Title: Clinical Outcomes of Screening and Diagnostic Mammography in a Limited Resource
Healthcare System
Version: 2 Date: 05 Dec 2023
Reviewer:  Khawlah Ammar
Reviewer's report:
Clinical Outcomes of Screening and Diagnostic Mammography in a Limited Resource
Healthcare System
Article Summary:
This is retrospective study of women referred to MM unit at tertiary hospital in Jordan, it
compares clinical outcomes between screening and diagnostic group.
Comments:
Abstract:
I would like if you can clarify that this study aims to compare clinical manifestations between
screening and diagnostic group.
Keywords:
Add screening recall rate
Introduction:
Very informative within the scope of the research, with very suitable length, but it would be
better if the researcher can add any numbers related either to the Arab or Middle East countries.
Materials and methods:
Is the included cases are the whole referred females or not?
You mentioned sex in the variable, I suppose the sample are all females right? So you can remove
it from the variables.
Would you please confirm the BMI was calculated at the time of MM and how? Did you measure
height and the weight or just consider women responses?
Regarding the included women, I suggest to exclude the patients who had previous history of
cancer
In the 4th paragraph, there is extra bracket,
Results:
Women were classified into screening group (n=634; 63%) and diagnostic group (n=371; 37%);
P=0.02. This p value reflects what? What is the contingency table that was used to calculate it?
The age range of participants was between 29 and 89 years, with women in the diagnostic group
being younger than the screening group, significantly younger or just younger? You may report
P value here.
The men age of menarche was 13.6, Typo error Mean
When talking about screening group, the total of the BIRADs group is not equal 634, the total
included they are 606 only which mean there is more 28 not mentioned.
Can you add more details on which BIRAD groups were considered for recall?
When talking about diagnostic group, Total of the mentioned numbers is 345 and not 371 as
indicated earlier in the manuscript
Discussion: as the researcher indicated that the cancer detection rate was 19/1000 can you add
any number from other countries for the comparison purposes –If available-
Recommendation:
This study would be much informative and highlights the importance of screening when talking
about treatment burden and outcomes, what I suggest is to compare tumor size and disease stages
between the cases from both groups (screening and diagnostic) in addition to compare treatment
outcome,
I recommend also adding the time frame for each participant to complete their investigations.
Tables:
In table 1, characteristics, the total of the diagnostic group is not equal 371, I suggest adding a
raw below each variable and fill it with the total.
For example when talking about smokers; the diagnostic group No; 427, Yes: 117 and unknown:
90 the total is 634, for the screening 229 and 89 and 35 the total is 353 and not 371, please check
all numbers there is discrepancy.
You can include table 2 and table 5 in one table, and P values can be calculated to measure
differences.
In table 2, add N for each group, you added it only for (core breast biopsy results N=43) I suggest
add it to all domains.
In table 2 you mentioned BIRAD 0 only with no more details in the manuscript why they still
have tis results did they miss the follow up or they were not communicated to be informed about
MM reports?
Table 3; you can add results of the screened women too in the same way
Table 4; you need to highlight the total number is higher than participants number, 371, as the
can select more than one symptom. Moreover I like the descending order so you can easily find
the most reported symptom and the least reported symptom
Comments to the editors:
This is an important article and reporting the findings very important to decision makers in
Jordan so I highly encourage the research team to work on upgrading this manuscript looking
to publish it, and I will be more than happy to follow up on the submitted comments with the
research team aiming to publish this manuscript.