Barriers and Facilitators to the Implementation of Nurse-Led Clinical Breast Examinations for the Early Detection of Breast Cancer in Primary Health Care: A Systematic Literature Review

Breast cancer is often detected at an advanced stage, particularly in areas with limited access to mammography. Clinical Breast Examination (CBE) is an early detection strategy that can be implemented in primary health care, with nurses playing a role in education, examination, referral, and follow-up. This study aims to identify factors that influence the implementation of nurse-led CBE. A systematic literature review was conducted based on the PICOS framework and the 2020 PRISMA guidelines. Literature was searched via PubMed, Scopus, Web of Science, and SAGE for studies from 2021 to 2026 that addressed the implementation of CBE by nurses or primary care providers among women in primary care settings. Qualitative, mixed-methods, observational, quasi-experimental, and randomized controlled trial designs were included. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 337 articles identified, eight studies met the inclusion criteria, three were of high quality and five were of moderate quality. Thematic synthesis yielded five themes, namely patient and family factors, healthcare provider competencies, primary care organization, referral and follow-up systems, and data recording and monitoring. Supporting factors included CBE training, integrated screening, patient education, data recording, and monitored referral systems. Major barriers included stigma, low awareness, staffing shortages, high workloads, poor referral communication, and incomplete follow-up. Nurse-led CBE has the potential to strengthen early detection of breast cancer in primary care. Its implementation requires clear care pathways, ongoing training, management support, consistent documentation, and monitored referral and follow-up systems. Findings should be interpreted with caution due to the limited number of studies and heterogeneity in study designs.