🇮🇷 Cancer in Iran

The 2024 analysis of the registry's 2016 data gives 7,383 prostate, 7,104 stomach, 6,546 colorectal, 5,378 bladder and 4,351 lung cancers in men, and 15,333 breast, 5,045 colorectal, 4,477 thyroid, 3,442 stomach and 1,887 lung cancers in women. Age-standardised incidence (Segi world population) was 192.96 per 100,000 in men and 162.33 in women, or 170.50 and 148.43 without non-melanoma skin cancer, which the authors note is below the world rates of 206.9 and 178.1. Median age at diagnosis was 64 in men and 57 in women. West Azarbaijan had the highest rate in men and Yazd in women. The paper's headline total of 124,833 and the sum of its sex tables, 123,807, differ by 1,026, which it does not explain. In the registry's first national report, for 2014, 112,131 cancers were registered and the order in men was stomach, prostate and colorectum, so prostate cancer moved to first place in men between the two reports.

The 2014 report describes the Iranian National Population-based Cancer Registry as covering 30 of 31 provinces, registering only malignant new primary tumours from pathology centres, hospitals and death registries, with quality checks and analysis in CanReg-5 software; 68.28% of the 112,131 cancers that year were confirmed under the microscope. The 2016 analysis describes it as managed by all 60 medical universities under the Ministry of Health and Medical Education, following IARC and International Association of Cancer Registries protocols, coding tumours in ICD-O-3 and registering by place of residence; about 30,679 patients without a national identity number were matched on name, father's name, birth date and sex. Researchers describe the registry's annual reports as publicly available, and peer-reviewed studies have used them up to diagnosis year 2018. The 2016 authors note the registry holds no information on mortality, survival or recurrence. A 2023 study linked records from SEPAS, Iran's integrated electronic health record, to find about 197,164 cancer patients for the registry.

A 2025 analysis of the registry found 27,530 thyroid cancers from 2014 to 2018, 79.7% in women, with the age-standardised rate rising from 4.61 per 100,000 in 2014 to 8.17 in 2018; the authors leave open how much is a true increase and how much is more diagnosis. A 2024 study of the registry's annual reports counted 19,679 gastrointestinal cancers in people under 50 from 2014 to 2018 and found the rate of early-onset colorectal cancer rising (age-standardised 3.07 per 100,000 over the period), while early-onset oesophageal cancer fell and early-onset stomach cancer held steady; Golestan had the highest rate of early-onset oesophageal cancer. A spatial analysis of 482,229 cancers registered from 2014 to 2017 identified the northern and north-western regions as high-risk areas for stomach cancer in both sexes and for lung cancer in men.

A 2021 policy analysis lists the Iran Health Insurance Organization's funds for government employees (5,413,088 members in 2018), rural residents and towns under 20,000 people (19,969,227), universal coverage, created in 2014 for people without insurance (14,441,544), and other groups such as students and people with disabilities (1,438,973); the Social Security Organization, which it describes as non-governmental and which covered 43,475,548 people in 2019; the Armed Forces Medical Services Insurance Organization; 17 institutional funds run by employers such as the petroleum industry; and commercial insurers selling supplementary cover. Since the Universal Health Insurance Act all basic insurers work under the regulations of the High Council of Health Insurance, and the basic benefits package is decided by representatives of the insurers, the medical associations and the Medical Council. The authors report that out-of-pocket payments fell from 80.5% of current health spending in 1995 to 38.8% in 2016, when Iran spent 8.1% of its GDP on health, and that a gap between public and private tariffs keeps out-of-pocket spending high.

The 2021 policy analysis says the Health Transformation Plan, funded by 10% of the net proceeds of the targeted subsidies law and 1% of value added tax, aimed that patients would not pay more than 10% of inpatient costs, 5% for rural patients following the referral system, with the same share whatever their insurer, and that coverage was extended to some expensive pharmaceuticals including 53 medicines for cancer treatment; rising costs then delayed insurers' payments to hospitals. At one Tabriz hospital, a study of 1,778 people admitted with lung cancer from 2010 to 2017 found the patient's share of hospital costs fell from 22.16% before the plan to 10.5% after it, while the cost of admissions rose. A 2021 scoping review of 137 studies found mostly positive effects on satisfaction and hospital performance but different, contradictory and sometimes negative results for financial protection and informal payments.

