Barriers and facilitators to breast self-examination in women under 50 in an international context: A qualitative systematic review

The stage and grade of a breast cancer diagnosis is a significant determinant of patient prognosis. Therefore, early detection via screening is recommended. Breast self-examination is a screening and breast health promotion technique that empowers women to be familiar with what their breasts look and feel like normally and be more confident to detect any changes. Self-examination is also a gateway to lifelong breast health awareness in young women who have not yet engaged with formal screening programmes. Globally, breast self-examination engagement is low and this study aims to identify the barriers and facilitators of breast self-examination in women globally under 50 years. Databases MEDLINE, PUBMED and CIANHL were searched. 3984 results were produced and 22 full texts were assessed. Eleven studies were included. Methodological quality was assessed using the JBI Critical Appraisal checklist and each study was assigned a ConQual grade. A meta-synthesis using a thematic analysis approach produced six over-arching themes that represented the barriers and facilitators identified: knowledge, attitudes and beliefs, influence of others, education, routine and emotions. Knowledge, attitudes and beliefs, and emotions were identified as the greatest barriers to self-examination. Contrastingly, routine appeared to have the greatest facilitatory impact, with the role of health care professionals and education also being facilitatory. The introduction of demonstrative teaching programmes at schools or universities, or guidelines specific to breast self-examination for health care professionals could be considered as next steps.