Barriers to Effective Breast Cancer Screening Programs: A Scoping Review

Background Breast cancer screening programs, particularly those based on mammography, are a cornerstone of early detection and breast cancer control strategies worldwide. Despite strong evidence supporting their effectiveness, many screening programs fail to achieve optimal performance, often reflected in low participation rates, limited population coverage, and inequitable access. Understanding the barriers that hinder the effectiveness of breast cancer screening programs is essential for improving implementation, participation, and outcomes. Previous studies have reported a wide range of barriers affecting breast cancer screening, including health system and programmatic limitations, provider-related factors, and patient-level, socioeconomic, and cultural determinants. However, the existing evidence is heterogeneous, context-dependent, and dispersed across disciplines. A comprehensive mapping of these barriers is needed to support policymakers, healthcare professionals, and program planners in strengthening screening strategies. Objective The objective of this scoping review is to identify and map health system, programmatic, provider-related, and patient-level barriers associated with reduced effectiveness of breast cancer screening programs, with particular emphasis on factors influencing screening participation and access. Review Question What barriers have been reported in the literature that hinder the effectiveness of breast cancer screening programs? Methods This scoping review will be conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligibility Criteria (PCC Framework) Population: Women eligible for breast cancer screening Concept: Barriers to effective breast cancer screening, including health system, programmatic, provider-related, patient-level, socioeconomic, and cultural barriers Context: Mammography-based breast cancer screening programs, including organized (population-based) and opportunistic screening settings Inclusion criteria: Original quantitative, qualitative, or mixed-methods studies Studies examining barriers, determinants, or facilitators related to breast cancer screening effectiveness or participation Peer-reviewed articles published in English Studies published from 2010 onwards Exclusion criteria: Studies focusing exclusively on diagnostic (symptom-driven) mammography Studies limited to imaging accuracy without programmatic or behavioral context Case reports, editorials, commentaries, and conference abstracts Studies focusing exclusively on high-risk genetic surveillance programs Information Sources and Search Strategy A systematic literature search will be conducted in the following electronic databases: PubMed/MEDLINE Scopus Web of Science The search strategy will be designed to capture studies explicitly addressing barriers to breast cancer screening programs and screening participation. Database-specific adaptations of the search strategy will be applied. Reference lists of included studies will be screened to identify additional relevant publications. Study Selection and Data Charting Titles and abstracts will be screened for eligibility, followed by full-text review of potentially relevant articles. Data will be extracted using a predefined data-charting form, including information on study characteristics, screening context, identified barriers, and reported outcomes related to screening participation or access. Data Synthesis Findings will be synthesized descriptively and thematically. Identified barriers will be categorized into major domains, including health system and programmatic barriers, provider-related barriers, patient-level barriers, and socioeconomic or geographic factors. Dissemination The results of this scoping review will be submitted for publication in a peer-reviewed academic journal and may inform future research, policy development, and improvements in breast cancer screening program implementation.