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

Br J Health Psychol. 2020 Feb;25(1):107-128. doi: 10.1111/bjhp.12397. Epub 2019 Dec 26.


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 = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .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 = .32, p < .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.

Keywords: breast cancer; help-seeking; mammography; meta-analysis; screening.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / psychology*
  • Databases, Factual
  • Early Detection of Cancer
  • Europe
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Help-Seeking Behavior*
  • Humans
  • Mammography / psychology*
  • Mammography / statistics & numerical data
  • Mass Screening
  • Middle Aged
  • Motivation
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data