OBJECTIVES: During the last decades, breast cancer screening programs have considerably increased in terms of number and improved in terms of clinical and technical standards. From an HTA perspective, clinical and economic issues are only two of several important aspects concerning breast cancer screening programs. The objective of research is to investigate to what extend societal and ethical aspects as well as the perspective of equal access for different groups of the population are addressed in breast cancer screening evaluation initiatives. METHODS: Systematic literature research; comparative analysis of societal, ethical and access aspects on the basis of several practical examples of screening programs in different countries and of theoretic scientific literature; evaluating structures of program-organisation along pre-defined indicators. RESULTS: In several countries breast cancer screening programs are also evaluated according to others than conventional indicators. These indicators do express attendance rates according to different social groups, and thus may explain differences in epidemiological outcomes of screening programs. CONCLUSION: Basic epidemiological indicators of the success of breast cancer screening such as prevalence can strongly vary depending on non-clinical and non-economic characteristics of screening programs. These societal, ethnic, ethical or equity aspects are primarily to be addressed via the organisational part of the programs. This is one reason why quality assurance in breast cancer screening should not only be strictly executed but also be improved in terms of a quality management.