Does cancer literacy predict cancer screening intention or uptake? A systematic review

Objective: To examine the association between cancer literacy (CL) and cancer screening behaviors, including screening intention and uptake. Methods: A comprehensive search was conducted across three databases up to October 2024 (CRD42024500935). Studies were included if they (i) had an observational design, (ii) measured CL using validated or ad hoc tools, and (iii) quantified its association with cancer screening intention and/or uptake. Quality was assessed using the Newcastle-Ottawa Scale. Findings were narratively synthesized by cancer type for each outcome. Results: Six cross-sectional studies met the inclusion criteria: one focused on screening intention, four on screening uptake, and one on both outcomes. Data were available for breast, cervical, colorectal, prostate, and skin cancer. Study quality was heterogeneous, with most studies rated as fair quality and affected by methodological limitations, including reliance on self-reported data, imprecise outcome definitions and measurements, and heterogeneous target populations. While higher levels of CL were linked to increased screening intentions in both included studies, findings on screening uptake were inconsistent across and within cancer types, with significant associations more commonly observed in adjusted analyses. Although a few studies suggested that awareness of the importance of preventive measures may influence screening adherence, the overall results remained inconclusive across all cancer types. Conclusions: This review suggests a positive association between higher CL and cancer screening intentions, although the evidence is limited. The role of CL in screening uptake remains uncertain, indicating that additional factors may influence adherence. Given the limited evidence, methodological variability, and study limitations, further research employing more robust and standardized approaches is essential to better understand the role of CL in cancer-related behaviors. Practical Implications: Improving CL may have a role in shaping cancer screening behaviors, particularly in promoting screening intention. More rigorous research is needed to clarify the role of CL in screening behaviors.