Barriers to breast cancer-related care among women in Pakistan: a systematic review.

Objectives: Barriers to breast cancer (BCa)-related care contribute majorly to a high mortality among Pakistani women. However, our understanding of these barriers is limited to studies that are limited geographically and by their small sample sizes. The objective of this study was to summarise all evidence and provide a comprehensive, one-stop manuscript which could assist interventionists who seek to address these barriers. Design: Systematic review. Data sources: We searched PubMed, Embase, Scopus and Google Scholar and performed a citation search to search for eligible studies published since inception to 24 November 2024. Eligibility criteria: Observational studies that evaluated barriers to BCa-related care among Pakistani females were eligible. Data extraction and synthesis: We used the National Institutes of Health quality assessment tool to assess the risk of bias. Data were extracted into a template, classified into themes using inductive reasoning and analysed descriptively. Results: We found 37 studies which were eligible. In these, we identified eight barriers to BCa-related care for Pakistani women: lack of awareness, accessibility, affordability, fear, hesitancy, cultural traditions, commitments and physician error. Of these, physician error contributed the least, while lack of awareness, cultural traditions, fear and poor accessibility were most commonly reported. Importantly, these barriers to BCa-related care vary depending on the context (eg, population, geographical area, presence or absence of BCa). Most barriers influence others (eg, poverty leads to inaccessible healthcare), portraying a complex and multifaceted scenario. Conclusions: Barriers to BCa-related care can be grouped into eight broad themes. Their subthemes are diverse and interlinked. Policy-makers need to consider all barriers, as ignoring one can limit the effectiveness of their interventions. PROSPERO registration number: CRD42024612667.