization of screening programs. In future studies on women’s cancer screening, facilitating factors and barriers of both supply (health system provision and policy implications) and demand‑side (individual and interpersonal factors) of healthcare provision has been strongly recommended.

Keywords


Iran; mass screening; review; women

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References


Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R,

Lopez AD, Murray CJ, et al. Breast and cervical cancer in 187

countries between 1980 and 2010: A systematic analysis. Lancet

;378:1461‑84.

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‑Tieulent J, Jemal A.

Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87‑108.

Radmard AR. Five common cancers in Iran. Arch Iran Med

;13:143‑6.

Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM,

Harirchi I, Najafi M, et al. Breast cancer in Iran: An

epidemiological review. Breast J 2007;13:383‑91.

Khorasanizadeh F, Hassanloo J, Khaksar N, Mohammad Taheri S,

Marzaban M, H. Rashidi B, et al. Epidemiology of cervical

cancer and human papilloma virus infection among Iranian

women — Analyses of national data and systematic review of

the literature. Gynecol Oncol 2013;128:277‑81.

Ahmadi A, Salehi F, Ahmadimirghaed Z. Cancer trends in

a province of Southwest of Iran, 2003‑2016. J Res Med Sci

;23:80.

Rafiemanesh H, Maleki F, Mohammadian‑Hafshejani A,

Salemi M, Salehiniya H. The trend in histological changes and

the incidence of esophagus cancer in Iran (2003‑2008). Int J

Prev Med 2016;7:31.

Zeinalian M, Eshaghi M, Sharbafchi MR, Naji H, Marandi SM,

Asgary S. A comparative study on cancer prevention principles

between Iranian traditional medicine and classic medicine. Int J

Prev Med 2016;7:61.

Miles A, Cockburn J, Smith RA, Wardle J. A perspective

from countries using organized screening programs. Cancer

;101:1201‑13.

Shapiro S, Coleman EA, Broeders M, Codd M, de Koning H,

Fracheboud J, et al. Breast cancer screening programmes in 22

countries: Current policies, administration and guidelines. Int J

Epidemiol 1998;27:735‑42.

van Ballegooijen M, Van Den Akker‑van Marle E, Patnick J,

Lynge E, Arbyn M, Anttila A, et al. Overview of important

cervical cancer screening process values in European

Union (EU) countries, and tentative predictions of the

corresponding effectiveness and cost‑effectiveness. Eur J Cancer

;36:2177‑88.

Adab P, McGhee SM, Yanova J, Wong CM, Hedley AJ.

Effectiveness and efficiency of opportunistic cervical cancer

screening: Comparison with organized screening. Medical Care

;42:600‑9.

Sankaranarayanan R, Budukh AM, Rajkumar R. Effective

screening programmes for cervical cancer in low‑and

middle‑income developing countries. Bull World Health Organ

;79:954‑62.

Pontén J, Adami HO, Bergström R, Dillner J, Friberg LG,

Gustafsson L, et al. Strategies for global control of cervical

cancer. Int J Cancer 1995;60:1‑26.

Joulaei H, Zarei N. Women’s cancer care in Iran. Cancer Control

;26:1073274819848432.

Akbari F, Shakibazadeh E, Pourreza A, Tavafian S. Barriers and

facilitating factors for cervical cancer screening: A qualitative

study from Iran. Iran J Cancer Prev 2010;3:178‑84.

Allahverdipour H, Asghari‑Jafarabadi M, Emami A. Breast

cancer risk perception, benefits of and barriers to mammography

adherence among a group of Iranian women. Women Health

;51:204‑19.

Allahverdipour H, Emami A. Perceptions of cervical cancer

threat, benefits, and barriers of Papanicolaou smear screening

programs for women in Iran. Women Health 2008;47:23‑37.

Ghourchaei A, Charkazi A, RazzaqNejad A. Knowledge, practice

and perceived threat toward breast cancer in the women living in

Gorgan, Iran. J Res Dev Nurs Midwifery 2013;10:25‑32.

Hajializadeh K, Ahadi H, Jomehri F, Rahgozar M. Health beliefs

and screening behavior of cervical cancer among the women of

Bandar Abbas. Life Sci J 2013;10:545‑51.

Hasani L, Aghamolaei T, Tavafian S, Zare S. Constructs

of the health belief model as predicting factors in breast

self‑examination. Hayat 2011;17:62‑9.

Jalilian F, Emdadi S. Factors related to regular undergoing

Pap‑smear test: Application of theory of planned behavior. J Res

Health Sci 2011;11:103‑8.

Montazeri A, Haji‑Mahmoodi M, Jarvandi S. Breast

self‑examination: Do religious beliefs matter? A descriptive

study. J Public Health 2003;25:154‑5.

Moodi M, Rezaeian M, Mostafavi F, Sharifirad GR. Determinants

of mammography screening behavior in Iranian women:

A population‑based study. J Res Med Sci 2012;17:750‑9.

Rezaee Ghazdehi M, Amini L, Parvizi S, Hoseyni AF. Attitudinal

barriers to mammography screening among women in Tehran.

J Mazandaran Univ Med Sci 2013;23:69‑75.

Sadatjediarani T, Akbari H, Hasanbeigi O, Askari Z. The

study of preventive and impeller factors of prevalent cancers

screening tests in women in Kashan during 2013. SJIMU

;22:56‑66.

Soltan Ahmadi Z, AbbasZadeh A, Tirgari B. Survey on the rate

and causes of women’s participation or nonparticipation in breast

and cervical cancers screening program. IJOGI 2010;13:37‑46.

