Barriers to cancer screening in Saudi Arabia: A systematic review

Introduction: Cancer remains a leading cause of morbidity and mortality worldwide, and its burden is rising in Saudi Arabia. Although effective screening programs for colorectal, breast, and cervical cancers exist, participation rates remain low. Understanding barriers to screening is essential to improve early detection and reduce cancer-related mortality. The objective of this review is to identify, evaluate, and synthesize existing evidence regarding barriers to participation in cancer screening programs among adults in Saudi Arabia. Materials and Methods: A systematic review was conducted in accordance with PRISMA 2020 statement and registered in PROSPERO. PubMed/MEDLINE, Cochrane, and Web of Science databases were searched for studies published from January 2017 to April 2025. Observational studies reporting barriers to colorectal, breast, or cervical cancer screening among adults in Saudi Arabia were included. Data were synthesized narratively using a thematic framework that encompassed knowledge-related, psychological, healthcare system, sociocultural, and economic barriers. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Results: Thirty-seven cross-sectional studies involving 39,079 participants met the inclusion criteria. Knowledge-related barriers were the most consistently reported across all cancer types. Psychological barriers, including fear of results, pain, embarrassment, and low perceived need in asymptomatic individuals, were common. Healthcare system barriers, particularly a lack of physician recommendation, limited access, and availability constraints, were especially prominent in colorectal cancer screening. Breast cancer screening was largely affected by psychological factors, while cervical cancer screening showed stronger sociocultural and access-related barriers, including preference for female physicians and cost or insurance concerns. Conclusions: Barriers to cancer screening in Saudi Arabia are widespread and multifactorial, primarily driven by knowledge gaps, psychological concerns, and healthcare system limitations. Implementation of culturally sensitive, provider-led, and system-level interventions that emphasize education, physician engagement, and improved access is necessary to increase screening uptake and facilitate early cancer detection nationwide.