A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The mean age of the patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox's regression model, it was found that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian breast cancer patients stands between western and eastern European countries and needs to be improved. It seems that early detection and better management using standard guidelines might contribute considerably to improvement of survival in women experiencing breast cancer.