Disability Inclusion in National Breast Screening Programs: A Systematic Review of Policies and Practices

Women with disabilities experience persistent inequalities in access to breast cancer screening. Existing reviews have primarily examined screening participation and barriers at the individual, provider, or service level. This systematic review will address a distinct and under-synthesized question: how national breast screening programs translate disability inclusion into formal policies, operational guidance, service adaptations, implementation practices, and monitoring arrangements. The review will systematically identify and synthesize national or nationally endorsed breast screening policies, clinical and operational guidelines, accessibility standards, program manuals, quality-assurance documents, monitoring frameworks, and relevant empirical implementation studies. It will evaluate provisions relating to accessible invitations and information, booking and communication support, physical and equipment accessibility, wheelchair or seated mammography, extended appointments, positioning and transfer assistance, supported decision-making, caregiver or support-person involvement, staff training, procedures following unsuccessful or incomplete mammography, alternative assessment pathways, and disability-disaggregated monitoring indicators. Academic evidence will be identified through MEDLINE via PubMed, WHO Global Index Medicus, OpenAlex, and Dimensions, with Google Scholar used as a supplementary source. A structured grey-literature search of government, national screening-program, public-health, and relevant professional-authority websites will also be undertaken. The anticipated outputs are a cross-national synthesis of disability inclusion in breast screening policy and practice, identification of policy-to-practice and policy-to-monitoring gaps, and development of a proposed minimum framework of indicators for disability-inclusive breast screening programs. The review methods will be prespecified before formal screening and data extraction, and the final review will be reported in accordance with PRISMA 2020.