Title: Factors influencing U.S. women’s interest and preferences for breast cancer risk
communication: A cross-sectional study from a large tertiary care breast imaging center
Version: 3 Date: 23 May 2024
Reviewer:  Naomi Noguchi
Reviewer's report:
This is a cross-sectional survey to ask women’s preference about whether they want to know
their breast cancer risk and how they want to be communicated. 1119 women who are already
participating in screening in a tertiary care centre responded to the survey including some
underserved populations participating at no cost. Women expressed strong interest in knowing
their own risk and the majority preferred verbal communication. I think this is a very interesting
and useful study and would like to suggest adding what proportion of respondents wanted at
least one form of verbal communication.
Abstract
ORs from multivariable analyses should be presented as “adjusted OR”.
Background, first paragraph, the last sentence. “Risk-based approaches to breast cancer
screening have the potential to decrease harms (i.e., false-positive, overdiagnosis) associated
with current age-based approaches, by improving early cancer detection, leading to more
effective and less invasive treatments, ultimately improving survival rates and quality of
life.8-10”
It is true that risk-based approach will decrease false positives and overdiagnosis. But this is
achieved by identifying low-risk population who are screened in a less intensive manner. Not
by detecting cancers early.
I feel that this survey is related to how to communicate high-risk status. So this part can perhaps
focus on benefits of risk-based screening in high-risk women – e.g. “Risk-based approaches to
breast cancer screening may improve early cancer detection in high-risk women leading to ……”
Methods/Analysis, about the middle of the paragraph. “We examined differences in
sociodemographic, breast cancer risk factors, and mammography screening history by interest
in knowing one’s breast cancer risk estimate (interested vs. neutral/not interested) using Fisher’s
exact test.”
I think the authors examined differences in interest in knowing one’s breast cancer risk estimate
by sociodemographic factors, breast cancer risk factors and mammography screening history
rather than the opposite.
Methods/Data Collection/Preferred Mode of Risk Communication
Please add that women were allowed to select multiple options.
Results regarding preferred mode of risk communication
Face-to-face and phone were both selected by about half of the respondents. It would be useful
to know if it is correct that almost everyone wanted at least one mode of verbal communication.
If this is the case, the screening provider can make sure to arrange at least one meeting either
in-person or over the phone with each participant.
There might have been people who selected “referral to a high-risk breast centre” wanting to
chat in person with a specialist. This may also count as “verbal” supporting the importance of
having at least one opportunity for each participant to speak with a doctor.
I would like to know what proportions selected
• Either telephone or face-to-face,
• Either telephone or face-to-face or referral,
It would also be useful to know whether people who selected either letter or online also wanted
verbal communication.