Implementation of Breast Cancer Screening and Its Effect Among Chinese Rural Women: A Mixed-Methods Evaluation Based on RE-AIM Framework

Background: Many rural areas lack screening for breast cancer. This study employs the RE-AIM framework to assess the implementation, effectiveness, and sustainability of a breast cancer screening program in China to provide insights into developing an effective implementation strategy suitable for rural areas with limited health resources. Methods: This mixed-methods study evaluated a breast cancer screening program in Ordos, Inner Mongolia, using quantitative and qualitative approaches. Quantitative data from 2016 to 2020 were gathered through surveys and screening results involving 116,013 women aged 35–64. Qualitative data were obtained via semi-structured interviews with MCHH health workers in 2024 to identify program facilitators and barriers. Quantitative and thematic qualitative analyses were conducted, with findings compared using a convergent mixed methods approach. Results: The screening program reached 35.05% of the target population by 2018, rising to 52.24% among women aged 35–64 in 2020. Cancer detection rates were 0.56/1000, ranging from 0.08/1000 in women aged 35–39 to 1.89/1000 in those aged 60–64. The PPV for biopsy was over 67%, but few patients with abnormalities completed the procedure. Key facilitators included strong patient-provider communication, staff involvement, adequate funding and training, and strict supervision, while barriers involved geographical distance, lack of multi-sector support, limited service capacity, and low health awareness. The “rural outreach” model and routine hospital screening were seen as the most effective solutions for the dispersed population and low self-efficacy. Increased awareness from prior screenings improved participation and compliance in subsequent programs. A key challenge in program maintenance was reduced quality control, supervision, and training efforts. Conclusion: It is recommended to delay the initiation of breast cancer screening to age 40 or 45 in rural areas with low incidence rates. Improving the screening capacity at primary healthcare facilities and strengthening the patient navigation system for timely referrals to higher-level centers are essential to enhance cancer detection in these regions. The “rural outreach” model is effective in reducing health disparities among marginalized women while simultaneously raising their awareness. Further research is needed to evaluate long-term outcomes and to develop customized implementation strategies for addressing the identified barriers.