Reviewer’s report
Title: Cultural Beliefs about Breast Cancer in Vietnamese Women
Version: 0 Date: 21 May 2018
Reviewer: Thach Tran
Reviewer's report:
This is an important and interesting topic. This study documents the extent to which women in rural  
Vietnam holding cultural beliefs related to breast cancer and examines the factors associating with  
those beliefs. I have few concerns and comments.
1.Aims of the study. The authors stated the aims of this study are 'to identify cultural beliefs  
associated with later-stage detection of breast cancer'. However, the beliefs this study examined  
not  only relate  to  detection  but  also  treatment.  This  study aimed  to  'identify factors  that  
influence those cultural beliefs'. Study design is a cross-sectional survey that is not able to  
identify the causal relationships.
2.Overall, the authors use 'cultural beliefs' and 'misconceptions' interchangeably and interpret  
'cultural  beliefs'  as  'misconceptions'.  In  general,  I  think  not  all  cultural  beliefs  are  
misconceptions. Did this study look at 'cultural beliefs' or misconceptions? 
3.Background. Need a reference for 'Breast cancer was involved in about 2.4 million cancer cases  
in 2015,…';
4.Probably the National Cancer Control Program (NCCP) has not been introduced in response to  
this increasing incidence of breast cancer only. The authors should rephrase that sentence.
5.Methods. I was wondering if the sample size had been calculated, if yes, please include in the  
manuscript.
6.The names and general demographic characteristics of the study sites should be provided.
7.The sentence 'Our final analysis included 289 women, excluding 37 subjects with insufficient  
responses' should be in the Results section.
8.The recruitment strategies used are convenient methods. The authors should discuss how it  
would affect the findings.  
9.'Cultural beliefs' is the main outcome in this study. How did the authors culturally verify and  
adapt the tool measuring the outcome? The tool was developed and used not in Asian countries.  
How was 'God' translated into Vietnamese?
10.Data analysis: what regression analysis did the author perform? What scale of the outcome was  
used? In Table 4, there are two coefficients for each independent variable. The interpretation  
'Women with misconceptions about breast cancer due to cultural beliefs were more likely to be  
40 years of age or below and lower income' likes the results from a logistic regression. 
11.T-tests and ANOV A were used, did the authors check if the distribution of the outcome is  
approximately normal? The distribution of the outcome should be provided.
12.Results. 'Nearly 80% of the subjects had graduated from secondary school at minimum'. Please  
compare that to the national number to show how representative your sample is. 
13.Table 2. M, SD, T F should be spelled out in the footnotes of the table. Why the cut-off VND  
2,650,000 was used? It is higher than the national poverty line.
14.In the first paragraph in page 13, p=0.06 is interpreted as being significant. 
15.The results in Table 3 should be adjusted for other characteristics (e.g. income and education).
16.Table 4. B, SE, , t, P should be spelled out. What statistical methods were used in this table   
should be noted under the table. The title 'Socio-demographic Variables Influencing Cultural  
Beliefs' makes the readers confused in the interpretation of the table. 'Influencing Cultural  
Beliefs' means number of cultural beliefs or the likelihood of having any cultural belief.
17.Discussion. This section should be restructured. Some information should be moved to the  
Introduction like the discussion on the effects of cultural factors on health. All implications  
should be grouped in one section before the Conclusion. It needs a section on the strengths and  
limitations of this study. The authors need to acknowledge any limitations of this study and  
discuss how it would affect the internal and external validity of the findings.
18.When taking all strengths and limitations into account, what is the level of generalisability of  
this study?
19.The authors should have more discussion on the Vietnamese culture when interpret the findings  
(e.g. the differences in cultural beliefs between age groups).
20.Not only 'statistical significance' but also 'clinical significance' should be taken into account  
when interpret the findings.
21.'this study shows that the younger age group in low income had greater misconceptions about  
breast cancer than the older age group'. No finding shows the comparison between 'younger age  
group in low income' and 'the older age group'. That sentence should be re-written. Does  
'greater misconceptions' means larger in the number of misconceptions? 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  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:
Acceptable
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