Review for 10.1186/1471-230X-7-39 (2007)

Reviewer's report
Title:Adherence to Colorectal Cancer Screening Guidelines in Canada
Version: 1Date:25 June 2007
Reviewer: Grazia Grazzini
Reviewer's report:
General
-------------------------------------------------------------------------------
Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
The Authors should explain better the modalities of selecting population in the
study design. They wrote that the CRC screening module was optional and
administered to about 40,000 individuals living in different health regions, but it’s
not clear whether in the study population there were also non respondents. Given
that subjects who completed questionnaires are usually more likely to attend
screening procedures, it’s very important to understand if the sample study is
really representative of whole population.
The Authors should therefore describe the features of population who filled the
CRC questionnaire in comparison to the whole population. If an important
difference would emerge from this comparison, the Authors should evaluate it in
the discussion
-------------------------------------------------------------------------------
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
-------------------------------------------------------------------------------
Discretionary Revisions (which the author can choose to ignore)
The study is interesting and I agree with the Authors about their conclusions, but
it should be more emphasized the concept that only an organized screening
program can reduce disparities in screening uptake.
Moreover, in this study adherence to FOBT screening guidelines was associated
with male sex, like in other studies cited by the Authors. In fact, several studies
(1, 2,3) showed an opposite trend concerning gender differences in screening
utilization. Women were more likely to receive faecal occult blood test screening
and less likely to receive invasive tests for screening than men, as emerging also
in a recent study (not cited by Authors) from Canada (4). The Authors should
comment on this aspect in the discussion.
1. Wardle J et al Gender differences in utilization of colorectal cancer screening J
Med Screen 2005;12:20–27
2. Persistent Demographic Differences in Colorectal Cancer Screening Utilization
despite Medicare Reimbursement BMC Gastroenterology 2005, 5:10
3. Seeff LC, Nadel MR, Klabunde CN, et al. Patterns and predictors of colorectal
cancer test use in the adult U.S. population. Cancer 2004;100:2093 – 103
4. McGregor SE et al. Low Uptake of Colorectal Cancer Screening 3 Yr After
Release of National Recommendations for Screening. Am J Gastroenterol
2007;102:1–9
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests