Barriers and facilitators of oral, breast, and cervical cancer screening in India: a systematic review

Oral, breast, and cervical cancer collectively constitute nearly one-third of new cancer cases in India, yet screening uptake remains critically low. Barriers operate across individual, sociocultural, socioeconomic, and health system levels. Yet, limited concrete systematic evidence exists on barriers to screening for oral, breast, and cervical cancers from both community and healthcare worker perspectives within the Indian context. A systematic review was conducted following PRISMA 2020 guidelines (PROSPERO Registration: CRD420261402558). The literature search covered studies published from January 2010 to May 2026 (coverage period). Database searches were executed between 15 April 2026 and 15 May 2026 (search execution period) across PubMed/MEDLINE, Scopus, and the Cochrane Library. The Population, Concept, Context (PCC) framework guided eligibility: adults aged ≥ 18 years and healthcare workers in India; barriers, facilitators, and factors affecting screening uptake or delivery of oral, breast, and cervical cancer screening across any Indian setting. Records were screened using Rayyan and quality assessed using the Mixed Methods Appraisal Tool (MMAT) 2018. Thematic synthesis was conducted, with community findings mapped to the Social Determinants of Health framework and healthcare worker findings mapped to the WHO Health System Building Blocks framework. Forty-one primary studies conducted across diverse regions of India were included, encompassing rural, urban, tribal, and mixed settings. From the community perspective, dominant barriers included fear of diagnosis, low perceived susceptibility, knowledge gaps, stigma surrounding breast and gynaecological examinations, male gatekeeping of healthcare decisions, financial and indirect cost burdens, distrust of public health facilities, and structural access constraints. From the healthcare workers’ perspective, critical barriers included knowledge and skill deficits among frontline workers, excessive workload, inadequate training, weak referral systems, supply chain failures, poor health information systems, and fragmented governance. Facilitators included structured training programmes, ASHA-led outreach, free-of-cost screening services, community-based screening delivery, and coordinated multi-sectoral governance. The Sikkim HPV self-sampling study further highlighted the acceptability and feasibility of community-based implementation within its study setting. Cancer screening gaps in India reflect systemic failures operating simultaneously on the demand and supply sides. Addressing them requires integrated strategies targeting workforce capacity, governance coordination, indirect cost reduction, continuity of care after a positive screen, and culturally sensitive community engagement. Evidence-based, context-specific interventions are urgently needed to strengthen India’s National Cancer Screening Programme-National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). PROSPERO ID: CRD420261402558.