Reviewer’s report
Title: 
Understanding Low Chemoprevention Uptake by Women at High Risk of Breast Cancer: Findings
from a Qualitative Inductive Study of Women’s Risk-Reduction Experiences
Version: 
2 
Date: 
14 Dec 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the
objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow confidence in
the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? If not,
can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
I congratule the authors for this important work. The study is well-conducted and well presented.
ADDITIONAL REQUESTS/SUGGESTIONS: 
This work very much helps in better understanding the low uptake of chemoprevention for breast cancer
from the women's perspective. Though very valuable, this manuscript should definitively benefit from
including the published findings regarding physicians views and prescription on breast cancer
chemopreventive drugs. These issues should be discussed and authors can figure out how to help in
formulate recommendations. It is noticeable that "Women who knew about chemoprevention but were
reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived
extremeness of the intervention, similarity to chemotherapy, unknown information about
chemoprevention, and reluctance to take medications in general". 
From this reviewer´s perspective these
concerns can be alleviated by well-informed and willing-to-prescribe physicians. Thus, authors are invited
to more in depth discuss references 21, 22, and other such as: Collins, et al. The Breast 2014. Assessing
and managing breast cancer risk: Clinicians' current practice and future needs. Keogh et al. The Breast
2019. Assessing and managing breast cancer risk: Clinicians' current practice and future needs. Smith et al.
Public Health Genomics 2016. 
Clinician-Reported Barriers to Implementing Breast Cancer
Chemoprevention in the UK: A Qualitative Investigation. Smith et al. Br J Gen Pract. 2017 
Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs'
attitudes, among others.
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Declaration of competing interests
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes