A rapid review of barriers and facilitators to cancer screening uptake (breast, cervical and bowel) in underserved populations

In the United Kingdom (UK), the National Health Service (NHS) provides population-based screening programmes for breast, bowel, and cervical cancer. These programmes were temporarily paused in March 2020, due to the COVID-19 pandemic, resulting in large numbers of the eligible population having their invitations delayed. This disruption may have had a disproportionate impact on underserved populations for whom there was a lower uptake prior to the pandemic. Some people may also be less willing to attend screening after the pandemic. Interventions and campaigns designed to encourage people to take part in cancer screening may need to be adapted after the pandemic, in particular those targeting underserved populations. This rapid review aimed to identify the barriers and facilitators to breast, bowel, and cervical screening uptake in underserved populations (e.g. clinically vulnerable, shielding, multi-morbidities, ethnic minorities, social deprivation, gender, age) during and since the onset of the pandemic, using evidence from the UK and other countries with similar cancer screening programmes (such as Australia and Netherlands), and to compare with the pre-pandemic literature. The pre-pandemic literature was identified using a supplementary scoping search for published systematic reviews. Three primary studies (two published and one ongoing trial) conducted during the pandemic were identified. Five systematic reviews of pre-pandemic evidence were also included. Two qualitative studies conducted during the pandemic were appraised as high quality but both included sample populations with limited representation. No primary studies specifically exploring the impact of the pandemic on barriers and facilitators to screening uptake among underserved groups were identified. The findings did not show marked differences in the barriers and facilitators for screening uptake before and during the COVID-19 pandemic in underserved populations. However, it is unclear whether this is because these genuinely remain unchanged or reflects the lack of available evidence. The findings may only be transferable to the population groups studied.