Assessing women's stated preferences for breast cancer screening: a systematic review and a meta-analysis

Abstract

Background: Breast cancer is the most common diagnosed disease, and the second leading cause of death among women. Thus, due to its importance, the current research is aimed at identifying the preferences of individuals for improving breast cancer screening programs and the related policies.

Method: A systematic search was applied on databases including - PubMed, Scopus, the Web of Science, Embase, Cochrane, SID- up to October 2022. The including articles were original or review papers that assessed individuals' willingness to pay. Also, articles including the effective variables or attributes for breast cancer screening program were included. Meta-analysis was applied to calculate Willingness to Pay (WTP) as a mean for breast cancer screening followed by vote-counting for identifying the variables and attributes correlated with screening.

Results: A total of 721 articles were identified during the first phase. After the screening process, thirteen papers were chosen, out of which, nine assessed mammography as a breast cancer screening program. The results of random effect meta-analysis on the including studies indicated that the rate of willingness to pay for screening was 0.28% of GDP per capita (95%CI: 0.14-0.43), which was found to be statistically significant. The result of stratified meta- analysis indicated that the rate of willingness to pay for screening was 0.22% of GDP per capita (95%CI: 0.07-0.37), which was found to be statistically significant. Generally, income was the basic factor for receiving screening services, and cost was an effective attribute for participating in screening programs.

Conclusions: To increase women's participation in breast cancer screening programs; it is essential to provide legitimate information and eliminate the barriers to women's non-participation. Offering rapid tests at low costs in healthcare centers (both in terms of travel and screening time) delivered by female staff can lead to an increase in women's willingness to participate in breast cancer screening programs.

Keywords: Breast cancer screening; Discrete choice method; Stated preferences; Systematic review; Willingness to pay.