Breast cancer is considered the great cancer as well as the leading cause of cancer-related deaths among women in the developed world. There were approximately 2.3 million new cases in 2020, accounting for 11.7 % of total cancer cases worldwide [1]. The incidence of breast cancer in Iran follows the pattern seen in the world and is mixed with local features of the country. Breast cancer has emerged as a major public health problem with an age-standardized incidence rate of 31.0 cases per 100,000 in 2012 and with rising trend during recent years [2]. Notably, the age of presentation in Iranian females is considerably lower (about ten years less than the global average) which may indicate differences in disease biology, risk factors and health system capacity. The surgical approach to breast cancer, one of the hardest decisions of the patient management, has been revolutionized over the past few decades [3].

It is also required that we look at the trends of surgery treatment of breast cancer, particularly in countries with different levels of health care access and provision such as Iran [4]. The epistemic revolution repressed by the transition from RM to BCS, facilitated by trial evidence like the NSABP B-06, has changed the standard of care in many countries [5]. Breast conservation therapy (BCT) with radiation delivers equivalent survival in early stage disease and better psychological and cosmetic outcomes than mastectomy. Nevertheless, the degree to which BCS has been realized in Iran, varies regionally. Understanding these trends is essential for improving patient outcomes, promoting equitable care, and informing policy [6].

Although a number of previous articles have described national cross-country trends, and potential drivers of the care of surgery for breast cancer in the country, many questions remain [7]. Furthermore, there are few data on the relative contribution access to radiotherapy, SES, surgical training, and patient’s preference in this region. We don’t have localized information and so it is hard for us to assess whether existing policy is working, or to target action where it is most needed [8], [9], [10].

Moreover, international experience revealed that BCS followed by adjuvant radiotherapy presents life expectancy superiority compared to BCS in patients with early breast carcinoma, but there is no Iranian study to compare long term overall survival (OS) in breast cancer patients when BCS was compared to mastectomy [11]. This gap does not enable healthcare providers and policy makers to make evidence-based decision for Iranian healthcare environment. Furthermore, cost analyses adapted to the economic conditions and constraints on health infrastructure of Iran are not available. It is majorly a challenge in the mainstreaming of good quality breast cancer care in the country [12], [13].

This study aims to provide insight into some of these data deficiencies, and reports here the ten-year trend of surgical approach selection and survival outcomes on BCS and mastectomy in the Fars province. The present study investigates an evidence-based method of improving the literature on breast cancer in Iran via the analysis of local modalities of treatment (e.g., surgical factors) and their consequent survival status. Results will inform decision-making among health professionals, patients and policy-makers to improve the quality and equity of breast-cancer care in resource-constrained settings.