Predictive Factors of Breast Cancer Mammography Screening Among Iranian Women


Breast cancer, Mammography, Lifestyle, Predictors


Introduction: Understanding the factors that influence women's cancer screening behavior is crucial in reducing cancer mortality through early detection. Therefore, the objective of this study was to examine the status of mammography and related factors among women who presented to the health centers of Khorasan Razavi province, Iran. Methods: For this study, a sample of 251011 women who visited healthcare centers affiliated with Mashhad University of Medical Sciences was selected. The study examined several variables, including sociodemographic information, current smoking, nutrition status, and physical exercise. All analyses were performed using Python programming language and SPSS software. Furthermore, to handle imbalanced data, we used SMOTE balancing method that is an oversampling method and produce synthetic samples from the minority class. Results: The factors of age, education, being employed, having children, family history of cancer, physical activity, smoking status, and diet were all predictors of mammography screening. Moreover, findings showed that age and family history of breast cancer were most important variables to predict mammography status, respectively. Conclusion: By examining various variables such as dietary habits, exercise, smoking, and demographic properties, it sheds light on the relationships between these factors and mammography screening. This provides valuable insights into the associations between breast cancer screening behavior and preventive lifestyle behaviors. By targeting both preventive lifestyle choices and breast cancer screening behaviors, interventions can effectively promote positive changes in behavior and ultimately reduce the incidence and impact of breast cancer.


Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet. 2016;388(10053):1459-544.

Bener A, Barışık CC, Acar A, Özdenkaya Y. Assessment of the Gail Model in Estimating the Risk of Breast Cancer: Effect of Cancer Worry and Risk in Healthy Women. Asian Pacific journal of cancer prevention : APJCP. 2019;20(6):1765-71.

Tahmasebi R, Noroozi A. Factors influencing breast cancer screening behavior among Iranian women. Asian Pacific journal of cancer prevention: APJCP. 2011;12(5):1239-44.

Uchida K, Ohashi H, Kinoshita S, Nogi H, Kato K, Toriumi Y, et al. Breast cancer screening and the changing population pyramid of Japan. Breast cancer (Tokyo, Japan). 2015;22(2):172-6.

Cui Z, Kawasaki H, Tsunematsu M, Cui Y, Kakehashi M. Factors Affecting the Cervical Cancer Screening Behaviors of Japanese Women in Their 20s and 30s Using a Health Belief Model: A Cross-Sectional Study. Current oncology (Toronto, Ont). 2022;29(9):6287-302.

Sun Y, Ma Y, Cao M, Hu Z, Lin W, Chen M, et al. Breast and cervical cancer screening adherence in Jiangsu, China: An ecological perspective. Frontiers in Public Health. 2022;10.

Sarkeala T, Heinävaara S, Fredman J, Männistö S, Luoto R, Jäntti M, et al. Design and respondent selection of a population-based study on associations between breast cancer screening, lifestyle and quality of life. BMC public health. 2015;15:1256.

Bahmani F, Vakilian K, Faramarzi M. Effects of Motivational Interview on Awareness, Attitude, and Practice of Breast Self-examination in High-risk Women: A Clinical Trial Study. Current Women`s Health Reviews. 2019;15(4):301-7.

Keshavarzi A, Asadi S, Asadollahi A, Mohammadkhah F, Khani Jeihooni A. Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior. Breast cancer : basic and clinical research. 2022;16:11782234221121001.

Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public health nutrition. 2006;9(6):755-62.

Maldonado S, López J, Vairetti C. An alternative SMOTE oversampling strategy for high-dimensional datasets. Applied Soft Computing. 2019;76:380-9.

Schober P, Vetter TR. Logistic regression in medical research. Anesthesia and analgesia. 2021;132(2):365.

Bagley SC, White H, Golomb BA. Logistic regression in the medical literature:: Standards for use and reporting, with particular attention to one medical domain. Journal of clinical epidemiology. 2001;54(10):979-85.

Yang L, Liu S, Tsoka S, Papageorgiou LG. A regression tree approach using mathematical programming. Expert Systems with Applications. 2017;78:347-57.

Brownlee J. Classification And Regression Trees for Machine Learning Machine Learning Mastery [Available from:

Tavakolian A, Farhanji M, Shapouran F, Zal A, Taheri Z, Ghobadi T, et al. Investigating the association of acute kidney injury (AKI) with COVID-19 mortality using data-mining scheme. Diagnostic Microbiology and Infectious Disease. 2023;107(3):116026.

Saheb-Honar M, Dehaki MG, Kazemi-Galougahi MH, Soleiman-Meigooni S. A Comparison of Three Research Methods: Logistic Regression, Decision Tree, and Random Forest to Reveal Association of Type 2 Diabetes with Risk Factors and Classify Subjects in a Military Population. Journal of Archives in Military Medicine. 2022;10(2).

Nellore SB. Various performance measures in Binary classification-An Overview of ROC study. IJISET-International Journal of Innovative Science, Engineering & Technology. 2015;2(9):596-605.

Tong Z, Liu Y, Ma H, Zhang J, Lin B, Bao X, et al. Development, validation and comparison of artificial neural network models and logistic regression models predicting survival of unresectable pancreatic cancer. Frontiers in Bioengineering and Biotechnology. 2020;8:196.

Fawcett T. An introduction to ROC analysis. Pattern recognition letters. 2006;27(8):861-74.

Bhandari A. AUC-ROC Curve in Machine Learning Clearly Explained Analytics Vidhya2022 [Available from:

Ho V, Yamal JM, Atkinson EN, Basen-Engquist K, Tortolero-Luna G, Follen M. Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas. Cancer nursing. 2005;28(2):119-29.

