Mapping interventions to increase uptake of breast and cervical cancer screening along the Intervention Ladder: a systematic review

Timely breast and cervical cancer screening greatly reduce mortality, yet uptake remains sub-optimal, and intervention effectiveness varies across populations and settings. This systematic review applies the Intervention Ladder framework to classify interventions by their level of intrusiveness and assess their effectiveness in increasing uptake. Five databases (PubMed, Web of Science, EMBASE, Cochrane Library, SCOPUS) were searched for articles published from 2004 to October 2024, using terms related to cancer screening, uptake, and behavioural interventions. Studies were included if they were randomised or cluster-randomised trials targeting under-screened women (never screened, overdue, or non-responders). Of 2,981 records identified, 240 full-texts were reviewed and 91 trials met inclusion criteria. Due to high heterogeneity in intervention types, populations, and outcome reporting, a narrative synthesis was conducted. Screening uptake was summarised as percentage-point change. Results showed that low-intensity strategies that support individual autonomy, such as mailed reminders or self-sampling kits, were consistently effective. In contrast, more intrusive interventions were infrequently implemented and showed no clear added benefit. These findings highlight the value of ethically proportionate, accessible strategies to enhance participation in cancer screening.