OBJECTIVES To develop a national breast cancer (BC) screening program through phased regional expansion using an advanced investment decision support simulation model informed by real world data in the Kingdom of Saudi Arabia (KSA). METHODS An agent-based modeling simulation (ABMS) tool will represent the KSA female population, BC burden and existing health system and project impact of infrastructure investment options. Data are drawn from existing sources including census, registries and health surveys; phased studies will generate real world data on the outcomes of new clinical interventions. In Phase 1, a mobile BC screening program was deployed in Riyadh with three mobile clinics equipped with appropriate technology and medical staffing with the goal to screen at least 10,000 women during 2012-2014 and establish a care pathway for accurate diagnosis. The modeling and phased studies will guide the national program development by evaluating the impact of investments on BC screening rates, outcomes and economic value. RESULTS The Phase 1 Riyadh program screened 12,877 females and established a care pathway model leading to 83 confirmed BC diagnoses (rate: 6.4 per 1000). Data visualization plotting breast cancer disease prevalence and mammogram installed base identified areas of high need and low resources in the regions of Riyadh, Hafr Al-Baten, Eastern, Al-Ahsa and Al-Jouf. The ABMS model to be developed will evaluate the impact of investment scenarios encompassing expansion of existing facilities and manpower, development of new radiology centers, and implementation of additional mobile programs. CONCLUSIONS The Riyadh program revealed higher rate of breast cancer in the region than previously reported, emphasizing the need to ensure access for accurate diagnosis and create a national program. Data visualization readily identified regions for prioritized expansion. Real world data will continue to inform the ABMS model to identify investments required to establish a national breast cancer program across KSA.