Title: Recognition and comprehension of breast awareness among hospital staff: a questionnaire
survey using the explanatory leaflet in Japan
Version: 1 Date: 18 Jun 2024
Reviewer:  Francesca de Nard
Reviewer's report:
This paper delves into hospital personnel’s knowledge, attitudes and beliefs towards breast
awareness, and investigates the communicative effectiveness of a breast awareness information
leaflet.
The paper covers a relevant issue for breast cancer screening appropriateness: the gradual shift
towards a breast awareness paradigm from the well established breast self examination culture
and practice, among women and practitioners. The study was conducted using a questionnaire,
administered before and after reading the leaflet. The study was well conducted with a proper
methodology and is well-reported.
However, the paper could benefit from some minor revisions, particularly in the reporting.
Page 5, Participants: The choice of this particular hospital’s staff as a source for sampling
should be further justified, keeping in mind that the results can be extrapolated with caution to
other contexts. Was sample size calculated a priori, and if not, for what reasons? Did the target
participants receive only one notification, or also one ore more subsequent reminds?
Page 5, Questionnaire and leaflet: the previous study[15] received IRB (ethics committee)
approval. However, this one looks like a different study. Did this particular study receive IRB
approval?
Page 11: The process of development of the leaflet could be briefly explained, if not already
reported elsewhere. The leaflet, even in the English version, is very well written and easy to
understand. I think its development deserves more space.
Page 11, Statistical analysis: in the methods section, a qualitative analysis of free-text responses
is mentioned, but, later in the paper, the results of the analysis are not reported, except for the
preference for the paper leaflet (page 24). Did this analysis reveal something interesting?
Page 12, Results: Regarding sex distribution, 88,6% of respondents were female. Does this
proportion reflect the local proportion of female employes, or do the authors think there might
have been a selection bias? Was the response rate higher or lower for particular occupations/
age classes?
Page 16, Table 3: 36% of participants think that starting breast cancer screening from the age
of 30 is evidence based, 25% think that the starting age is 20. This finding is concerning. How
do the authors explain it? Why more than half of the hospital personnel that manages patients
on a daily basis is convinced that the screening starts before the recommended age, that is, in
a age range that is recommended against? Are there cultural/marketing reasons? Is the local
medical market prone to offer breast cancer screening procedures for women under 40 or are
there restrictions?
Page 24, Discussion: among the limits, I would mention that the comprehension of BA was self-
reported, and not measured with specific comprehension questionnaires.
Page 25, Declarations: ‘formal consent was not required’, while in page 11: ‘at the outset of the
questionnaire, consent was obtained’…
The process of obtaining IRB approval and participants’ consent should be better explained.