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Background: Breast cancer is emerging as a leading cause of mortality among women and adolescent girls in Sub-Saharan Africa (SSA). However, there is a lack of clarity on the enablers and barriers associated with the implementation of preventive strategies, such as breast self-examination (BSE), particularly among adolescent girls., Objective: This paper presents a protocol for conducting a systematic review aiming to synthesise studies on the enablers and barriers to implementing BSE education programmes among adolescent girls in SSA., Methods and Analysis: The systematic review will be conducted from December 2024 to August 2025, following the predefined methodological framework outlined in the PRISMA guidelines. To gather relevant studies, a comprehensive search will be conducted across four main online databases, namely PubMed, Scopus, Cochrane Library and EMBASE, along with other relevant grey literature sources, such as Google Scholar, to identify pertinent literature on this topic. The screening process will involve an initial review of titles and abstracts to quickly identify relevant studies, followed by a thorough assessment of the full-text versions of selected studies. Two reviewers, working independently, will extract data and evaluate the risk of bias in the included studies using either the Joana Briggs Institute's Critical Appraisal tool or Cochrane's Risk of Bias tool V.2 (RoB 2). The focus of the included studies will be on BSE among adolescents aged 10 to 19 years of age. Depending on the results of the literature search and the characteristics of the findings in the selected studies, we will conduct a meta-analysis if possible. Alternatively, a narrative synthesis will be conducted. The review will provide empirical evidence to inform health promoters and policymakers in advocating for BSE, particularly, among adolescent girls in SSA, with the ultimate goal of mitigating the risk of breast cancer., Ethics and Dissemination: Since this study is based on the analysis of already published research articles, ethical approval is not required. The results will be disseminated through peer-reviewed academic publications and presentations, informing further research and practice regarding BSE education programmes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Regular breast screening is one of the most effective ways to detect early signs of breast cancer but travel distance to cancer-diagnostic facilities can affect breast screening attendance. Yet, limited studies have examined the impact of distance to cancer-diagnostic facilities on clinical breast screening behaviour among women in sub-Saharan Africa (SSA). This study examined the influence of travel distance to a health facility on clinical breast screening behaviour in five SSA countries: Namibia, Burkina Faso, Cote D'Ivoire, Kenya, and Lesotho. The study further assessed variations in clinical breast screening behaviour across diverse socio-demographic characteristics of women., Methods: A sample of 45,945 women was drawn from the most recent Demographic and Health Surveys (DHS) for the included countries. The DHS uses 2-stage stratified cluster sampling to select nationally representative samples of women (15-49) and men (15-64) via a cross-sectional design. Proportions and binary logistic regression were used to examine associations between the women's socio-demographic characteristics and breast screening attendance., Results: The overall proportion of survey participants who underwent clinical breast cancer screening was 16.3%. Travel distance to a health facility had a significant (p < 0.001) impact on clinical breast screening behaviour as 18.5% of participants who self-reported distance as "not a big problem" attended clinical breast screening compared to 10.8% who self-reported distance as "a big problem". The study further found that various socio-demographic factors were significantly associated with breast cancer screening uptake, including age, education level, media exposure, wealth status, parity, contraceptive use, health insurance coverage, and marital status. The multivariate analysis controlling for other factors confirmed the strong association between distance to health facilities and screening uptake., Conclusions: The study found that travel distance is a significant factor affecting clinical breast screening attendance among women in the selected SSA countries. Furthermore, the likelihood of breast screening attendance varied depending on different women's characteristics. It is crucial to prioritise breast screening interventions, particularly among the disadvantaged women identified in this study, to achieve maximum public health benefits., (© 2023. The Author(s).)