Barriers against utilization of population-based cancer screening services in Germany

Ali Zafar; Nelli Tschobur; Milena Koch; Anne Josephine Dutt; Katharina Mengler; Andreas Ihrig; Hans-Christoph Friederich; Till Johannes Bugaj; Jens Staeudle; Imad Maatouk; Gwendolyn Mayer; Franziska Baessler

doi:10.1007/s10389-025-02539-5

journal article Open Access Jul 14, 2025

Barriers against utilization of population-based cancer screening services in Germany

Ali Zafar Nelli Tschobur Milena Koch Anne Josephine Dutt Katharina Mengler Andreas Ihrig Hans-Christoph Friederich

Till Johannes Bugaj Jens Staeudle Imad Maatouk

Gwendolyn Mayer Franziska Baessler

Journal of Public Health · Oxford University Press (OUP)

View at Publisher Save 10.1007/s10389-025-02539-5

Abstract

Abstract

Aim
Cancer screening services are underutilized by the general population in many countries with subsidized healthcare systems. This study aimed to determine the attendance rates and barriers in accessing age- and gender-specific cancer screenings offered free-of-charge in Germany.

Subject and methods
A purpose-derived questionnaire was developed to collect data on sociodemographic characteristics, uptake of recommended screenings, and perceived or experienced barriers. Group differences of dichotomous variables were calculated by Welch’s t-tests (p < .05). Age-group differences were determined via the Kruskal–Wallis test.

Results
Overall 74% out of 314 participants did not attend their recommended cancer screenings on time. Lack of time due to work and irrelevancy of screening offer were reported as the main reasons for not attending screenings by 45% and 38% of participants, respectively. Men reported lower attendance rates than women (p = .002). From principal component analysis of individual items, six barrier categories were derived as: fear of cancer/consequences, patient-physician interactions, lack of time/overwork, lack of information/personal relevance, practitioner unavailability and alternative/infrastructural barriers. “Lack of time/overwork” was the most significant barrier category (male M 3.28; SD 1.42 and female M 2.57; SD 1.40), especially for men as compared to women (p < .001). Men also reported higher values for “lack of information/personal relevance” of screening than women (p < .001) and “fear of cancer/consequences” (p = .005). Younger participants (18–49 years) reported higher values for all barrier categories.

Conclusions
Lack of time was a significant factor for not attending recommended cancer screenings on time. Male participants attended screenings less often than women, citing lack of time and information about services, and fear of cancer. Frequent information exchanges between public and stakeholders are recommended.

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Published: Jul 14, 2025
License: View

Authors

Hans-Christoph Friederich

Department of Internal Medicine, Division of Integrated Psychosomatic Medicine University Hospital Wuerzburg Wuerzburg Germany

Funding

Universitätsklinikum Heidelberg

Strube Stiftung Stuttgart

Cite This Article

Ali Zafar, Nelli Tschobur, Milena Koch, et al. (2025). Barriers against utilization of population-based cancer screening services in Germany. Journal of Public Health. https://doi.org/10.1007/s10389-025-02539-5

Barriers against utilization of population-based cancer screening services in Germany

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