Title: Impact of Same Day Screening Mammogram Results on Women’s Satisfaction and
Overall Breast Cancer Screening Experience - A Quality Improvement Survey Analysis
Version: 0 Date: 15 Feb 2022
Reviewer's report:
Impact of Same Day Screening Mammogram Results on Patient Satisfaction and Overall Breast
Cancer Screening Experience - A Quality Improvement Survey Analysis
Abstract: The background statement in the abstract states, “An increasing number of breast
cancer cases and associated mortality due to delayed diagnosis warrants improved methods to
provide a timely and convenient breast cancer screening experience.” Although the statement
about the burden of disease is true globally, this manuscript addresses countries where screening
mammography is common. Thus, the background statement should address the underlying
purpose of the study, which is measuring satisfaction with same day screening and interpretation.
In context, the background could emphasize the current situation, ie, “Most women undergoing
routine screening mammography do not receive results for [period of time], and for this some
approach results in stress, inconvenience, added costs, delayed diagnosis, and loss to followup,
et….”
Introduction: As noted above in my comments related to the abstract, the opening narrative
is not relevant to the topic under investigation, and the reader likely will wonder why global
comparison of breast cancer incidence and mortality with other cancers is presented. More
appropriate would be a statement of the mammography experience of tens of millions of women
in the US each year, involving (maybe, who knows?) over an average of 30 days between exam
and results, and we are approaching maybe a billion or more days of some level of collective
involvement in the annual screening and follow-up process. If the authors retain the description
of the global burden of disease, these figures need to be qualified as estimates in each instance.
As a descriptive adjective, if any rounding has taken place, “approximately” is appropriate
to the rounding, but the actual or rounded number also is an estimate. Second point, breast
cancer accounts for 6.9% of overall cancer mortality, not overall mortality, which would be the
contribution of breast cancer to all causes of death. The authors are correct that it is the leading
cause of death from cancer among women. Also, reference 1 was published in 2021, not 2020.
Regarding reference 2, it was published in 1992. After more than 30 years since that study was
conducted, it is reasonable to ask if these findings still apply. Probably. It also may be that
there just haven’t been any recent studies on factors associated with mammography adherence
in average US women, but I encourage the authors to add a more recent reference if one can
be found. Note that neither the Glockner (reference 2) nor the Gierisch (reference 3) citations
include a reference number.
Second paragraph in the introduction, first sentence, “have consistently….” not, “has
consistently…” Also, reference 4, Dibden, et al. is mis-cited as reference 2.
Third paragraph in the introduction, ACR & SBI breast cancer screening recommendations
should be reference 6, not references 3 and 4. Reference 5 probably should be deleted since
it relates the screening outcomes not factors associated with attending screening. References 6
and 7 pertain to U.S. guidelines, not global guidelines. Reference 8 by Ciatto, et al.  pertains to
reasons for non-adherence to mammography screening in 1992, not anxiety and depression in
the week before the appointment. There is a reference 9 Austin, et al) in the reference list that
is not cited in the paper. The description of the findings by Bull, et al. is not cited (reference
12), meaning references 10 and 11 are skipped. It is not clear that references 10 and 11 also are
from the early 1990s and may not be generalizable to the current circumstance of screening in
the US in the 2020s.
Note, at this point I am not going to check any further references for correct placement or
relevance. The authors are responsible for this and I suggest that proof their entire manuscript
for the placing and relevance of each reference.
In the analysis, the authors report that there was not a statistically significant difference in
improved screening experience, i.e., in the proportion of women who said that same day results
measurably improved their experience compared with receiving results later. The authors might
provide some greater context. In their facility, what is the average time between an exam and
when results are reported? Was there any delays due to the need to retrieve prior studies from
another location? How many women had to have additional views after the initial interpretation?
For women who reported no improvement in their experience or no advantage to same day results
vs. having results reported later, was there any attempt to understand why half of women saw
no advantage to same day results?  The finding is counterintuitive. For the women who reported
a worse experience, any idea why? It seems odd that women would agree to receive same day
results, and then regard the experience as worse. Note, it is not appropriate to state, “although
not statistically significant…..” and then state 48% of patients reported significantly improved
screening experience.” It would be acceptable to say an improved screening experience, but it
is either a significant difference or not.
Page 6, first sentence, instead of “early screening,” the authors might say “regular screening,”
or “adherence to screening recommendations.”
In the conclusion, the authors state that “Breast cancer screening is associated with significant
anxiety and distress.” This is not strictly true. Some women experience mild anxiety, but very
few women report significant anxiety and distress, and mostly it is short lived. Moreover,
although some European studies have reported that adverse experiences influence future
attendance, that has not been shown to be a significant influence in the US. There is no question
that there is value in improving the mammography experience, but it is not correct to state
that the mammography experience for most women is accompanied by significant anxiety and
distress. The authors should focus on the degree to which same day screening and receiving
results improves satisfaction, and overcomes the stress experienced by some women during the
time that elapses between screening and notification of results.