Reviewer’s report
Title: Perceived Barriers to Early Diagnosis of Breast Cancer in South and South Western
Ethiopia: a qualitative study
Version: 1 Date: 04 Oct 2019
Reviewer: Tam Truong Donnelly
Reviewer's report:
Abstract: 
This paper addresses an important women's health issue. Structured abstract is well written. 
Table:  Need to have tables report some general demographic data of participants (cancer patients and
health care providers)
Background: 
- This section needs to include more information. Authors should include information regarding breast
cancer incident and mortality rates in Ethiopia and Africa if statistic available. 
- As this manuscript is about early diagnosis of breast cancer, review of literature should include more
contextual information related to the current early detection of breast cancer in Ethiopia. It should
include information about the country's current breast cancer screening guidelines and public education
regarding both breast cancer and its screening. 
- If statistics available regarding Ethiopian women's breast cancer screening rates, please include it in
this section
Methods:
- Please  elaborate on the qualitative methodology.  What  is  the research  question(s)/ objective(s);
explain why exploratory qualitative study is a good fit for the study and a best way to answer the
study's research question(s). 
- Procedure needs elaboration on recruitment procedure. How were patients and HCPs made aware of
the study? How were they contacted and invited to participate in the study. 
- Please elaborate on the inclusion and exclusion criteria. 
- Ethical concern (issue related to coercion) regarding recruitment of patients.
- Were participants informed that participation is voluntary and that they can withdraw anytime without
repercussion? 
- Analysis section needs to elaborate on who performed data analysis and how the rigor of data analysis
was attained and maintained.
Results: Well written in some sections, few suggestions as follow.
- Socio-demographic characteristic needs more info and would be more effective to put it in a table.
- In section: Patient related barriers, did the author investigate patients' knowledge and awareness of
breast cancer screening as well? This is important to include because early detection of breast cancer is
directly related to awareness and practice of breast examinations. 
- The subheading "Health care provider related barriers" is misleading would it be more accurate to
change to "Health care provider's perception of related barriers"?
Discussion: 
-  It  would  be  very helpful  to  the  readers  and  health  care  providers  if  the  authors  give  specific
recommendations to address issues identified in the study's findings. 
Although some parts of the paper is well written, the paper needs editing.  
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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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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4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
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