Reviewer's report 
 Factors Related to the Practice of Breast Self Examination (BSE) and Pap Smear Screening Title: 
Among Malaysian Women Workers in Selected Electronics Factories 
Authors: 
Dr Heng Leng Chee ( hengleng@medic.upm.edu.my )
Rashidah Shuib ( rashidah@kb.usm.my )
Khadijah Shamsuddin ( khadijah@mail.hukm.ukm.my )
Intan Osman ( intan@usm.my )
 1  19 Feb 2003 Version: Date: 
 Anette Hjartåker Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
The paper is clearly written and easily accessible, but could benefit by some shortening, especially 
in the discussion. 
Discretionary revisions 
Abstract: 
Results: Please do not use the abbreviation IUD, but write the name in full. 
Introduction: 
Pg. 5 and 6: Please give incidence rates for breast cancer and cervical cancer in Malaysia. Please 
also give the number of new cervical cancer cases per year (as is already given for breast cancer). Pg. 6: The last sentence in the third section can be deleted ("Furthermore, it is difficult...) 
Methods: 
Pg. 8: The second sentence in the second section is unclear and needs to be rewritten ("The pre-test was carried ...). Pg. 8: Regarding the abbreviation IUD, please write the name in full the first time it is presented in 
the paper. 
Pg. 9: POR is not mentioned further in this paper either in the result section or in the discussion, and one may therefore question the relevance of mentioning it. 
Results: 
Pg. 9 and onwards: As all the percentages are given in the tables it is not necessary to give all of them in the text. Pg. 10: First sentence in second section: Write 53.0%. 
Pg. 12: Second sentence: for non-Malays an OR of 1.62 is given in the text, whereas in Table 5 the 
corresponding OR is 1.63. These figurers should be identical. 
Discussion: 
Pg. 12 and onwards: When comparing the prevalence of BSE with the prevalence found in other 
studies it is stated that figures are "lower", "higher" etc., while in fact the figures may not be 
significantly different. It would be better to avoid these terms, and rather rewrite the sentences. This 
goes for instance for the first section on pg. 14 where the figures really don't differ much. 
Pg. 16: Third section: do the authors have any thoughts regarding the different Pap smear pattern use in the present study and in the NHMS and the Singapore study? Any ideas about what the difference is due to? 
Pg. 17: Second section: please give some references to the statement starting with "Studies in other 
countries have also found....' Pg. 18: First section: the last part of the sentence is unclear and should be rewritten. Pg. 18: Last section: please emphasize what is the correct response to the knowledge question on 
BSE. 
On the whole: Please make sure that when referring to the same paper/study more than once this is 
done in such a way that the latter sentence may be understood and read independently of former 
referring. In some sentences it may for instance be better to use the term 'a study' than the term 'the 
study', or one may write 'the ... study mentioned before'. 
Tables: 
Table 1: It is not necessary to give n = 1720 more than once in the table. 
Table 2: Please include 'ever' in the variables on 'have done the examination', i.e. 'have ever done 
the examination' Table 5: Please clarify that the adjusted models consist of all the listed variables (included simultaneously). 
Compulsory revisions 
Abstract: 
Methods: Please indicate the response rate and how many women are included in the study. 
Methods: 
Pg. 7: How many factories were initially invited to participate in the study? Pg. 7: How many women were invited to participate and how many did? (i.e., the response rate) 
Results: 
Pg. 10: The application of the term 'contraceptive' does not seem to be strictly defined (e.g., first sentence of the page (includes all kinds of contraceptives) versus the last sentence of the page (oralcontraceptives and IUD only)). Please make sure that the term is unambiguously used. 
Pg. 11: The variable 'pregnancy status' is included in the chi-square analyses (Table 3), but not in 
the logistic models. Why is that? Pg. 11: Last section: is the statement "... was so small as to render the analysis too imprecise" based on a multivariate model where the marital status variable is included? If yes, this should be 
stated more clearly. If a multivariate model on Pap smear including marital status is not yet analysed 
this should be done. It will be of interest to compare a model including the martial status variable with 
an identical model but without this variable. Do the confidence intervals change considerably when 
the marital status variable is included? Based on the results discussed at pg. 16 and 17 it is very 
important to look into the impact of marital status. 
Pg. 11: Have the models been examined for effect modification (i.e., interactions)? If yes, please give the results, if no, this should be examined and the results presented. 
Discussion: 
On the whole: The response rate and how representative the women participating in the study are, need to be discussed. 
Tables: 
Table 5: Please clarify that the last category listed is the reference category (e.g., less or equal to 
years). 
Table 5: Regarding the Pap smear models: in the text (pg. 12) and in Table 3 it is stated that non-Malay women are more likely to take Pap smear test than Malay women. However, if the ethnicity variable in Table 5 is to be read as the other variables in the tables, i.e. using the last 
category as the reference category, the order of the categories seem to be mixed up. The same 
goes for the variable 'educational attainment'. The way the table stands now it says that Malay 
women have an OR of Pap smear of 1.90 compared to non-Malay women, and that women with 
upper secondary education or more have an OR of Pap smear of 1.51 compared to women with 
lower secondary education or less education. 
Competing interests: 
None declared.