Title: “I haven’t had that information, even though I think I’m really well-informed about most
things”: A qualitative focus group study on Australian women’s understanding and views of
potentially modifiable risk factors for breast cancer
Version: 1 Date: 21 Mar 2023
Reviewer:  Annie S. Anderson
Reviewer's report:
This is well conducted study and nicely written paper that reports womens knowledge about
breast cancer risk and their response to information about risk reduction.
Minor comments
Whilst it is nice to use a quote as a title, one that highlights the words breast cancer might be
more appropriate.
Age 40 is quite young to screen and not regular in Europe so it might be useful to comment on
this for international audiences. Is screening at this age offered to high risk women (e.g. through
family history clinics).
In the conclusion (and earlier) there is little mention of physical activity although alcohol and
obesity are mentioned
I am surprised that family history/genetics did not feature more strongly
Major comment
This work is very similar to research we have carried out in Scotland and I don’t feel says
anything new. There are now a number of past ongoing studies combining cancer prevention
with screening (both bowel and breast) and I think these should be referenced.
For example, the paper by Anderson et al in relation to colorectal screening as many similarities
Stead M, Eadie D, Caswell S, Craigie A, Anderson AS, the BeWEL team. Understanding the
potential and challenges of adenoma treatment as a prevention opportunity: insights from the
BeWEL formative study. Prev Med. 2012;54(1):97–103.
Further relevant papers re lifestyle and cancer prevention
Anderson AS, Craigie AM, Caswell S, Treweek S, Stead M, Macleod M, et al. The impact of a
body weight and physical activity weight loss intervention (BeWEL) initiated through a national
colorectal cancer screening programme. BMJ. 2014;348:g1823.
Anderson AS, Mackison D, Boath C, Steele RJC. Promoting changes in diet and physical activity
in breast and colorectal cancer screening settings- an unexplored opportunity for endorsing
healthy behaviours. Cancer Prev Res (Phila). 2013;6(3):165–72. 47.
Fisher B, Dowding D, Pickett KE, Fylan F. Health promotion at NHS breast cancer screening
clinics in the UK. Health Promot Int. 2007;22(2):137–45 Epub 2007 Jan 11. 49.
Fisher BA, Wilkinson L, Valencia A. Women's interest in a personal breast cancer risk
assessment and lifestyle advice at NHS mammography screening. J Public Health (Oxf).
2017;39(1):113–21. https://doi.org/10.1093/ pubmed/fdv211.
Sinclair JMA, Dutey-Magni PF, Anderson AS, Baird J, Barker ME, Cutress RI, et al. A
Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast
of Health): Development and Usability Study. JMIR Res Protoc. 2020;9(1):e14580. https://
doi.org/10.2196/14580 https://www. ncbi.nlm.nih.gov/pubmed/32012091.
Stevens C, Vrinten C, Smith SG, Waller J, Beeken RJ. Determinants of willingness to receive
healthy lifestyle advice in the context of cancer screening. Br J Cancer. 2018;119(2):251–7.
https://doi.org/10.1038/s41416-01 8-0160-4 Epub 2018 Jul 11.
Stevens C, Vrinten C, Smith SG, Waller J, Beeken RJ. Acceptability of receiving lifestyle
advice at cervical, breast and bowel cancer screening. Prev Med. 2019;120:19–25. https://
doi.org/10.1016/j.ypmed.2018.12.005 Epub 2018 Dec 19.
Knudsen MD, Hjartåker A, Robb KA, de Lange T, Hoff G, Berstad P. Improving
Cancer Preventive Behaviors: A Randomized Trial of Tailored Lifestyle Feedback in
Colorectal Cancer Screening. Cancer Epidemiol Biomark Prev. 2018;27(12):1442–9. https://
doi.org/10.1158/1055-9965.EPI-18- 0268 Epub 2018 Nov 2.
Having worked in this area (breast cancer and lifestyle) we have found that the challenge is
not engaging with women but gatekeeping by health care staff (who thinking screening is for
screening and are too busy to highlight anything else).
So I think a bit more of a review about this area would be useful and our paper
(Anderson AS, Chong HY, Craigie AM et al (2021) A novel approach to increasing community
capacity for weight management a volunteer-delivered programme (ActWELL) initiated within
breast screening clinics: a randomised controlled tria. International Journal of Behavioral
Nutrition and Physical Activity, 18(1), [34]. https://doi.org/10.1186/s12966-021-01099-7
On pages 9,10,11 re mammography setting should be discussed more detail.