The Iran Health Insurance Organization's page on special patients, read in Persian from an Internet Archive copy of 23 April 2021, defines them as people with haemophilia, thalassaemia, multiple sclerosis, haemodialysis, kidney transplant and peritoneal dialysis, who receive free cover in its universal coverage fund. A news item it published on 16 April 2023 quotes its director-general of specialised services: about 665,000 people carried a marker for a special or hard-to-treat disease, 30% had used the matching package, the commonest markers were diabetes, hypertension, cancer, multiple sclerosis and dialysis, and cancer, spinal muscular atrophy, diabetes and multiple sclerosis had the highest spending in the special and hard-to-treat diseases fund. Markers are assigned by doctors, from health ministry data or by the insurer's staff, and the services are then delivered through electronic prescribing. OnCo could not read the ministry's package itself, so which cancer medicines it covers, and at what co-payment, is not on this page.

Using WHO's Universal Health Coverage Service Planning, Delivery and Implementation tool and information from Iran's health insurance agencies, the 2025 study found all 73 listed breast cancer actions provided in Iran, with heavy reliance on outpatient centres and hospitals rather than primary care; 87% of services were recognised and accepted by health insurance, with coverage from 20% for magnetic resonance imaging to 100% for intravenous targeted therapy for metastasis, and genomic tests and four medicines (pembrolizumab, pertuzumab, anastrozole and fluorouracil) not covered. In a 2019 household survey of 138 women with breast cancer, the average out-of-pocket payment was 97.87 US dollars a month; 13.77% of their households faced catastrophic health spending and 5.07% were pushed into poverty, concentrated among the poorest, many of whom sold assets or borrowed.

The regulator's history page, read in Persian from an Internet Archive copy of 18 April 2021, traces a pharmaceutical deputy ministry back to 1352 (1973 to 1974) and says the Food and Drug Organization was formed in 1389 (2010 to 2011) with the approval of the Supreme Administrative Council. The same site lists offices for health technology assessment and economic studies, rational use of medicines, tariffs and pharmaceutical care standards, and pharmacovigilance, and publishes the official national medicines list. A 2019 study based on interviews with experts and managers in the regulatory system describes how, when sanctions-related shortages peaked in 2012, the regulator lowered prices, cut the market share of imports, made domestic manufacture easier, encouraged foreign investment in local production and gave financial support to patients who could not pay for medicines. OnCo found no published description of reliance or priority pathways for cancer medicines in Iran; it is named under gaps.

The 2024 study compared new molecular entities approved by the US Food and Drug Administration, the European Medicines Agency, Japan's Pharmaceuticals and Medical Devices Agency and the Iranian regulator from 2001 to 2021, using the Iranian government's official medicines list. Of 710 US approvals, 410 were approved in Europe, 344 in Japan and 148 in Iran. For the 148 approved in both the United States and Iran, the mean relative lag was 65.18 months (SD 61.56), with a maximum of 237 months. For antineoplastic and immunomodulating agents (ATC group L) the mean lag was 77.2 months against the United States, 63.96 against Europe and 57.93 against Japan. It measures registration, not when a medicine reached patients or was paid for; where only the year of approval was known, the authors took the start of that year.

In a ministry news item dated 22 Shahrivar 1402 (13 September 2023), read in Persian from an Internet Archive copy, the director-general of the office for non-communicable disease management said early detection of colorectal cancer is carried out free across the country in comprehensive health service centres, with a simple first test offered by health workers to attendees over 40 and positive results referred through the referral system to hospitals. National programme data for 2018 and 2019 cover people aged 50 to 69: 1,365,248 (14.23%) were assessed in 2018 and 1,304,377 (12.89%) in 2019, and 3.09% and 2.57% had a positive faecal immunochemical test. In Isfahan, where the test has been used since January 2016 under the IraPEN primary care package for people aged 50 to 70, 345,207 of 874,674 eligible people (about 40%) took part from 2016 to 2019; 21,264 (6.1%) tested positive, about 20% of them had a reported colonoscopy, and 971 people were found to have polyps and 110 to have bowel cancer.

