Barriers to cancer screening uptake and approaches to overcome them: A systematic literature review

Raquel Aguiar-Ibanez^1*Yves Paul Vincent Mbous²Sugandh Sharma³Ravi Chakali³Evanka Chawla³

• ¹Merck (Canada), Kirkland, Canada
• ²Merck (United States), Kenilworth, New Jersey, United States
• ³PAREXEL International (Hyderabad), TELANGANA, Telangana, India

IntroductionCancer screening programs play a crucial role in early detection, improving survival rates and reducing the burden of advanced cancer. However, uptake remains inconsistent due to multifaceted barriers. This systematic review aimed to identify factors that impact cancer screening uptake across multiple tumor types and interventions to overcome barriers to cancer screening uptake.MethodsA systematic literature review was conducted using Embase® and MEDLINE® (May 2012 to May 2022) to identify observational studies that reported factors associated with screening uptake in adults, worldwide, with no tumor-specific restrictions. Records identified were screened by two independent reviewers. Included studies were data extracted by two reviewers and the results were reported narratively, focusing on identifying factors that acted as barriers or facilitators to cancer screening uptake, along with potential interventions to improve screening uptake.ResultsOverall, 811 studies were identified that reported factors influencing the uptake of screening programs, with 658 studies covering screening programs for breast, cervical, lung, colorectal, gastric and prostate cancers. Barriers to cancer screening included: being unmarried, experiencing higher deprivation, lower socioeconomic status and rural living conditions. Facilitators to cancer screening included: older age, poor perception of health, previous cancer history, family history of cancer, previous cancer screening history, having knowledge of the disease, positive attitudes to screening, perceived cancer risk, higher education level, having children, higher income, higher socioeconomic status, having health insurance, urban residence, having access to care, and recommendations for screening by primary care physicians. Mixed findings were identified for race and ethnicity, employment and smoking status. Targeted educational programs were the most suggested strategy to overcome barriers to cancer screening uptake.ConclusionBarriers to cancer screening across multiple tumor types are complex, spanning demographic and patient-level factors, social and economic factors, provider and community challenges, and access to health care. While certain barriers are shared across tumor types, others are unique, reflecting the specific requirements of screening for different tumors. Addressing these barriers requires multi-level strategies that integrate both universal and cancer-specific approaches. Targeted interventions and supportive policies can increase screening participation, facilitate earlier cancer diagnosis, and reduce disparities in cancer outcomes.