Abstract
BACKGROUND: Breast cancer screening (BCS) is underutilized in China, despite evidence demonstrating its effectiveness in reducing breast cancer mortality through early detection. This review aims to identify the facilitators and barriers to BCS intention or participation among female residents in mainland China, in order to inform the interventions promoting BCS decisions. METHODS: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline. Qualitative and quantitative studies published from inception to June 2024 were retrieved from PubMed, ScienceDirect, Web of Science, Scopus, and China National Knowledge Infrastructure. Factors with statistically significant associations with BCS decisions, and factors indicated to influence BCS decisions were extracted from included studies. Narrative synthesis was conducted to categorise the factors into 5 constructs: attitudes, subjective norms, perceived behavioural control, socio-demographic factors, and other factors against the guidance of the Theory of Planned Behaviour (TPB). RESULTS: A total of 82 studies were included, among which 13 and 72 studies reported on BCS intention and participation, respectively. Twenty-one themes were identified from the included studies. Among these, general positive feelings about BCS in the ‘attitudes’ construct, perceived norms from friends and acquaintances in the ‘subjective norms’ construct, knowledge of breast health in the ‘perceived behavioural control’ construct, and breast self-examination in the ‘other factors’ construct were the most commonly reported factors. These factors were positively associated with BCS decisions. Low income level was the most common barrier associated with BCS decisions in the construct of ‘socio-demographic factors’. All the constructs collectively contributed to BCS decision making. CONCLUSION: Approaches that aim to promote BCS should take into account the key factors in TPB constructs and their interactions. Health promotion efforts should focus on BC symptoms, risk factors, and screening methods to enhance public awareness. Women with low-incomes should be prioritised for financial subsidies from government and primary insurance programmes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26233-7.