The health ministry's director-general for non-communicable diseases said in September 2023 that breast cancer early detection is done free at health centres, and gave breast cancer as the commonest cancer in the country at about 15,000 new cases a year, over 95% of them in women. Under IraPEN, Iran's package of essential non-communicable disease interventions introduced as a pilot in 2015, the Isfahan programme examined 450,876 people aged 30 to 69 from 2017 to 2020; it identified 134,508 with symptoms, referred 258,599 to the next level and recorded about 55,974 mammograms, at a direct cost of 310,514,608,558 rials. A 2025 scoping review of 129 studies concluded that Iran's health system lacks an organised breast cancer screening initiative, citing infrastructure, sociocultural barriers, health insurance packages that are not integrated, and little research on key indicators.

The 2026 analysis of the national STEPS 2021 survey included 8,158 women aged 18 to 45: 0.85% (95% CI 0.69 to 1.02) had received the HPV vaccine and 39.4% (38.21 to 40.6) had taken part in cervical screening, rising from 27.99% at 18 to 35 to 54.07% at 36 to 45, and higher among married and wealthier women (42.47% in the highest wealth quintile against 28.29% in the lowest). The authors compare this with the World Health Organization's elimination target of 90% vaccination coverage and put screening about 30 points short of its target. The 2014 registry report gives an age-standardised rate of 1.78 per 100,000 women, and the 2016 tables 806 cases. OnCo could not read a ministry source describing a national cervical screening programme, its age range or its test; it is named under gaps.

AryoGen Pharmed, which its own site places in the CinnaGen group, lists among its products Zytux (rituximab), AryoTrust (trastuzumab) and Stivant (bevacizumab). Its phase 3 trial in 126 patients with metastatic colorectal cancer at 22 Iranian sites (NCT03288987) found progression-free survival of 7.7 months with its bevacizumab and 7 months with the original, a hazard ratio of 0.79 (90% CI 0.46 to 1.35), within the non-inferiority margin. CinnaGen's trial of its pertuzumab P013 in 214 women with HER2-positive breast cancer (NCT04957212) found breast pathological complete response of 67.62% against 71.57% with Perjeta, within the equivalence margin. A post-marketing study of AryoTrust in 597 women (NCT06021379) found decreased heart pumping function in 5.7%. Local production was among the regulator's responses to sanctions-related shortages in 2012. A 2025 analysis of breast cancer services nevertheless lists pertuzumab among medicines the insurers did not cover.

A 2016 review of Iran's drug shortages identified 73 shortage medicines, 17 (23%) used for cancer, among them cytarabine, doxorubicin, fluorouracil, capecitabine and rituximab, and found that the vast majority of the 73 were covered by export-control exemptions that should have eased their purchase; the authors attribute the shortages to firms and banks remaining cautious about business with Iran. In a 2024 qualitative study, 53 Iranian specialists described instability in financing and regulation, shortages, low-quality imported materials, high prices, loss of staff, delayed and inadequate care, limited international collaboration, more adverse events and wider equity gaps. In a 2022 survey of 21 outpatient medicines for children's cancers in Urmia, 14 had availability below 50% and one was unavailable; insured patients in every income decile could afford the lowest-priced versions, while without insurance only the richest decile could afford the regimens studied, and not the acute lymphoblastic leukaemia regimen. These are reports and surveys, not a measure of outcomes.

In the Golestan Cohort Study, 1,833 of 50,045 people aged 40 to 75 developed cancer over a median ten years; opium use was associated with all cancers combined (hazard ratio 1.40, 95% CI 1.24 to 1.58) and with oesophageal (1.38), gastric (1.36), lung (2.21), bladder (2.86) and laryngeal (2.53) cancer, rising with dose and holding in never-smokers as well as smokers. A 2024 modelling study, noting that Iran accounts for 42% of global opium consumption, estimated that keeping opium use at its current prevalence of 5.6% would cause 111,130 new cancers in Iran by 2035, and that cutting prevalence by 10% to 50% could prevent 9,016 to 49,006, mostly lung, stomach and bladder cancers. The International Agency for Research on Cancer's Monographs volume 126 group summarised the classification in The Lancet Oncology in 2020.

