breast cancer is the most common type of malignancy and one of the major causes of death in women worldwide .
in advanced nations , breast cancer is a very frequent malignancy diagnosed among women , and in the developing nations , it is placed second to cervical cancer ( 1 ) .
breast cancer is also the primary cause of cancer death among women globally , responsible for around 375,000 deaths in the year 2000 ( 2 ) .
a total of 39,620 women died from this disease in the united states in 2013 ( 3 ) .
studies have identified numerous risk factors for breast cancer in women , including increasing age , personal and family history , genetic factors , race and even socio - economic factors ( 1 , 35 ) .
breast cancer is estimated to account for 27% of all new cancer cases and 15% of cancer - related mortality in women in the usa ( 5 ) .
it is estimated that $ 17.2 billion has been spent on breast cancer care in the united states in 2014 ( 6 ) .
it is shown that a number of major developing economies such as india , china and brazil will be facing breast cancer epidemics by 2020 ( 7 ) .
also , breast cancer is considered as a costly disease , and inflicts a notable burden on economic resources of every nation because of its high incidence and prevalence ( 8) .
iran has the highest incidence rate of cancer in the middle east ( 9 ) . in asian nations such as iran
currently , the incidence and prevalence of breast cancer in iranian women is 22 per 100,000 and 120 per 100,000 respectively ( 11 ) . according to the national center for cancer registration ,
breast cancer incidence has increased dramatically from 2001 . in 2010 , 23% of all cancers diagnosed in women were breast cancer cases .
the incidence rate of breast cancer is estimated to be 22.09% in 100,000 women , with the age - standardized incidence rate estimated at 28.25% in 100,000 women ( 12 ) . in iran , breast cancer has a leading rank compared to other types of cancer identified in females ( 13 ) comprising 24.4% of all malignancies with a crude incidence rate and asr of 17.4 and 23.1 per 100,000 , respectively ( 14 ) .
investigations have specified that the mean age of breast cancer patients in iran is approximately 10 years younger than in western countries ( 1517 ) .
given that scopus covered more iranian journals ( 18 ) and also was available , we used this database .
the aim of this study was to analyze iran research performance on breast cancer in national and international context , as reflected in its publications indexed in scopus database during 19912015 .
the current experiment was rooted from the studies of breast cancer research from iranian authors over a twenty - five - year period .
data were retrieved from scopus citation database produced by elsevier . to estimate the global number of published works on breast cancer , the following string was used ;  breast cancer or breast malignancy or breast tumor or mammary ductal carcinoma 
our main strings were keywords in title , abstract and keywords as well as iran in the affiliation field . also , the above mentioned expressions were looked for in the document search tab of scopus .
the search was performed on december 31 , 2015 . by utilizing searching and analyzing strategies in scopus , we first searched the data , then we used scopus analyzer , and analyzed the results . also , to recover the statistics of world research in breast cancer , the key words
 breast cancer or breast malignancy or breast tumor or mammary ductal carcinoma were looked for in various sections , such as title , keyword and abstract , using the software of scopus search tab .
from 1991 to 2015 , the total number of articles about breast cancer research found in scopus , were about 353,893 articles . during the study period
, 126 nations with more than 10 papers , contributed to the literature on the topic of breast cancer .
the share of global publication for the top 30 most prolific nations in breast cancer research fluctuated from 0.46 to 34.57% during 19912015 .
the united states scored the 1 rank with a global publication share of 34.57% ( 122,370 papers ) during 19912015 , followed by the united kingdom ( 7.79% share , 27,584 papers ) , germany ( 5.66% share , 20,045 papers ) , china ( 5.56% share , 19,711 papers ) and italy ( 5.15% share , 18,229 papers ) at 2 , 3 , 4 and 5 positions , respectively .
france , japan , canada , netherlands , australia , spain , india , south korea , sweden , switzerland , belgium , turkey , denmark , taiwan , greece and poland ranked from 6 to 21 positions with their global publication share ranging from 4.59 to 1.44% .
brazil , austria , israel , finland , norway , iran , singapore , ireland and egypt contributed less than 1% share in world research output in breast cancer ( table 1 ) .
