Improving Breast Cancer Outcomes by Enhanced Activities in Early Detection and Diagnosis: An Umbrella Review and Meta-Analyses of Randomised Controlled Trials in High-Income Contexts With Universal Healthcare Coverage.

IntroductionVariations in short-term breast cancer survival call for promotion of primary prevention, screening, risk awareness and earlier symptomatic presentation.MethodsWe conducted an umbrella review of published systematic reviews on promotion of screening participation or awareness of and help-seeking behaviours for symptoms with a focus on breast cancer and transferable lessons from the other top five male and female adult cancers in the UK (or other high-income countries with universal healthcare). We searched Ovid MEDLINE, EMBASE and Cochrane Database of Systematic Reviews (up until 31.12.25). Two reviewers independently screened 20% of titles and abstracts and all full-texts, as well as carried out all AMSTAR 2 assessments to exclude less informative and 'critically low' quality reviews. We extracted information within included reviews on relevant primary studies to conduct random effects meta-analyses.ResultsForty-three reviews were included, reporting on 168 relevant randomised controlled trials showing significant increases in screening uptake for scheduled versus open appointments (Odds ratio(OR);95% Confidence Intervals(CI)=1.88;1.63,2.17, k=6), advance notification letters versus standard invitation only (OR;95% CI=1.13;1.07,1.20, k=6), letters signed by General Practitioners (OR;95% CI=1.35;1.19,1.53, k=14), educational information (in paper-format) versus no such information (OR;95% CI=1.33;1.05,1.69, k=18), follow-up by calls (OR;95% CI=1.49;1.04,2.14, k=11) or text messages (OR;95% CI=1.28;1.05,1.56, k=7), phone counselling (OR;95% CI=2.63;1.47,4.70, k=4), multi-lingual approaches (OR;95% CI=1.35;1.11,1.63, k=13). Screening uptake was higher in most versus least socially disadvantaged areas for multi-lingual approaches by phone (p=<0.01), follow-up calls (p=<0.01), reminder letters (p=0.03) and 'implementation intentions' (goal-directed plans promoting screening) (p=<0.01). Meta-analyses also showed significant improvements for decision aids (paper-format) on knowledge (OR;95% CI=3.88;1.52,9.93, k=7) and informed choice (OR;95% CI=4.97;1.72,14.35, k=4). Statistical heterogeneity was prevalent, potential publication bias and most studies had high or unclear risks of bias.ConclusionSome effective interventions were identified; however, information on inequalities across outcomes and interventions targeting awareness and help-seeking behaviours were limited.