Reviewer ’s report  
Title: A LONGITUDINAL STUDY OF THE PR EVALENCE AND CHARACTERISTICS OF 
BREAST DISORDERS DETECTED BY CLI NICAL BREAST EXAMI NATION DURING 
PREGNANCY AND SIX MONTHS POS TPARTUM IN IBADAN, SOUTHWESTERN 
NIGERIA  
 
Version: 0 Date: 07 Jul 2018  
 
Reviewer: Jerilynn Prior  
 
Reviewer's report:  
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be in cluded in a text format.  
 
Major comment:  
You have created a large and extended observational study of breast abnormalities with the 
fundamental data from a clinical breast exam in the late first or early mid -trimester repeated in 
the third trimester, 6 wee ks post -partum and 6 months post -partum. It is currently unclear how 
many women were studied at each point, whether or not women were lactating, and some other 
important details.  
At the moment this research still lacks a primary objective and a research (a  priori) hypothesis.  
Specific necessary changes  
1. Provide a primary objective for this study —you only have a descriptive aim.  
2. Provide an a priori hypothesis for this research —I presume the goal was to prevent 
pregnancy -associated breast cancer.  
3. Please identify in some way (with a STARD figure or by showing the frequency of 
examinations in a bar graph) the number of repeated clinical breast examinations (CBE) 
experienced by each of the total number of participants. Also identify how many women 
were e liminated because of previous breast cancer.  
4. Add to these Keywords:  longitudinal, clinical breast examination, and post -partum.  
5. Please identify at each post -partum examination, the data on abnormal CBE findings by 
those women who were lactating and those who were not (unless almost all do in which 
case that should be in the demographics table).  
6. Please identify the proportion of and likely representativeness of the participating women 
compared with all the women in that city.  
7. The MammaCare metho d and programme need to be described and referenced for the 
reader—I found that there is an ancillary centre in Ibadan. Is this a for -profit programme? It 
seems very pro clinical breast examination at a time when most preventive task force 
recommendations feel that is it not useful.  
8. I would repeat within the methods that the study was approved by local ethics boards and 
that the women signed informed consent.  
9. Please add to Table 1 —height, weight, BMI and age at menarche  
10. Please identify that all o f the participants were of African heritage (of different tribes). Also 
in the discussion, identify the racial background of the women in each of the studies 
described since there may be racial differences in risks.  
11. In Table 1 is the "Family History of  Cancer" referring to breast cancer? Please specify.  
12. Would help a lot to know whether or not the breast lump was tender -would expect that to 
differentiate between the abscess, mastitis and things like cysts or lymph nodes  
13.  Please provide a frequenc y distribution graph of the number # of women with one 
abnormal CBE, two, three or four in the total number of women (n=?)  
14.  Please provide a frequency distribution graph of the % of women at each of the four 
measurement points that had an abnormal CBE —it is now not clear whether most of the 
abnormalities are repeated ones in a few of the women or more widely distributed across 
the whole of the participants.  
15.  Please describe how or if parity relates to the occurrence of clinical breast abnormalities.  
 
Minor changes needed   
1. Line 27—revision for singular/plural  
2. Line 29—please describe adult human females as "women" throughout the paper  
3. Line 74 please review —presently doesn't make sense  
4. Lines 86 -90+ please revise —incomplete sentence  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an a dditional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interes ts 
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the pu blication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
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