Review for 10.1186/1471-230X-14-22 (2014)

Reviewer's report
Title:Do high risk patients alter their lifestyle to reduce risk of colorectal cancer?
An observational study
Version: 1Date:4 October 2013
Reviewer: Larissa Fujii
Reviewer's report:
This manuscript discusses lifestyle modifications made by people with a family
history of CRC. It is an observational study that has the limitations nicely outlined
in the discussions section that reflect the biases associated with a survey.
Major Compulsory Revisions:
1) The lifestyle modifications are general modifications that are made to not only
decrease the risk of CRC, but also other more common diseases (heart disease).
Therefore, how can these lifestyle modificaitons only be attributed to the
perceived CRC risk? Therefore, discussion points like "most of our high-risk
population had adopted at least one healthy behavior because of thoughts about
CRC" is not a true cause-and-effect relationship based on just this survey results.
2) The significance of the lifestyle modifications made by this high risk group is
unknown as it could be similar in other patients (ex: general population) who may
not be at high risk (comparison data not provided). Were surveys on lifestyle
modifications also sent out to those without a family history of CRC to serve as a
comparison?
3) The significance of these lifestyle modifications also is unclear as the timing of
these modifications and follow-up findings on colonoscopies are not clarified in
this patient population.
4) Unclear significance and calculation of the odds ratio- how can it compare ALL
healthy lifestyles using 2 scales (1 scale for the answer to each question and 1
scale for level of lifestyle change)?
Minor Essential Revisions:
1) Grammar
2) Clarify what classifies as each level in the rating system of "not at all, a little,
somewhat, very much so." This is not a standardized scale so each person may
interpret this differently, affecting the reliability of the results.
3) Add an OR of incoprorating healthy lifestyle modifications based on the NZGG
category.
4) Sample size calculations- why was only 250 people sampled?
5) Were all of these patients undergoing routine surveillance or were some
colonoscopies performed for clinical symptoms such as bleeding or weight loss?
If patients were included due to the presence of symptoms, their level of anxiety
and rate of lifestyle changes would be affected.
6) Table 1 should not have the category "personal history of cancer" as these
patients were not included in the 148
7) Table 2 format is not ideal- the 7 cateogries within the GAD-7 score should be
under the global GAD-7 score and the number/percentages of each question are
not aligned.
Discretionary Revisions:
1) How were the patient's randomly selected?
2) How generalizable is the NZGG recommendations? Is it used commonly in
New Zealand or the outside countries?
3) How were 34 deemed ineligible?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests