Breast cancer screening in Europe and the role of general practitioners: A 32-country comparative survey

Introduction: Breast cancer is the commonest cancer in women, and screening can allow earlier-stage diagnosis. While there are European recommendations on the age-range and frequency of breast cancer screening, participation in these programmes varies substantially, and this could be due to differences in how they are organised and implemented. The role that primary healthcare professionals play in the process is unclear. We aimed to describe the breast cancer screening programmes in European countries and investigate how primary healthcare professionals are involved in this screening process. Methods: A cross-sectional survey in 32 countries. Key informants with relevant expertise answered online questions about the characteristics of their screening programmes and general practitioners’ (GPs’) roles in this. Responses were refined through an iterative consensus process. Data were examined to identify patterns in GP engagement. Results: We found important differences between European breast cancer screening systems. While most had population-based screening, four countries relied on opportunistic screening. In 15 countries GPs had little or no involvement in the process of breast cancer screening, and in 13 countries GPs had some involvement, including identifying eligible patients, issuing referrals, and following-up results. Screening uptake rates tended to be higher in countries with well-established population-based screening programmes which give little or no GP involvement. Few countries linked GP engagement to incentives or performance measures. Conclusion: Countries with lower screening uptake should consider either enhancing GP involvement or transitioning to a structured, population-based screening system. Further research should explore how best to integrate primary care within national screening strategies.