Advancing Mammographic Screening Among Underserved Groups: A Systematic Review and Meta-Analysis of Intervention Strategies to Increase Breast Cancer Screening Uptake

Abstract

Objectives: Breast cancer (BC) is a leading cause of cancer related disability and mortality. Despite efforts to implement mammography screening programs, uptake rates vary widely due to socioeconomic factors and accessibility challenges. To improve participation, interventions targeting barriers faced by underserved groups are crucial for promoting equitable screening and early detection. Methods: A systematic search and meta-analysis was performed to identify strategies to reduce disparities and enhance participation in BC screening, with particular attention to underserved groups, including individuals with low SES, underinsured, with immigrant background or part of ethnic minority. Results: The meta-analysis of 44 randomized studies involving 161,141 individuals (of which 14,720 belonged to underserved groups) showed that, compared to usual care, interventions regarding BC screening were effective in increasing mammography uptake [pooled OR 1.55 (95%CI 1.39–1.73)], particularly, among underserved groups [pooled OR 1.81 (95%CI 1.43–2.28)]. Overall, the most effective were educational interventions. Among underserved groups, reminders, telephonic interventions, navigation services and cultural-sensitive approaches were highly effective. Conclusion: Combining these strategies can simultaneously address multiple barriers, ensuring comprehensive support throughout the BC screening process and improved access to screening for underserved groups. Systematic Review Registration: Identifier CRD42023393352.