Barriers to Effective Breast Cancer Screening Programs: A Scoping Review

Abstract Breast cancer screening is one of the most important secondary prevention strategy when effective, but participation rates varies across different health systems around the globe. Barriers to effective screening are multifactorial and overlapping. Using PRISMA-ScR, a scoping review was conducted, using PubMed/MEDLINE, Scopus, and Web of Science databases, related to breast cancer, screening programmes and barrier. Studies, published between 2000 and 2025, examining constrains for successful screening coverage, that met inclusion criteria were analysed, while diagnostic imaging, high risk population assessment and treatment/follow up strategies were excluded. From 2,262 initially included records, 103 studies were eligible – most of them originated from Europe 43.7%, then North America 34.0%, Asia–Pacific 20.4% while no studies were conducted exclusively in African continent. Analysis showed predomination of studies with quantitative designs - 68.9%. Almost half of studies were focused on organized screening (48.5%), 22.3% opportunistic screening, while others represented mixed/unclear contexts. Study analysis showed overlapping barriers across categories. The most commonly observed are patient-level barriers, in 75.7% of studies, followed by access-related (61.2%), health system/organizational (57.3%), socioeconomic and cultural (41.7%), and provider-related determinants (32.0%). Particular emphasis was on disadvantaged populations, such as low socioeconomic status women, ones that live in rural/remote communities, and/or women with disabilities, and those with previous false-positive screening reports. Indicating that addressing an isolated barrier is unlikely to lead to more effective screening; rather, actions should be directed toward integrated strategies that incorporate a personalized approach encompassing the identified barriers.