Background
Participation in cancer screening programmes remains suboptimal despite strong evidence of effectiveness. Financial incentives have been proposed as behavioural tools to increase screening adherence, but their impact varies widely across settings, cancer types and incentive designs. A comprehensive synthesis of available evidence is needed to inform public health decision-making.
Objectives
To evaluate the effectiveness of financial incentives on women’s participation in cervical, breast and colorectal cancer screening programmes.
Methods
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, following a protocol registered in PROSPERO. MEDLINE, CINAHL and the Cochrane Library were searched from December 2024 to June 2025. Quantitative studies comparing financial incentives with no incentive or usual care and reporting screening completion among women aged ≥25 years were included. Two reviewers independently screened studies extracted data and assessed risk of bias using RoB 2 and ROBINS-I tools. A random-effects meta-analysis (REML with Hartung-Knapp adjustment) was performed. Prespecified subgroup analyses explored incentive amount, follow-up duration, cancer type and population characteristics. Certainty of evidence was assessed using the GRADE approach.
Results
Eleven studies (10 randomised controlled trials and one cohort study), including approximately 20,152 women, were included. Financial incentives increased screening participation compared with no incentive or usual care (pooled risk ratio [RR] 1.58; 95% confidence interval [CI] 1.22-2.05), with substantial heterogeneity. Stronger effects were observed when screening completion was assessed within one month (RR 2.69; 95% CI 1.05-6.89), with effects remaining significant at approximately 12 months (RR 1.70; 95% CI 1.19-2.42). Incentives of moderate monetary value (approximately USD 10-25) showed the most consistent effects. Evidence was comparable across breast and colorectal cancer screening, while evidence for cervical cancer screening was limited. Effects tended to be larger in socioeconomically disadvantaged populations, although estimates were imprecise. Overall certainty of evidence ranged from low to moderate, mainly due to high heterogeneity.
Conclusions/Implications for practice or policy
Financial incentives probably improve women’s participation in cancer screening programmes, particularly when modest in value and delivered within short follow-up windows. Given substantial heterogeneity, incentive-based interventions should be carefully designed and integrated within broader public health strategies to ensure ethical acceptability, equity and sustainability.