Community health service center is the main gatekeeper for breast cancer screening, while its efficacy of screening is difficult to guarantee for the re-striction of screening process by various factors.

To analyze the focus issue of breast cancer screening program in the real world and explore corresponding solutions.

A mixed-methods convergent design was used to collect quantitative and quali-tative data. In the quantitative study, typical sampling method was used to select one community health service center in each of the four districts of Tianjin as the investigation institution from April 2021 to November 2022, accidental sampling method was used to select age-eligible women within 3 km of the four institutions as resident survey respondents, so as to explore the issues existing in the on-site operation of breast cancer screening. In the qualitative study, 9 residents, 12 physicians participating in the screening and 4 leaders were selected through purposive sampling from June to November 2022 for semi-structured in-terviews. The grounded theory was used to analyze the interview content, and the grounded theory framework of the focus issues of breast cancer screening was plotted. Combined with literature and typical investigation data, a mixed methods study was conducted to determine the focus issues of breast cancer screening.

The quantitative study showed that in the advocacy work, the promotion method is traditional, the awareness rate and participation rate of residents was 46.3% (143/309) and 32.4% (100/309) , respectively; in the screening work, the institutions invested different human and material resources, and the average waiting time of screening residents accounted for 62.2% (40.5/65.1) of the total time; in the follow-up and referral work, the invested human and material resources were little, the mammography referral compliance of residents was 29.9% (59/197) . The qualitative study showed that a total of 38 comprehensive open codes were formed in the interview and converged into 10 axial codes and 3 core codes, including advocacy organization, screening organization, follow-up and referral. The mixed methods study showed that 3 focus issues were identified in final, including how to improve residents' participation rate, how to ensure adequate human and material resources in screening institutions, and how to improve residents' mammography referral compliance.

The efficacy of breast cancer screening is influenced by advocacy organization, screening organization, follow-up and referral. It is necessary to rationally allocate resources to ensure adequate human and material resources for screening institutions; innovate promotion methods, expand coverage of promotion and improve residents' health literacy, participation rates and mammography referral compliance, to ensure the substantial progress of breast cancer screening and provide reference for opti-mizing the efficacy of breast cancer screening.

社区卫生服务中心是负责乳腺癌初筛的主要"阵地"，在其开展乳腺癌筛查过程中常受到许多因素制约，筛查效果难以保证。

分析乳腺癌筛查项目在真实世界的焦点问题并探讨相应解决途径。

采用混合方法研究的聚敛式设计，收集定量与定性数据。定量研究探究现场运行存在的问题：采用典型抽样法，于2021年4月—2022年11月在天津市4个区各选取1家社区卫生服务中心作为调查机构；采用偶遇抽样法，选取4家机构周围3 km内适龄女性作为居民调查对象。定性研究采用目的抽样法，于2022年6—11月对天津市9个区的9名受筛居民、12名参筛医生及4名分管领导进行半结构化访谈，运用扎根理论分析访谈内容，绘制乳腺癌筛查焦点问题扎根理论框架图。结合文献、典型调查数据进行混合方法研究，确定乳腺癌筛查的焦点问题。

定量研究结果：在宣传工作中，机构宣传方式传统，居民的知晓率、参与率分别为46.3%（143/309）、32.4%（100/309）；在筛查工作中，机构投入人力、物力不尽相同，筛查居民平均等待时长占总时长62.2%（40.5/65.1）；在随访转诊工作中，人力物力投入少，居民钼靶转诊依从性为29.9%（59/197）。定性研究结果：访谈内容共形成38个综合开放式编码并汇聚为10个主轴编码和3个核心编码（宣传组织、筛查组织和随访转诊）。混合研究结果：最终确定3个焦点问题，即"如何提高居民参与率""如何确保筛查机构人力和物力充足""如何提高居民钼靶转诊依从性"。

乳腺癌筛查效果受宣传组织、筛查组织及随访转诊三方面共同影响。为保证乳腺癌筛查取得实质性进展，优化乳腺癌筛查效果，需合理分配资源，确保筛查机构人力和物力充足；创新宣传方式，扩大宣传覆盖面，提升居民健康素养，提高参与率和钼靶转诊依从性。