The Evolution of Population-Based Cancer Registries in Iran: A 70-Year Journey

Abstract

Cancer registration is a cornerstone of effective cancer control programs, providing essential data on cancer incidence, prevalence, and mortality. This paper reviews the development, current status, and challenges of the Population-Based Cancer Registry (PBCR) program in Iran. Since the 1950s, Iran has made significant efforts to establish systematic cancer registration, culminating in the expansion of PBCRs across multiple provinces. The Golestan Province Cancer Registry was the first Irani an registry included in the international Cancer Incidence in Five Continents (CI5) report in 2014, with Ardabil Province joining in 2023, reflecting growing international recognition. The Iranian PBCR program has evolved through national legislation mandating cancer reporting, expansion from pathology-based to population-based registries, and continuous quality improvement initiatives. Despite progress, challenges re main, including underreporting, data completeness, and timeliness. The most recent national PBCR report (2018) documented approximately 141,000 new cancer cases with age-standardized incidence rates of 182.8 and 165.3 per 100,000 for men and women, respectively. Regional disparities were evident, with higher rates of oesoph ageal, stomach, and lung cancers in northern provinces and breast, colorectal, and prostate cancers more common centrally. Projections indicate a 42.6% increase in new cancer cases by 2025, underscoring the urgent need for enhanced cancer con trol strategies. Survival analyses reveal substantial variation by cancer type and re gion, with higher survival in provinces with better socioeconomic indicators. Fur thermore, modifiable risk factors such as smoking, overweight, opium use, and Helicobacter pylori infection contribute significantly to cancer burden in Iran. To strengthen the PBCR program, priorities include timely publication of reports, improving data quality and coverage, and expanding international certification and publication. Sustained political commitment and resource allocation are essential to optimize cancer surveillance and support evidence-based policy to reduce Iran’s growing cancer burden.