Healthcare affordability and breast cancer screening uptake: an ecological analysis

Mammography is the standard method for breast cancer screening, reducing the incidence of advanced and life-threatening cancers through early detection. Despite its proven benefits, participation rates remain below the ideal target of 70–75% in many countries. To estimate the relationship between healthcare expenditure and mammography screening participation rate, we fitted linear regression models for 24 European countries, where the dependent variable is mammography screening participation and the independent variable is a healthcare expenditure variable. We then predicted the mammography screening participation rate of selected countries with organized population-based mammography screening programs based on their healthcare expenditure. Our findings reveal a strong correlation between healthcare affordability and screening participation. A significant negative association with mammography screening participation (β = − 1.44, P = 0.002) suggests that higher reliance on out-of-pocket payments for healthcare services is associated with lower participation rates in mammography screening. While direct interventions such as reminders and pre-scheduled appointments aim to improve participation, broader healthcare policies and economic factors may have a greater impact. Addressing financial barriers and strengthening healthcare support systems could enhance screening uptake and improve early cancer detection.