Reviewer ’s report  
 
Title: Determinants of breast cancer early detection for cues to expanded control and care: the 
lived experiences among women from western Kenya  
 
Version: 0 Date: 26 Sep 2016  
 
Reviewer: Satish Gopal  
 
Reviewer's report:  
 
Thank you for the opportunity to review this paper. This is a qualitative study evaluatin g 
knowledge, attitudes, and health seeking behavior toward breast cancer and screening among 
Kenyan women conducted through focus groups. Sampled women included urban vs rural, 
different ages, marital status, and education levels. The study found abundant misconceptions 
with some interesting urban -rural differences. Some comments for consideration by the authors 
are as follows:  
1. Including the interview guide as a supplemental file would be valuable to inform other 
similar studies in the region and assist  in the interpretation of these results.  
 
2. Were women asked about specific approaches to make breast cancer screening early 
detection more effective and accessible in their communities? The focus groups seemed to 
elicit fairly generic misconceptions lead ing the authors to make somewhat generic 
recommendations for improvement like addressing fear of diagnosis. Qualitative information 
of this type would ideally be most valuable if it can be used to formulate more specific 
recommendations which may be differ ent between the various subgroups of women assessed.  
 
3. It seemed somewhat surprising that urban women were more 'controlled by their husbands' 
vis a vis accessing breast cancer services than rural women. Were there differences in the 
interview that might  have preferentially elicited this information among urban women, or do 
the authors have another explanation in this cultural context? Would be useful to elaborate.  
 
4. Additionally, there seems to be widespread misunderstanding that HIV is linked to breast 
cancer. This is not true, and nearly all epidemiologic studies have shown null or negative 
associations between HIV and breast cancer. Do the authors have explanati ons for this? Was 
any corrective education undertaken?  
 
5. Opening sentence cites cancer as the 3rd highest cause of morbidity, but then cites proportion 
of deaths in parentheses. 'Morbidity' should probably be replaced with 'mortality'.  
 
6. I found the pa per overall too long, I believe exceeding 6000 words. I think for a scientific 
manuscript, these results can be presented much more efficiently, and I would try to shorten 
the manuscript insofar as possible with more organized and clearer structure, conclu sions, 
and key messages.  
 
7. How many interviewed women were working and had NHIF medical coverage? It seemed 
strange that covered public sector services were in place but so underutilized? Again, specific 
recommendations about how to improve utilization o f existing services in the discussion 
might be more valuable than more generic recommendations.  
 
8. I believe these were community women without much prior personal experience with breast 
cancer or screening? So when they describe fear after having a lump,  these are largely 
imagined experiences rather than historical accounts? Would be worth clarifying.  
 
9. Specific comments on the national representativeness of the women sampled would be useful 
to include.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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 speci fy 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  
  
Declara tion of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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