Health and health belief factors associated with screening and help-seeking behaviours for breast cancer symptoms: a systematic review and meta-analysis of the European evidence

Purpose: The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. Methods: Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis a narrative synthesis was undertaken. Results: Sixty-five studies were included. Never having had cervical screening (d=-0.72, p<0.001) and higher perceived barriers to mammography (d=-0.40, p<0.001) were associated with lower levels of screening attendance. Possessing health insurance (d=0.49, p<0.001), greater perceived benefits (d=0.31, p<0.001) and motivation (d=0.36, p=0.003) towards screening, and higher perceived seriousness (d=0.24, p=0.019) and susceptibility (d=0.20, p=0.024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d=0.32, p<0.001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. Conclusions: The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity