Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review

Cristiana Sofia Ferreira; Joana Rodrigues; Stefanie Moreira; Filipa Ribeiro; Adhemar Longatto-Filho

doi:10.3892/mco.2021.2301

Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review

Mol Clin Oncol. 2021 Jul;15(1):139. doi: 10.3892/mco.2021.2301. Epub 2021 May 19.

Authors

Cristiana Sofia Ferreira¹, Joana Rodrigues¹, Stefanie Moreira¹, Filipa Ribeiro^{1

2}, Adhemar Longatto-Filho^{1

2

3

4

5}

Affiliations

¹ School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal.
² Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal.
³ ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal.
⁴ Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP 14784-400, Brazil.
⁵ Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, SP 01246-903, Brazil.

Abstract

Breast cancer is the most common cancer affecting women worldwide. Adherence to breast cancer screening guidelines is frequently lower in racial, ethnic and cultural minority populations and is affected by potential inequities or barriers to screening that these minorities face. Therefore, the aim of the present study was to collect information from different minority groups worldwide, assess adherence to breast cancer screening and evaluate barriers or limitations causing non-adherence, which should facilitate the development of effective interventions. A search was conducted through PubMed and Web of Science. Studies were considered as eligible if they met the following criteria: i) Female patients; ii) breast cancer screening program implemented in the country; iii) minority groups; iv) asymptomatic; v) report written in Portuguese or English; vi) study published from 2015 onwards. The Critical Appraisal Skills Programme checklist was used for qualitative studies and the Strengthening The Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies. From the 348 initial articles, 86 were removed due to duplication and 19 were selected, analyzed and summarized, accordingly. Of the 19 studies included, 5.3% were classified as high quality, 52.6% as moderate to high and 42.1% as moderate. A total of 15 studies were cross-sectional and 4 were qualitative, collectively including 250,733 women. The rate of adherence to mammogram in different minorities was evaluated, obtaining a mean value of 49.7% in the last 2 years, and statistically significant barriers were selected and divided into sociodemographic; personal; ethnic, cultural and religious; and external factors. The characteristics of each population play a major role in the population's breast health practices. If the population, adherence rates, barriers and inequities are carefully studied, screening models may be customized and participation to breast cancer screening can be optimized, thereby reducing the high breast cancer-associated mortality.

Keywords: breast cancer; breast cancer screening; breast cancer screening adherence; breast cancer screening barriers; minority.

Grants and funding

Funding: The present study was developed under the scope of project NORTE-01-0145-FEDER- 000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020) under the Portugal Partnership Agreement, through the European Regional Development Fund (FEDER), and by National funds, through the Foundation for Science and Technology (FCT)-project UIDB/50026/2020 and UIDP/50026/2020.