Teymoori P, Habibi S. Application of a health belief model for

explaining mammography behavior by using structural equation

model in women in Sanandaj. SJKU 2014;19:103‑15.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC,

Ioannidis JP, et al. The PRISMA statement for reporting

systematic reviews and meta‑analyses of studies that evaluate

health care interventions: Explanation and elaboration. PLoS

Med 2009;6:e1000100.

Zoorob R, Anderson R, Cefalu C, Sidani M. Cancer screening

guidelines. Am Family Phys 2001;63:1101‑12.

Akbari H, Arani TJ, Gilasi H, Moazami A, Gharlipour Z,

Gholinpour AA, et al. Study of motivational factors and causes

of nonparticipation to breast and cervical cancer screening tests

among women attending health centers in Kashan city. Ilam

Univ Med Sci 2014;22:137‑48.

Allahverdipour H, Emami A. Perceptions of cervical cancer

threat, benefits, and barriers of Papanicolaou smear screening

programs for women in Iran. Women Health 2008;47:23‑37.

Ghaoomi M, Aminimoghaddam S, Safari H, Mahmoudzadeh A.

Awareness and practice of cervical cancer and Pap smear testing in a teaching hospital in Tehran. Tehran Univ Med J

;74:183‑9.

Ghazdehi MR, Amini L, Parvizi S, Hoseyni AF. Attitudinal

barriers to mammography screening among women in Tehran.

J Mazandaran Univ Med Sci 2013;23:69‑75.

Hasani L, Aghamolaei T, Tavafian SS, Zare S. Constructs

of the health belief model as predicting factors in breast

self‑examination. HAYAT 2011;17:84.

Saberi F, Sadat Z, Abedzadeh M. Factors associated with cervical

cancer screening and its barriers among women: Kashan, Iran.

Payesh 2012;11:365‑70.

Soltanahmadi Z, Abbaszadeh A, Tirgari B. A survey on the rate

and causes of women’s participation or nonparticipation in breast

and cervical cancers screening programs. Iran J Obstet Gynecol

Infertil 2010;13:37‑46.

Banaeian S, Kazemian A, Kheiri S. Knowledge, attitude and

practice about breast cancer screening and related factors among

women referred to health care centers in Boroujen in 2005.

J Shahrekord Univ Med Sci 2006;7:28‑34.

Mokhtari L, Khorami Markani A, Habibpoor Z. Correlation

between health beliefs and breast cancer early detection

behaviors among females referring to health centers in Khoy

city, Iran. J Health Promotion Manag 2014;3:56‑64.

Rejali M, Yadegarfar G, Mostajeran M, Aghdak P, Fadaei R,

Ansari R. Evaluation of the status of breast cancer screening

in women in isfahan province, Iran. J Health Syst Res

;13:415‑21.

Naghibi SA, Shojaizadeh D, Yazdani Cherati J, Montazeri A.

Breast cancer preventive Behaviors among Iranian women:

A systematic review. Payesh 2015;14:181-91.

Montazeri A, Vahdaninia M, Harirchi I, Harirchi AM, Sajadian A,

Khaleghi F, et al. Breast cancer in Iran: Need for greater women

awareness of warning signs and effective screening methods.

Asia Pac Fam Med 2008;7:6.

Moghaddam Tabrizi F, Vahdati S, Khanahmadi S, Barjasteh S.

Determinants of breast cancer screening by mammography in

women referred to health centers of Urmia, Iran. Asian Pac J

Cancer Prev 2018;19:997‑1003.

Ahmadipour H, Sheikhizade S. Breast and cervical cancer

screening in women referred to urban healthcare centers in

Kerman, Iran, 2015. Asian Pac J Cancer Prev 2016;17:143‑7.

Parsa P, Mirmohammadi A, Khodakarami B, Roshanaiee G,

Soltani F. Effects of breast self‑examination consultation based

on the health belief model on knowledge and performance of

Iranian women aged over 40 years. Asian Pac J Cancer Prev

;17:3849‑54.

Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group

counseling based on health belief model on cervical cancer

screening beliefs and performance of rural women in

Kaboudrahang, Iran. Asian Pac J Cancer Prev 2017;18:1525‑30.

Ghahramani M, Alami A, Moghaddam HM, Moodi M. Screening

for cervical cancer: An educational intervention based on

transtheoretical models and health belief in women of Gonabad,

Iran. Iran J Obstet Gynecol Infertil 2018;21:22‑32.

Rezaeian M, Sharifirad G, Mostafavi F, Moodi M, Abbasi MH.

The effects of breast cancer educational intervention on

knowledge and health beliefs of women 40 years and older,

Isfahan, Iran. J Educ Health Promot 2014;3:43.

Termeh Zonouzy V, Niknami S, Ghofranipour F, Montazeri A.

An educational intervention based on the extended parallel

process model to improve attitude, behavioral intention, and

early breast cancer diagnosis: A randomized trial. Int J Women’s

Health 2019;11:1‑10.

Mousavi SM, Harirchi I, Ebrahimi M, Mohagheghi MA,

Montazeri A, Jarrahi AM, et al. Screening for breast cancer

in Iran: A challenge for health policy makers. Breast J

;14:605‑6.

Asadzadeh VF, Broeders M, Kiemeney L, Verbeek A.

Opportunity for breast cancer screening in limited resource

countries: A literature review and implications for Iran. Asian

Pac J Cancer Prev 2011;12:2467‑75.

Shrivastava SR, Shrivastava PS, Ramasamy J. Screening of

cervical cancer: Barriers and facilitators. Iran J Cancer Prev

;6:177.