Review for 10.1186/1471-230X-6-18 (2006)

Reviewer's report 
 Colorectal cancer screening awareness in Greece Title: 
 1  6 April 2006 Version: Date: 
 Marion R Nadel Reviewer: 
Reviewer's report: 
General 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
1. The authors should provide more information about the study sample. What was the sampling 
frame? The authors state (Page 3) that they surveyed a random sample of Hellenic primary care 
physicians, but they do not provide information on how the sample was selected. How representative 
of all primary care physicians are the survey respondents? The authors should discuss the low 
response rate (211/600 or 35%)) to the survey, the fact that trainees seem to be over-represented, and the likely effect on the results. 2. The authors report the percentages of respondents who recommend DRE for colorectal cancer 
screening. Since the 2 questions on the questionnaire asked about tests recommended during a 
general check up and about tests for cancer screening in general, how do the authors know that physicians are recommending DRE for colorectal cancer screening rather than for prostate cancer screening? If more specific follow-up questions were asked, they should be described. 
3. The discussion in the top paragraph on Page 7 is unclear, especially for readers not familiar with 
the Hellenic system. The authors should make their points more clearly. For example, what does “coping with the actual Hellenic primary care physician composition” mean? Or the rest of the paragraph beginning “the observed low screening recommendation rate among young physicians 
should not necessarily translate in a negative future…?” 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
1. In Table 2, in the Denis study, how can the percentage of physicians that recommend SOBT be 
greater than the percentage that recommends colorectal cancer screening practice? 
2. In the Discussion, the authors state that the colorectal cancer screening “implementation rate was 
not satisfactory in any of the European studies.” But in Table 2, the Ganry study found that 95% of 
physicians recommended colorectal cancer screening. 3. Page 2, Results: delete “the” before 25% on line 2 and before 48% on line 4. 
4. Page 4, Medical questionnaire: change “50 year” to “50 years” in 1st question. 
5. Page 5, Subgroups analysis and statistics, line 5: re-phrase “we considered null its prescription” 6. Page 5, Results: rephrase “addressed for” in the last sentence. 7. Page 6, Discussion, 2nd paragraph, line 2: Add “of” after “regardless” 
8. Page 6, Discussion, 2nd paragraph, last sentence: change “it’s” to “its” 
9. There is no reference to Table 1 in the text. 
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Discretionary Revisions (which the author can choose to ignore) 
1. Change title to “Colorectal cancer screening awareness among physicians in Greece” 
2. The Background includes the statement “Colorectal cancer screening is therefore strongly 
recommended. The authors should consider summarizing the recommendations, e.g., which tests are currently recommended for colorectal cancer screening? 3. It would be of interest to readers not familiar with the health care system in Greece to be told how 
screening operates in Greece (e.g., organized vs. opportunistic) and whether colorectal cancer 
screening is covered by a national health care system or by private health insurance. 4. Since the authors begin their paper by comparing European to U.S. cancer survival, they should consider adding a reference to colorectal cancer screening recommendations among U.S. 
physicians. Results of a national primary care provider survey conducted in the U.S. can be found in 
Klabunde et al. (A national survey of primary care physicians colorectal cancer screening 
recommendations and practices. Prev Med 2003; 36:352-362) 5. The study found that colorectal screening recommendations during usual check ups were 
markedly higher among specialists in general medicine than among other subgroups. Even though 
this result just missed being statistically significant (p=0.054), it is probably worthy of mention in the 
Abstract and perhaps the Discussion. 
6. In Table 1, N’s or confidence intervals should be included, in addition to the percentages. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.