Ricardo-Rodrigues I, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-Trujillo I, López de Andrés A. Social disparities in access to breast and cervical cancer screening by women living in Spain. Public Health. 2015;129(7):881-8.

Ryu SY, Crespi CM, Maxwell AE. What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2013;23(6):e403-10.

Lee HY, Stange MJ, Ahluwalia JS. Breast cancer screening behaviors among Korean American immigrant women: findings from the health belief model. Journal of Transcultural Nursing. 2015;26(5):450-7.

Lee SY, Lee E, Natipagon-Shah B, Toyama J. Factors Associated with Breast Cancer Screening among Korean American Women in California: Results from the California Health Interview Survey 2015–2016. Asian Pacific journal of cancer prevention : APJCP. 2018;19(11):3271-7.

Borrayo EA, Hines L, Byers T, Risendal B, Slattery ML, Sweeney C, et al. Characteristics associated with mammography screening among both Hispanic and non-Hispanic white women. Journal of women's health. 2009;18(10):1585-94.

Simon MS, Gimotty PA, Coombs J, McBride S, Moncrease A, Burack RC. Factors affecting participation in a mammography screening program among members of an urban Detroit health maintenance organization. Cancer detection and prevention. 1998;22(1):30-8.

Blom J, Yin L, Lidén A, Dolk A, Jeppsson B, Påhlman L, et al. Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer. International journal of cancer. 2008;122(7):1618-23.

Li M, Han M, Chen Z, Tang Y, Ma J, Zhang Z, et al. Does marital status correlate with the female breast cancer risk? A systematic review and meta-analysis of observational studies. PLOS ONE. 2020;15(3):e0229899.

Ascunce N, Salas D, Zubizarreta R, Almazán R, Ibáñez J, Ederra M. Cancer screening in Spain. Annals of oncology : official journal of the European Society for Medical Oncology. 2010;21 Suppl 3:iii43-51.

Islam RM, Billah B, Hossain MN, Oldroyd J. Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review. Asian Pacific journal of cancer prevention : APJCP. 2017;18(7):1751-63.

Charkhchi P, Schabath MB, Carlos RC. Breast, Cervical, and Colorectal Cancer Screening Adherence: Effect of Low Body Mass Index in Women. Journal of women's health (2002). 2020;29(7):996-1006.

Leinonen MK, Campbell S, Klungsøyr O, Lönnberg S, Hansen BT, Nygård M. Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway. Preventive medicine. 2017;94:31-9.

Performance conditions of breast cancer screening methods and its efficient factors among women referring to health centers of Tabriz. Iranian Journal of Nursing Research. 2009;4(13):27-38.

Oran N, Can H, Senuzun Aykar F, Aylaz R. Health promotion lifestyle and cancer screening behaviors: A survey among academician women. Asian Pacific journal of cancer prevention : APJCP. 2008;9:515-8.

Bahrami M, Taymoori P, Bahrami A, Farazi E, Farhadifar F. The Prevalence of breast and Cervical Cancer screening and related factors in woman who refereeing to health center of Sanandaj city in 2014. Zanko Journal of Medical Sciences. 2015;16(50):1-12.

Patrão AL, de Almeida M, Matos SMA, Menezes G, Gabrielli L, Goes EF, et al. Healthy lifestyle behaviors and the periodicity of mammography screening in Brazilian women. Women's health (London, England). 2021;17:17455065211063294.

Lagerlund M, Drake I, Wirfält E, Sontrop JM, Zackrisson S. Health-related lifestyle factors and mammography screening attendance in a Swedish cohort study. European Journal of Cancer Prevention. 2015;24(1):44-50.

Ng'ang'a A, Nyangasi M, Nkonge NG, Gathitu E, Kibachio J, Gichangi P, et al. Predictors of cervical cancer screening among Kenyan women: results of a nested case-control study in a nationally representative survey. BMC public health. 2018;18(Suppl 3):1221.

Spongier JG, Konen JC. Annual screening mammography, among diabetic women: Demographics, psychological stress, and family functioning. Family & Community Health. 1996;18(4):1-8.

Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. International journal of behavioral nutrition and physical activity. 2008;5(1):1-24.

Friedenreich CM. Physical activity and breast cancer: review of the epidemiologic evidence and biologic mechanisms. Clinical cancer prevention. 2011:125-39.

Rakowski W, Clark MA, Truchil R, Schneider K, Meersman S. Smoking status and mammography among women aged 50–75 in the 2002 behavioral risk factor surveillance system. Women & health. 2005;41(4):1-21.

Lian M, Jeffe DB, Schootman M. Racial and geographic differences in mammography screening in St. Louis City: a multilevel study. Journal of Urban Health. 2008;85:677-92.

Byrne MM, Davila EP, Zhao W, Parker D, Hooper MW, Caban-Martinez A, et al. Cancer screening behaviors among smokers and non-smokers. Cancer epidemiology. 2010;34(5):611-7.

Richard A, Rohrmann S, Schmid SM, Tirri BF, Huang DJ, Güth U, et al. Lifestyle and health-related predictors of cervical cancer screening attendance in a Swiss population-based study. Cancer epidemiology. 2015;39(6):870-6.

Muus KJ, Baker‐Demaray TB, Bogart TA, Duncan GE, Jacobsen C, Buchwald DS, et al. Physical activity and cervical cancer testing among American Indian women. The Journal of rural health. 2012;28(3):320-6.

McFarland DM. Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions. International nursing review. 2003;50(3):167-75.