Background: Breast cancer screening is a critical strategy for improved outcomes. However, access remains uneven across the Americas, shaped by sociodemographic, structural, and psychosocial factors. Identifying barriers and facilitators is essential to strengthen screening programs and reduce disparities.
Objectives: This systematic review examines barriers and facilitators to breast cancer screening across countries of the Americas, highlighting variations influenced by sociodemographic contexts.
Methods: We searched PubMed, SciELO, Lilacs, Epistemonikos, and DOAJ between June 30 and July 31, 2025. Eligible studies included trials and observational research published from 2000 onward that reported barriers or facilitators to breast cancer screening in populations across seven countries of the Americas. Studies conducted before 2000 were excluded to ensure relevance to policy and practice within the past 25 years. The review is registered in PROSPERO (CRD420251079207).
?Results: This review included 32 studies addressing barriers to breast cancer screening in the Americas. Most employed randomized controlled trial and observational cross-sectional designs. Interviews and surveys were the most common data collection methods, followed by focus groups, with several studies using multiple approaches. The majority of studies were conducted in the United States and primarily evaluated barriers among health system users. The median sample size across studies was 550. Across the literature, a wide range of barriers and solutions were identified, comprising 31 barrier categories and 27 solution categories. On average, studies reported five barriers and six proposed solutions. The most frequently reported barrier was transportation challenges, followed by fear of diagnosis, and limited health literacy. The most common solutions proposed were providing education and personalized counseling. Barriers were reported across diverse sociodemographic groups, most commonly among women aged 50 years or older (mean age 59), residing in urban areas, with high school education or less, low income, unemployment, lack of health insurance, and predominantly identifying as White or African American. In Latin American countries, the most common barrier was transportation or distance to health facilities, followed by fear of diagnosis, and lack of information or communication. In the United States, fear of diagnosis was the leading barrier, followed by transportation challenges, and lack of insurance. Providing education about cancer screening was the most frequently cited solution in both Latin America and the United States. Personalized counseling was also relevant in both contexts, while equitable access to screening was emphasized in Latin America and guidance to navigate services was more frequently reported in the U.S.-based studies. Across the studies, the most common limitations were limited representativeness of findings and reliance on self-reported data with potential recall bias.
Conclusion: Barriers to breast cancer screening in the Americas are multifaceted, reflecting structural, informational, and psychosocial determinants. Transportation difficulties, fear of diagnosis, and limited literacy emerged as key obstacles, disproportionately affecting socioeconomically disadvantaged women. Despite contextual differences, patterns of barriers were similar across Latin America and the United States, underscoring persistent inequities in access. Facilitators primarily focused on patient-centered strategies, particularly education, counseling, and navigation support. Addressing these barriers and facilitators is essential to reducing breast cancer disparities across the Americas.