Reviewer ’s report  
 
Title: The reporting and diagnosis of uterine fibroids in the UK:  an observational study  
 
Version: 0 Date: 12 Oct 2015  
 
Reviewer: Donna Baird  
 
Reviewer's report:  
 
Review, BMWH -D-15-00050:  The reporting and diagnosis of uterine fibroids in the UK:  an 
observational study.  
 
 
This is a topic of great relevance to women's  health.  Fibroids are prevalent, and documentation 
of incidence rates is very important.  The authors have taken advantage of a large primary care 
data base to assess the number of women found to be affected and the degree of under -diagnosis 
occurring. Th eir findings are important.  
 
 
1. Please describe in more detail the methods for review of free text (validation step 1).  
 
 
2. Table 1 is more clear than the text describing the results.  It would be helpful to have 
terminology for each process which is follo wed throughout the text and table.  For 
example:  The stepwise process for each group could be something like:  
 
"read codes" for initial identification of potential cases  
 
"free -text" for verification of read code info  
 
"PCP validation percents"  
 
"group -speci fic final estimates"  
 
"final combined estimate across groups"  
 
The following are a couple examples of my confusion in reading the text.   
 
 
a) the abstract states that "The overall incidence of UFs was 5.8 per 1000 woman years." 
But in the discussion it states  that "Based on the total estimated number of UF cases 
identified using Read codes, the incidence of UFs was 5.8 per 1000 woman years."  The 
latter is really the total number of cases validated from original read codes after 
combining data from the 4 study  groups, isn't it?  
 
b) The Figure 2 legend states that the graph is based on read codes for UF.  Is it really based 
on read codes that were validated by free -text analysis?  
 
 
 
3. Incidence rates will vary a lot by the age distribution of women in the study s ample.  The 
authors aim to "estimate the incidence of UFs in the UK general population," but the 
actual age distribution of their eligible sample will probably vary substantially from the 
age distribution of the UK.  Can the authors present their age distr ibution (frequency of 
women in each age group) and also the age distribution of women 15 -54 in the UK in 
order to help the reader evaluate the findings?  The age distribution also affects 
comparisons made with other studies.  Reference 19 includes no 15 -24 year olds, and this 
will increase their incidence estimates.  The study of active duty armed forces women will 
have almost no teenagers, but will also have a relatively low percentage of older 
reproductive aged women.   
 
 
 
4. Page 7:  the questionnaires that were sent out to PCPs for the hysterectomy, UPP, and 
HMB groups requested information about "whether the hysterectomy, UPP, or HMB was 
related to UFs."  This is a very subjective interpretation.  Ultrasounds and patholo gy will 
document whether fibroids were present, but whether they were related to the procedures 
or HMB is often difficult to tell.  Please provide exact wording of the question(s), for the 
information of the reader.  
 
 
 
5. The discussion needs to include a p aragraph on limitations of the study including that this 
study is designed to estimate the incidence of clinically -relevant fibroids and will not 
capture the true incidence of the condition because many women have fibroids that are 
not symptomatic or are n ever identified as a medical problem.  
 
 
 
 
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 requi red 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  
additio nal statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of  language in the manuscript:  
 
Needs some language corrections before being published  
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
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 for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial com peting 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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