Factors associated with participation of breast cancer screening in female residents in China: a systematic review and meta-analysis
Background: Breast cancer (BC) is the most common cancer and the leading cause of cancer-related death in women worldwide. According to the global cancer observatory of International Agency for Research on Cancer, the new cases, prevalent cases of BC, and BC-related deaths among Chinese women accoun...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606524004504 |
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| Summary: | Background: Breast cancer (BC) is the most common cancer and the leading cause of cancer-related death in women worldwide. According to the global cancer observatory of International Agency for Research on Cancer, the new cases, prevalent cases of BC, and BC-related deaths among Chinese women accounted for more than one-tenth of the global data in 2022, highlighting the necessity of BC control in China. Breast cancer screening (BCS) was reportedly underutilised in China despite the evidence showing that screening is an effective strategy for BC control allowing early detection and timely intervention to reduce mortality. This review aims to identify the factors associated with BCS participation among female residents in mainland China in order to better inform the design of BCS programs in the future. Methods: This was a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guideline. Randomised controlled trials, quasi-experimental studies, and other quantitative studies using logistic regression analysis published from inception to June 12, 2024 were retrieved from PubMed, ScienceDirect, Web of Science, Scopus, and China National Knowledge Infrastructure. Two researchers independently conducted study selection, data extraction and quality assessment, and reached consensus with a third reviewer when necessary. A random-effects model meta-analysis was performed using Stata 14 software when three or more studies identified the same factor. Subgroup analyses were performed by study population, study area, study setting, study period, sampling method, and study quality. A leave-one-out sensitivity analysis was also performed. The study registration number at PROSPERO is CRD42024546523. Findings: A total of 67 studies were included from 34,311 records. Of these, 55 studies (791,858 samples) were eligible for meta-analysis for 22 factors. The study quality was generally moderate and high, with 29 and 25 studies, respectively. Meta-analysis of experimental studies revealed that previous education specific to BC symptoms, risk factors and BCS methods (OR= 4.72; 95% CI: 2.97, 7.51) was the strongest factor facilitating BCS participation. And meta-analyses of other quantitative studies further identified knowledge about BC or BCS (OR=2.74, 95% CI: 1.23, 6.10), previous breast self-examination (BSE) (OR=2.57, 95% CI: 1.62, 4.07) as facilitators with strong effects, and no experience of physical examination or cervical screening (OR=0.24, 95% CI: 0.17, 0.34), lower income (OR=0.49, 95% CI: 0.37, 0.65), ethnicity other than Han (OR=0.62, 95% CI: 0.44, 0.87) as barriers with strong effects. Interstudy heterogeneity was identified, while sensitivity analysis showed the unchanged results of these factors. Subgroup analyses revealed that knowledge of BC and BCS facilitated BCS only among women in the community (OR=2.16, 95% CI: 1.47, 3.16), but not among women in the medical facility. Interpretation: Our results highlighted the importance of reinforcing population-based breast education to enhance public awareness on BC symptoms, risk factors, BSE and BCS methods in order to drive the uptake of BCS. Targeting approaches focusing on women without medical examination experience, or with low income, or with ethnicities other than Han should be considered. Future trials should explore approaches using these factors as potential targets to promote BCS. |
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| ISSN: | 2666-6065 |