Background:

Breast cancer remains the most common malignancy among women in China. Although a national free screening program has been implemented, screening uptake remains suboptimal, raising concerns regarding equity and policy effectiveness. This study aimed to examine socioeconomic, policy-related, and health perception determinants of breast cancer screening participation using a large multi-province population dataset.

Methods:

A cross-sectional survey was conducted in July 2023 using multi-stage stratified random sampling across five representative provinces in China: Sichuan, Yunnan, Hubei, Fujian, and Shandong. A total of 37,883 women aged 18–74 years were included. A structured questionnaire grounded in Andersen’s Behavioral Model was used to collect information on socio-demographic characteristics, enabling resources, health status, and screening behavior. Multivariable logistic regression analysis was performed to identify independent predictors of screening participation.

Results:

Overall, 61.2% of participants reported having undergone breast cancer screening at least once. Older age and higher educational attainment were significantly associated with increased screening uptake. Awareness of the national free screening policy emerged as the strongest predictor of participation. Higher householdincome, a personal history of breast disease, andafamily history of breast cancer werealsopositively associated with screeninguse.Incontrast, students, farmers, andself-employedwomen demonstrated substantiallylowerparticipation rates. The most commonlyreportedbarriers were low perceived necessityandtimeconstraints, indicating persistent gapsinriskperception and health communication.

Conclusion:

Breast cancer screening participationinChina is shaped by socioeconomicdisparities, policy awareness, and perceivedneed. Strengthening policy disseminationandimplementing targeted interventionsforunderserved occupational groups mayimprovescreening equity and early detection. Thesefindings provide actionable evidenceforoptimizing population-based screeningstrategiesin rapidly evolving health systems.

Lianxue Zhang is a Master of Public Health candidate at Peking Union Medical College, China. Research focuses on women’s health, particularly the epidemiological characteristics, screening behavior mechanisms, and prevention strategies of breast and cervical cancer. Experience includes participation in large-scale population-based surveys and health policy evaluation studies, with responsibilities in questionnaire design, data management, and statistical analysis. Systematic expertise has been