OnCo's OpenAlex file (oncology as the primary subfield, whole counting by author country, built 8 September 2026) gives Iran 1,258 works in 2021, 1,159 in 2022, 1,175 in 2023, 1,139 in 2024 and 1,225 in 2025. The same file counts 1,463 ClinicalTrials.gov studies of any condition with a site in Iran. The Iranian Registry of Clinical Trials, whose home page (Internet Archive copy of 10 June 2025) describes it as a primary registry in the World Health Organization's registry network set up with the Ministry of Health and hosted by Iran University of Medical Sciences, showed 43,868 trials registered, across all conditions and all registrants; OnCo could not read how many are cancer trials. The CinnaGen pertuzumab trial shows the pattern: registered in the Iranian registry on 11 June 2018 and on ClinicalTrials.gov on 12 July 2021, after it had finished. OnCo's graph's trial records whose ClinicalTrials.gov sites include Iran numbered two before this page; it adds the three biosimilar studies listed below.

NCT06555003 (CLEAR-DEBIRI), sponsored by Tehran University of Medical Sciences, compares irinotecan-loaded drug-eluting beads with systemic chemotherapy against chemotherapy alone in unresectable colorectal liver metastases; it started in January 2025 at the Imam Khomeini Hospital Complex and plans 116 participants. NCT06687681 tests intrathecal injection of active allogeneic natural killer cells in 40 planned patients with high-grade glioma at Rasoul Akram Hospital in Tehran, from November 2024. The three biosimilar studies, all completed and all with sites only in Iran, are AryoGen's bevacizumab trial in metastatic colorectal cancer (NCT03288987, 126 patients, 22 sites), CinnaGen's pertuzumab trial in HER2-positive breast cancer (NCT04957212, 214 patients, 44 sites) and AryoGen's trastuzumab safety study (NCT06021379, 597 women, 15 sites).

behdasht.gov.ir, fda.gov.ir, ihio.gov.ir, tamin.ir, irct.behdasht.gov.ir and ikhc.tums.ac.ir all failed to respond within 25 seconds. The Internet Archive's most recent copy of the health ministry's home page held only a JavaScript challenge, so the ministry is quoted from a single archived news item of 13 September 2023. The regulator's history page is from an April 2021 copy, the insurer's special-patients page from April 2021 and its news item from June 2023, and the trial registry's home page from June 2025. The archive itself began refusing requests partway through the work, so other archived pages, such as the Cancer Institute's own site and the regulator's medicines list, were not read. Every institution record built from these copies says which copy it used.

The figures on this page are from the 2014 report (Cancer Epidemiology, 2019) and the 2016 analysis (Cancer Reports, 2024), plus thyroid and early-onset gastrointestinal studies that use registry data to 2018. The ministry's own registry pages were not reachable or archived in readable form. Whether the registry has published national figures for 2019 to 2024, and whether coverage changed during the COVID-19 pandemic, could not be checked. The 2016 analysis's headline total and the sum of its sex tables differ by 1,026.

IARC codes Iran's mortality estimate as derived from national incidence through modelled mortality-to-incidence ratios using registry survival data. A 2025 study used the health ministry's death registration system for spatial analysis of cancer deaths from 2017 to 2019, but its counts fall sharply from 2017 to 2018 and do not read as complete national totals, so OnCo did not use them. National five-year survival figures were not found either. Both would need the ministry's own statistics, which could not be reached.

The cervical screening figures on this page come from a national survey, not from a programme description. The regulator lists an office for health technology assessment and economic studies, and the health ministry an office for health technology assessment, standards and tariffs, but no published threshold or decision record for cancer medicines was found. The health insurer's special and hard-to-treat diseases package is issued by the ministry and was not reachable. Published average times from Iranian approval to insurance cover were not found. The country's National Cancer Control Programme is referred to in a 2015 review, but its current text was not reached. The Iranian Registry of Clinical Trials publishes a total of registered trials but OnCo could not read a count of cancer trials, and gives none here.