Breast cancer care interventions for Indigenous women across the care continuum: a he Pikinga Waiora-informed systematic review

Indigenous women experience persistent inequities in breast cancer outcomes, including later-stage diagnosis and poorer survival. Although culturally grounded interventions have improved engagement and psychosocial outcomes, less is known about how they align with implementation principles across the breast cancer care continuum. This review applies an Indigenous implementation science framework, He Pikinga Waiora (HPW), to examine reported cultural grounding, Indigenous participation and authority, systems integration and relational knowledge. A systematic review was conducted in accordance with PRISMA guidelines. Four databases and grey literature sources were searched (2000–2025). Eligible studies reported implemented breast cancer interventions involving Indigenous women and included implementation or intervention outcomes. Interventions were mapped across the cancer care continuum and rated for alignment with the four HPW domains: Cultural Centredness, Community Engagement, Systems Thinking, and Integrated Knowledge Translation. Ratings reported HPW alignment and implementation depth. Twenty studies reporting 13 interventions were included. Implementation outcomes most concerned acceptability and feasibility, while intervention outcomes included improvements in knowledge, psychosocial wellbeing, engagement with care, treatment access, and reduction of structural barriers. Patient navigation and culturally tailored education were the most common modalities. One intervention was rated as having Very High HPW alignment and two were rated as having High alignment, characterised by Indigenous governance, culturally concordant workforce models, multilevel coordination, and strong integration within care systems. The remaining interventions were rated as having Medium or Low alignment, generally reflecting culturally grounded delivery with more limited structural integration. No intervention explicitly targeted the symptomatic diagnostic interval. Culturally grounded interventions reported favourable engagement and wellbeing outcomes but were seldom accompanied by sustained structural integration. Indigenous governance, culturally concordant workforces, coordinated care pathways, and embedded learning processes may create stronger conditions for sustained implementation. The absence of interventions addressing symptomatic diagnosis is a critical evidence gap. Future research should develop and test Indigenous-led models across earlier diagnostic stages while examining implementation outcomes, including adoption, fidelity, and sustainability. This review was prospectively registered with PROSPERO (CRD420251141784).