Breast cancer screening in the Caribbean: a comparative study across six Caribbean Islands with a transatlantic perspective

Breast cancer (BC) is the primary cause of cancer-related mortality among women globally, including within the Caribbean Region. This burden of disease underscores the critical need for effective breast cancer screening (BCS) programs yet implementation of BCS varies greatly among Caribbean countries. This study presents a comparative analysis of the similarities, differences, and opportunities of BCS programmes and their implementation on six Caribbean islands to subsequently use the so-called AAAQ-model to evaluate aspects of the programmes more in-depth. This mixed-methods study combined quantitative and qualitative data from Aruba, Bonaire, Curaçao, Guadeloupe, Jamaica and Sint Maarten – Caribbean islands with different languages (Dutch, Papiamentu, French and English), colonial histories, and governing structures (independent states, affiliated territories or special municipalities of continental European countries). Data was gathered from published and grey literature, input from stakeholders and two discussion sessions. Five of six islands have implemented BCS programs, with clinical breast examinations or mammography. Participation in BCS is free of charge. Start of the programs and age-ranges varied. The target population is reached by invitations by mail and social media. Three islands conduct extensive BCS promoting communication campaigns annually in October. Cultural contextual factors influencing screening uptake and implementation included a limited health-seeking culture, and high turnover of BCS health providers. Lower inclusion of women with limited health literacy, lower education levels, lower socioeconomic status, fear for mammography discomfort or cancer and geographical hurdles were recognized as possibly contributing to lower participation in BCS. Similarities and differences between the BCS programs in the six Caribbean islands were identified, suggesting that exchange of good practices in the Caribbean could play an important role in improving BCS programs. A role of history and (post-)colonial transatlantic relations in shaping contemporary health systems was recognized. Multilateral communication and knowledge transfer between the islands and continental European countries can resolve these differences and stimulate best screening practice.