interestingly , among 30 most productive countries in terms of continental share in breast cancer research , there are 16 countries from europe with publication share of 38.72% , 9 asian countries with share of 18.16% , 2 countries from north america with share of 38.79% , 1 country from south america , 1 from australia / oceania and 1 from africa with publication share of 0.99% , 2.57% and 0.46% respectively ( table 1 ) .
breast cancer research and treatment  with 7,348 items was the first in rank , and 
20 journals were the highest publishing journals , which published almost 25% of literature on breast cancer ( table 2 ) .
iran s cumulative publication output during 19912015 in breast cancer research which indexed in scopus , consists of 2,399 papers with an average of 95.96 papers per year and achieved an h - index of 48 . hence
; with 2,399 papers , iran ranked 27 among the top 30 nations with a worldwide share of 0.67 % . over the 25-year period from 1991 to 2015
, iranian breast cancer research outputs increased from 1 paper in 1991 to 432 papers in 2015 .
the publication output in breast cancer has increased rapidly . from 2,399 papers , a total of 1,753 ( 73% ) papers
iranian cancer research articles have received 15,574 citations during 19912015 , and average citations per paper were 6.49 , the highest average citations per paper was for 2015 ( 8.79 ) and the lowest was during 19912005 ( 1.96 ) ( table 3 ) .
the 20 top publishing journals published 744 ( 31% ) iranian research articles on breast cancer , among them , there were 15 iranian journals . from the 20 top publishing journals ,
ranks the first with 252 published articles and  international journal of hematology oncology and stem cell research  ranks 20 ( table 4 ) .
the higher numbers of publications were in the article type with 84.66% , followed by the review with 6.23% , conference papers with 4.25% , letters with 2.41% , articles in press with 1.20% , book chapters with 0.33% , editorials with 0.33% , short surveys with 0.25% , notes with 3.39% , errata with 0.08% , and the least number of publications was in books with 0.04% .
iran has collaborated with 103 countries in breast cancer research , among them , the united states ranked 1 with 124 papers followed by canada with 84 papers , united kingdom with 55 papers , malaysia with 53 papers , germany with 48 papers , sweden with 47 papers , australia with 32 papers , italy with 31 papers , india with 21 papers and france with 18 papers . in total , these ten countries published 513 ( 21% ) papers in collaboration with iran .
altogether , 160 iranian universities and research centers have produced a total of 2,399 papers on breast cancer .
tehran university of medical sciences has contributed 638 ( 26.59% ) publications followed by shahid beheshti university of medical sciences 220 ( 9.17% ) , shiraz university of medical sciences 217 ( 9% ) , tarbiat modares university 209 ( 8.7% ) , isfahan university of medical sciences 182 ( 7.58% ) , mashhad university of medical sciences 155 ( 6.46% ) , tabriz university of medical sciences 152 ( 6.33% ) , islamic azad university 152 ( 6.33% ) and university of tehran 143 ( 5.96% ) .
we found six authors who wrote more than thirty documents on breast cancer studies as follows : abdolrasoul talei from shiraz university of medical sciences with 59 papers and h - index of 15 , abbas ghaderi from shiraz university of medical sciences with 46 papers and h - index of 25 , ali montazeri from iranian institute for health sciences research with 42 papers and h - index of 37 , mohammad esmaeil akbari form shahid beheshti university of medical sciences with 36 papers and h - index of 11 , zuhair mohammad hassan from pasteur institute of iran with 35 papers and h - index of 22 and ramin sadeghi from mashhad university of medical sciences with 33 papers and h - index of 14 .
this study specified that iran , with 2,399 papers in breast cancer research , ranked 27th amongst the top thirty countries and its worldwide portion was 0.67 % .
although the number of papers have increased over 19912015 , breast cancer cases are increasing too .
iran has the highest incidence of cancer in the middle east at 110 cases per 100 000 population per year , leading to 105 deaths every day ( 9 , 19 ) .
iran is quickly moving toward an  elderly society  with an associated growth in cancer incidence , including breast cancer ( 19 ) .
statistics show that the prevalence of non - communicable diseases such as cancer increased dramatically in iran , also , the results of the iranian cancer registry , displays that the screening programs are not yet operative in the initial screening of the cases ( 20 ) .
this increases significant concern for law makers to describe suitable diagnostic and treatment facilities , and improve breast cancer control policies in iran ( 19 ) .
it seems that more effort should be made to control breast cancer , including screening and diagnostic programs also conducting supported studies in this field .
