Reviewer ’s report  
 
Title: The reporting and diagnosis of uterine fibroids in the UK: an observational study  
 
Version: 0 Date: 02 Oct 2015  
 
Reviewer: Patricia Moorman  
 
Reviewer's report:  
 
This manuscript describes the accuracy and validity of using data from a primary care database 
in the United Kingdom, The Health Improvement Network, to assess the incidence of uterine 
fibroids.  Because l arge databases are increasingly used for medical research, it is important to 
have a good understanding of the quality of the data, particularly for a condition like uterine 
fibroids where multiple codes may be used in the medical record to describe the co ndition or its 
symptoms.  Overall the paper was well -written, the data are clearly presented and the 
interpretation of the findings is generally sound.   
 
 
 
Minor Essential Revisions:  
 
1. It would be useful to have a description of how information from ref errals to specialists, 
especially gynecologists, would be incorporated into the database.  Were referrals to 
gynecologists that resulted in a fibroid diagnosis captured in this database?  This 
comment is also relevant to the point made in lines 213 -215 in the discussion, where the 
authors note that primary care providers were more likely to record symptoms or 
procedures rather than a diagnosis.  If it is the gynecologist, rather than the primary care 
provider, who does the ultrasonography to confirm a diagn osis of fibroids, it seems 
perfectly reasonable that symptom codes predominated at the primary care level.  
 
 
2. The authors should discuss the possible bias that may have resulted from the incomplete 
response when questionnaires were sent to primary care p roviders to confirm diagnoses.  
The authors based their estimates of incident cases on the proportion of cases validated 
by questionnaire responses.  If many or all of the non -responders to the questionnaire 
were non -cases, the confirmation rates could hav e been considerably lower.  Further 
consideration of this possible bias would be useful, including possibly doing sensitivity 
analyses in which the investigators assume first that all non -responder questionnaires 
would have confirmed the diagnosis and then  that all of them would have not confirmed 
the diagnosis.  
 
 
 
 
 
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 whic h 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 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  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
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 publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 com peting 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.  
 
I agree to the open peer review policy of the journal. I understand that my name will be includ ed 
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as  confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal