Global variations in breast cancer screening coverage and programme indicators: an evidence analysis of multi-source data from 75 countries/regions

Screening is effective in reducing the disease burden of breast cancer. Breast cancer screening coverage is a key performance indicator of population-based programmes, yet global data on the screening coverage rate still remains insufficient. We aimed to provide a comprehensive assessment of breast cancer screening programme characteristics across countries. We collated and compared screening coverage, invitation, and participation rates, and described patterns of screening coverage stratified by development levels, regions, and age. Following the PRISMA 2020 guidelines, we systematically searched the PubMed, Web of Science, and Embase, supplemented by the CanScreen5 repository, the US CDC’s National Breast and Cervical Cancer Early Detection Program, and official national health websites. Based on the retrieved literature, government websites and official documentations, we extracted quantifiable indicators for each country/region’s screening programme. Where only sub-national data were available, we incorporated these as representative units to ensure data comparability. We performed descriptive statistical analyses and subgroup analyses stratified by Human Development Index (HDI), WHO regions, and age groups. No formal meta-analysis was conducted due to substantial heterogeneity in study designs and indicator definitions. On this basis, we evaluated the global differences in screening coverage. All screening coverage rates were calculated using the median. Among the 75 countries/regions included, 35 countries/regions have established official screening guidelines and 42 provided data on screening coverage. Mammography/digital breast tomosynthesis (DBT) remains the primary screening method. In resource-limited countries and regions, clinical breast examination (CBE) is the most recommended screening method. By analyzing the screening coverage rates of countries/regions with available data, we found that the median of screening coverage is 45%. Stratified analysis by age shows that the screening coverage rate for the 50-69 age group was higher than that for the 40-49 and 70-79 age groups. Screening coverage remains sub-optimal worldwide. Strengthening invitation systems, expanding access to free diagnostics and treatment, and developing context-specific protocols warrant consideration as potential strategies to improve screening coverage, though these relationships require formal evaluation in future research.