Tehran University of Medical Sciences Basic & Clinical Cancer Research 2228-6527 16 4 2025 11 17 230 240 Azin Nahvijou Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences Kazem Zendehdel Cancer Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran 2025 07 20 2025 09 14 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 Iranian 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 remain, 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 oesophageal, 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 control strategies. Survival analyses reveal substantial variation by cancer type and region, with higher survival in provinces with better socioeconomic indicators. Furthermore, 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. https://bccr.tums.ac.ir/index.php/bccrj/article/view/577