The low coverage rate of breast cancer screening has affected the prevention and control effect of breast cancer in China. Factors related to the screening coverage rate include multiple aspects of the screening implementation process.

Based on the implementation process of breast cancer screening in China, this study aims to simulate the changes in the breast cancer screening coverage rate before and after the implement optimization measures to provide suggestions for optimizing the breast cancer screening coverage rate in China.

From July to September 2022, we systematically searched the journal literature on female breast cancer screening in four databases, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collate and summarize the relevant influencing factors of women's screening behaviors. Collating and analysing the breast cancer screening pathways and systematic subjects of breast cancer screening in China based on the official documents of the relevant governmental websites on breast cancer screening. Based on China's breast cancer screening pathways, screening subjects and screening behavioral correlates, we constructed the causality diagram of the breast cancer screening coverage and the stock flow diagram of the system dynamics of the breast cancer screening coverage. Simulating the effects of some optimisation strategies for breast cancer screening coverage in China, 2010-2040.

The model simulates previous screening strategies and policy resource environment. Breast cancer screening coverage gradually increased to 40% between 2010 and 2013. From 2013 to 2040, it fluctuates between 40% and 45%, showing a trend of slow decline at first and then a slow rise. Policy intervention scenarios, based on the improved population's screening intention and screening accessibility strategy, respectively simulated five kinds of optimization measures of breast cancer screening coverage rate from 2024. The five measures are as follows: (1) focusing on publicity and education, (2) standardizing the quality of screening services, (3) controlling per-case screening costs, (4) doubling the number of special breast cancer screening slots, (5) standardizing the quality of screening services and controlling per-case screening costs. The measure of focusing on publicity and education will increase rapidly coverage rate during 2024-2030 to 60.38%, then increase slowly to 66.04% during 2031-2040. The screening coverage rate will rapidly increase to 60.27% before 2029, after standardizing the quality of screening services. Then it will slowly increase to 66.04% from 2030 to 2040. After controlling per-case screening costs, the screening coverage rate will increase from 46.95% to 54.17% in 2024-2026. Then the screening coverage rate up to 58.95% in 2027-2040. Compared with no optimization measures during 2024-2040, doubling the number of special breast cancer screening slots will only increase the screening coverage rate by 1%-2%. The screening coverage rate in 2024-2040 increased from 46.95% to 86.79%, after standardizing the quality of screening services and controlling per-case screening costs.

Breast cancer screening coverage is projected to fluctuate from 41.7% to 46.0% in China from 2024 to 2040. Improving screening intention or accessibility can improve screening coverage, but the two optimization measures have their own upper limits. Meanwhile, in the Chinese population, the optimization measures to improve screening intention are better than the optimization measures to improve screening accessibility. Combined optimization measures to improve population's screening intention and screening accessibility can break through the upper limit of their respective promotion and have a better effect on improving screening coverage.

乳腺癌筛查覆盖率低影响了我国乳腺癌的防控效果。影响筛查覆盖率的相关因素涉及筛查实施过程的多个方面。

基于我国乳腺癌筛查的实施过程，模拟预测优化措施实施前后乳腺癌筛查覆盖率的变化，为我国乳腺癌筛查覆盖率的优化提供建议。

于2022年7—9月系统检索PubMed、Web of Science、中国知网、万方数据知识服务平台4个数据库中关于女性乳腺癌筛查的期刊文献，整理归纳女性筛查行为的相关影响因素；基于相关政府网站关于乳腺癌筛查的公文文件整理分析我国乳腺癌筛查途径及系统主体。基于我国乳腺癌筛查途径、筛查主体和筛查行为相关因素，构建乳腺癌筛查覆盖率因果关系图和乳腺癌筛查覆盖率系统动力学存量流量图，并进行我国2010—2040年乳腺癌筛查覆盖率促进策略的仿真模拟。

模型模拟既往筛查策略和政策资源环境，2010—2013年乳腺癌筛查覆盖率逐渐提高至40.0%，2013—2040年在40.0%~45.0%波动，呈现出先缓慢降低，后缓慢上升的趋势。模拟政策干预从2024年开始：（1）加强宣传教育，2024—2030年覆盖率快速提高至60.4%，后2031—2040年缓慢提高至66.0%；（2）规范筛查服务质量，2024—2029年覆盖率快速提高至60.3%，2030—2040年缓慢提高至66.0%；（3）控制例均筛查费用，2024—2026年覆盖率从47.0%提高至54.2%，2027—2040年筛查覆盖率提高至59.0%；（4）乳腺癌专项筛查名额加倍，2024—2040年相比于无优化措施，筛查覆盖率有1.0%~2.0%的提高；（5）规范筛查服务质量+控制例均筛查费用，筛查覆盖率在2024—2040年从47.0%提高至86.8%。

预计2024—2040年，我国乳腺癌筛查覆盖率在41.7%~46.0%波动，提高筛查意向或筛查可及性都能提高筛查覆盖率，提高筛查意向比提高筛查可及性效果更好，但两种优化措施有各自提升上限。人群筛查意向和筛查可及性的组合优化措施可突破各自提升上限，对提高筛查覆盖率有更好的效果。