Reviewer’s report
Title: 
Relationship of attitudes toward uncertainty and preventive health
behaviors with breast cancer screening participation
Version: 
1 
Date: 
09 Feb 2021
Reviewer's report:
Comments to the authors of:
Relationship of attitudes toward uncertainty and preventive health behaviors
with breast cancer screening participation
The authors have aimed to assess the possible sociodemographic and economic
determinants of participation in breast cancer screening with mammography in
Japan. This is an interesting and important article within the field of breast
cancer. The authors have taken the first revision suggestions into account and
answered/revised accordingly. However, a few comments are still necessary.
Main comments: 
The reader needs at an early stage to know about the economic implications for
the Japanese women, i.e. is mammography covered by medical insurance? What
proportion of women is not covered? What is the actual cost of a screen?
The reader also needs the annual incidence and mortality rate of breast cancer in
Japan (see below).
Background, paragraph 1: "the number who die of the disease is increasing;
14,653 per 100,000 population died of breast cancer in 2018 in Japan". This can
not be correct. It would mean that 14% of the total female population died from
BC every year! Japan has an approximate incidence rate of 142 per 100 000
women years (Sourcee: GLOBOCAN).
Minor comments:
Background, paragraph 2. Reporting on 5 year survival from breast cancer from
different populations is not optimal as these measures are greatly influenced by
leadtime bias due to screening programmes. Would it be possible to use
mortality rates instead?
Method, paragraph 1. What do the authors mean by referring to the cohort as
preliminary?
Discussion, page 13. The authors refer to the Comprehensive Survey of Living
Conditions in 2016. Is this survey of the same population, same area etc.? This
needs to be further explained.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
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