Breast cancer outcomes are strongly tied to stage at detection, making screening disparities a life-or-death equity issue. Black African women in high-income countries consistently attend mammography screenings at lower rates than the general population, yet the evidence base for what actually moves the needle has remained fragmented — until now.
This systematic review synthesized findings from 1,767 initially identified studies, ultimately including 12 that met criteria for evaluating interventions specifically targeting Black African women's breast screening uptake. Every included study originated in the United States, a geographic limitation that shapes the conclusions. Interventions spanned radio and print health messaging, community-based support programs, and individualized patient navigation. Eleven of the twelve studies reported positive effects on at least one of three outcomes: actual mammogram uptake, screening knowledge, or stated intention to screen. The standout approach was individual patient navigation combined with problem-solving behavior-change techniques — a structured method drawn from the Behavior Change Technique (BCT) taxonomy — which demonstrated the most consistent and robust associations with increased screening engagement.
Patient navigation as a cancer-screening intervention has accumulated a reasonably strong evidence base over the past two decades, particularly for colorectal and cervical cancer in underserved populations. Its application here adds to that record, though the exclusive US origin of all included studies is a significant constraint. Structural healthcare differences, insurance systems, and community trust dynamics vary enormously across high-income countries, meaning interventions effective in American settings may not translate directly to the UK, Canada, or Australia without adaptation. The review also exposes a stark research gap: no qualifying interventions have apparently been developed or rigorously evaluated for this population outside the US. The reliance on intention and knowledge as proxy outcomes — rather than confirmed screening attendance — further limits causal interpretation. Incrementally confirmatory for US contexts, but potentially paradigm-prompting for researchers and public health planners elsewhere.