Title: Breast cancer screening motivation and behaviours of women aged over 75 years: A
scoping review
Version: 2 Date: 23 Dec 2023
Reviewer's report:
A great scoping review regarding breast screening motivation and behaviours of women >75
years. Its publication will add to the literature of breast screening for women >75 years, but there
are issues with clarity of methods and results that should be dealt with before publication.
Detailed comments:
Abstract:
- OVID is not a database.
- The databases in the abstract are not exactly same as the ones in search strategy.
Introduction:
- “Others have argued that decisions about continuing with screening mammography should
depend on individual patient risk and health management preferences”. Please add citation for
this statement.
-  “Although mammography may enable early detection of breast cancer, false-positive results
and overdiagnosis   may also result, with studies estimating that up to 25% of breast cancer
cases in the general population may be over diagnosed (25-27).” This sentence is unclear, please
reframe it.
- “The risk of being diagnosed with breast cancer increases with age and approximately 79%
of new cases of breast cancer in high-income countries are in women over the age of 50.”
It is more appropriate to use international statistics for high-income countries, such as data
from GLOBALCAN (or Cancer Today) rather than the statistics from a single country. Same
comment for the following sentence.
- Authors specified the background, knowledge gap and rational of this scoping review but did
not specify the aim/objectives.
Materials and methods:
- Eligibility criteria: Public and private services/settings were mentioned in both concept and
content, but no description or definition of these two services/settings was given in neither
section.
- Type of sources: “ This date was selected due to an evaluation undertaken for BreastScreen
Australia recommending expansion of the age group to include 70–74-year-old women (37).”
It seems like authors conducted this work for the evaluation for breast screening program in
Australia. In such case, it is worth mentioning this at the beginning of the work, such as in title,
introduction and aims to facilitate further reading.
- Search strategy: there was no date of performing such search.
- Table 1: S17: the limitation of time period (i.e. 2012-current) is different with the one in type
of sources (i.e. from 2009)
Results:
- “…using the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) flowchart (43). ” Authors has made clear for the flowchart and there is no need to
report it over and over again. This part of the sentence is redundant.
- “Data collection methods varied with quantitative methods being used most frequently (n=8),
and qualitative (n=5) and mixed methods (n=1) also used.” Minor grammar errors in this
sentence, like conjunctions. Please reframe.
- Table 2:
o “Journal name” does not provide any extra information – best to be removed.
o “Main outcome” is better to be placed before main findings.
o One extra column of “Theme” could be added to display which paper is under which theme/s.
- “In this same study, intentions to screen varied significantly (56)….. having a mammogram
previously impacted likelihood of ongoing screening.” This section wasn’t clear. Authors started
with “intensions” to screen (e.g. may participant in the future) and exampled 3 items correlated
with “attendance” at screening (e.g. already attended) rather than “intentions”, and then came
back to the “screening intention”/”likelihood or ongoing screening”.
- “...women with lower educational attainment were less likely to understand all the DA’s content
(46.3% vs 67.5%; P< .001); had less knowledge of the benefits and harms of mammography
(adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; p< .001); and were
less likely to have their screening intentions impacted (adjusted percentage, 11.4% vs 19.4%;
p= .01).” This section has no comparison group, assuming compared to women with higher
educational attainment?
Discussion:
- “These included no longer receiving an invitation to attend, transport difficulties and not
wanting to be a burden on relatives or friends (44, 50, 55).”: “no longer receiving an invitation
to attend” seems to under the rational of “choice or receipt of information”. It confused me that
why authors put it under “changes in individual circumstance”.