Reviewer ’s report  
Title: A LONGITUDINAL STUDY OF THE PR EVALENCE AND CHARACTERISTICS OF 
BREAST DISORDERS DETECTED BY CLI NICAL BREAST EXAMINATION DURING 
PREGNANCY AND SIX MONTHS POS TPARTUM IN IBA DAN, SOUTHWESTERN 
NIGERIA  
 
Version: 0 Date: 26 Jun 2018  
 
Reviewer: Iztok Taka č 
 
Reviewer's report:  
BMWH -D-18-00300  
"PATTERN OF BREAST DISORDERS DETECTED BY CLINICAL BREAST 
EXAMINATION AMONG PREGNANT AND LACTATING WOMEN IN IBADAN, 
SOUTHWESTERN NIGERIA - A LONGITUDINAL STUDY"  
 
General remarks  
The authors performed a longitudinal study of 1.248 pregnant women recruited i n their first 
trimester - till 26 weeks gestational age consecutively from selected antenatal clinics, in Ibadan, 
Southwest Nigeria. A pretested interviewer - administered  questionnaire was used to collect 
information on demographics and history of breast d isorders at recruitment. Clinical breast 
examination using MammaCare® technique was performed at recruitment and follow up visits at 
third trimester, six weeks postpartum and six months postpartum. Women with breast disorders 
were referred for breast ultra sound scan and those with Breast Imaging Reporting and Data 
System ≥4 had ultrasound guided biopsy. Mean age of participants was 29.7±5.2 years and mean 
gestational age at recruitment was 20.4±4.4 weeks. Seventy -two participants (5.8%) had a past 
history o f benign breast disorders and 345 (27.6%) were primigravidae. Overall, breast disorders 
were detected among 223 (17.9%) participants and 149 (11.9%) had it detected at baseline. 
Findings from the clinical breast examination showed that 211 (94.6%) were pal pable lumps or 
thickenings in the breast, 28 (12.6%) persistent pain, and 63 (28.3%) were abscesses, infection 
and mastitis. Twenty out of 127 (15.7%) participants who had breast ultrasound scan performed 
were classified as BIRADS ≥3. Lesions found were re active lymph nodes (42.5%), prominent 
ducts (27.1%), fibroadenoma (9.6%), breast cysts (3.8%) and fibrocystic changes (2.5%). No 
malignant pathology was found on ultrasound guided biopsy. Authors concluded that breast 
lump was a major breast disorder among  pregnant women attending antenatal clinics in Ibadan.  
Routine clinical breast examination and follow up of pregnant women found with breast 
disorders could facilitate early detection of pregnancy associated breast cancer in low resource 
settings.  
 
Author s acknowledged the major limitation of the study, which is in fact that about 40% of 
women referred for ultrasound scan have not showed up and that this may affect some of the 
findings of the study. Moreover, bias could arise also from different nurses wit h different level of 
experience in breast examination.  
Nevertheless the topic is very interesting and could serve as an important basis for further 
research.  
 
There are some corrections needed before the article is suitable for publication, which are 
mark ed in the attached document.  
 
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 which 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 manus cript or would you recommend an 
additional statistical review?  
If an a dditional statistical review is recommended, please speci fy 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:  
Needs some language corrections before being published  
Declaration of competing interes ts 
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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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holds or has applied for patents relating to the content of the manuscript?  
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