the findings of the present study indicated that the higher numbers of publications were in the article type with 84.66% , followed by the review with 6.23% , and the least number of publications was in books with 0.04% .
it seems that books are neglected , and not only iranian researchers but also all researchers on breast cancer research worldwide should pay more attention to this issue .
iranian researchers have published their papers , mostly in domestic journals ; the reason for this is that , most iranian journals have only recently been qualified to be indexed by scopus . in a study by rasolabadi et al
, there were 5 journals publishing 140 ( 20% ) , of which there was just one iranian publication which became the first amongst other publications ( 22 ) .
biglu in his study , found that most of the iranian studies were issued in thailand , the united states and the united kingdom ( 23 ) , which is not consistent with the current study .
results showed that iranian cancer research articles have received 15,574 citations during 19912015 , and average citations per paper were 6.49 .
this finding is consistent with findings of rasolabadi et al , which showed iran s publication output in diabetes research as measured by average citation per paper was 6.19 on the whole ( 24 ) .
iran has collaborated with 103 countries in breast cancer research , among them united states ranked 1st followed by canada , united kingdom , malaysia , germany , sweden , australia , italy , india and france . in total , these ten international collaborative partners published 513 ( 21% ) papers in collaboration with iran .
this finding is inconsistent with findings of rasolabadi et al studies ( 12 , 24 and 25 ) . among ten international collaborative partners , malaysia ranked fourth ,
perhaps the reason is that in past decade many iranian students had graduated from malaysian universities .
there were 9 most productive iranian universities with more than 140 papers in the field of breast cancer research including ; tehran , shahid beheshti , shiraz , isfahan , mashhad , tabriz university of medical sciences , tarbiat modares university , islamic azad university and university of tehran .
these 9 most productive iranian universities have published 2,068 ( 86.20% ) papers out of 2,399 papers in total .
this finding is inconsistent with findings of rasolabadi et al and the biglu study ( 2224 ) .
though ; these 9 iranian universities are among the biggest domestic universities , with predictable productivity .
the results showed that 6 authors have produced 251(10.46% ) papers in breast cancer research , namely abdolrasoul talei , abbas ghaderi , ali montazeri , mohammad esmaeil akbari , zuhair mohammad hassan and ramin sadeghi . according to the lotka s law ( the quantitative percentage of researchers in a discipline that have contributed to its many research practices ) ,
they are regarded as prolific researchers in the production of information on breast cancer in iran .
the number of iranian research papers on breast cancer and also the number of citations to them are increasing .
although the quantity and quality of papers are increasing , regarding the prevalence of breast cancer in iran and also the ineffectiveness of screening programs in the early detection of the cases , more effort should be done and iranian strategy designers should invest more on breast cancer research .
 introductionas a common type of malignancy , breast cancer is one of the major causes of death in women globally . the purpose of the current study was to analyze iran research performance on breast cancer in the context of national and international studies , shown in the publications indexed in scopus database during 19912015.methodsdata were retrieved from the scopus citation database in this scientometric study . 
 the following string was employed ;  breast cancer or breast malignancy or breast tumor or mammary ductal carcinoma  keywords in the main title , abstract and keywords and iran in the affiliation field were the main related keywords . 
 the terms used were searched in scopus using the tab specified for searching documents . 
 time span analyzed was 1991 to 2015 inclusive . using the analyzing software of scopus 
 , we analyzed the results.resultsirans increasing publication production during 19912015 in breast cancer research which indexed in scopus , consists of 2,399 papers with an average of 95.96 papers per year , and achieved an h - index of 48 . 
 iranian cancer research articles have received 15,574 citations during 19912015 , and average citations per paper were 6.49 . 
 iran ranked 27th among the top 30 nations with a worldwide stake of 0.67 % , the 20 top publishing journals published 744 ( 31% ) iranian research articles on breast cancer , among them , there were 15 iranian journals.conclusionthe number of iranian research papers on breast cancer and also the number of citations to them , is increasing . 
 although the quantity and quality of papers are increasing , regarding the prevalence of breast cancer in iran and also the ineffectiveness of screening programs in the early detection of the cases , more effort should be made , and iranian policy makers should consider more investment on breast cancer research . 
1. Introduction
2. Material and Methods
3. Results
4. Discussion
5. Conclusions