DR. VICTOR MINICHIELLO
Journal Editorial Office
BioMed Central
Kaposvár, 05. September 2013
Dear Dr. Minichiello,
Response letter: MS: 1452038983949123 (KATALIN HIDEGHÉTY)
“First result of differentiated communication—to smokers and non-smokers—in order
to increase the voluntary participation rate in lung screening”
Thank you for the lector’s review of the manuscript. We have read the questions and
comments.
We appreciate the critical comments that could help us to make the manuscript more
understandable. We have revised the manuscript based on the comments. Below, we
would like to outline our responses.
We hope the answers for the specific questions and applied changes contribute to a
better understanding of the manuscript. For the better understanding we indexed the
reviewer’s comments and questions.
Rev. 2, Comment 1.
It would be necessary to summarize the Hungarian situation, regulation regarding
tumor screening programs, in particular actual approach to lung screening.
Response to Rev. 2, Comment 1.
Hungary has the highest rate of mortality due to cancer in Europe. A comparison
between Hungary’s cancer mortality data and the corresponding data of the rest of
Europe leads to the conclusion that Hungary leads the male mortality statistics in
smoking-related lung and oral cavity cancer.
Given the extremely unfavourable conditions in Hungary compared to other countries,
the government of the Republic of Hungary is determined to permanently reduce
malignant neoplastic diseases. It plans to do this through complex, coordinated societywide cooperation that includes all affected disciplines and addresses all involved groups
of people. Following recommendations of the World Health Organization’s (WHO)
National Cancer Control Programmes the Hungarian National Cancer Control
Programme was initiated.
Organized mass screenings. Performed within the framework of the healthcare system,
and financed from the public purse organised mass screening is a public health action.
Breast screening: Breast screening is performed bi-annually for women aged 45-65, and
consists of a mammogram and a physical examination of the breast.
Cervical screening: For several decades, Hungarian protocol has been to screen the 2565-year-old female population once a year.
Colorectal screening: Women and men of age 50-70 are targeted for this screening. The
test is performed every two years and seeks to determine if there is any hidden intestinal
bleeding, through the immunochemical analysis of faeces.
Ad hoc screenings. Oral cavity screening: Given the dramatic increase in mortality due
to cancers of the oral cavity, this is an urgent task.
Prostate gland screening: Demonstrating the presence of prostate-specific antigen
(PSA) and a palpation examination of the prostate gland through the rectum is an
appropriate manner of screening for prostate cancer.
Skin screening: International literature warns that the incidence of skin cancer is rising
continuously. To achieve the earliest possible diagnosis of skin cancer, symptom-free
persons aged 20-40 years should be screened by a dermatologist every three years and
people over the age of 40 years should be screened annually.
Lung screening: While once tuberculosis was the most feared respiratory disorder,
today its place has been taken by lung cancer. Throughout the world – including
Hungary – lung cancer is the number one cause of cancer death.
Testicle screening: Recommended annually, starting at the age of 18 years. (Source:
Hungarian National Cancer Control Programme. Budapest, 2006.)
Formerly the lung screening program was introduced in Hungary for screening
Tuberculosis (TB). Since the occurrence of the disease has decreased in the past decades
the meaning of the screening program has also changed. Instead of TB currently one of
the main aims of the program is to detect lung cancer.
The lung screening is performed using chest X-ray. The program provides opportunity
for the people aged over 40 years to take part in the screening annually. In this case all
arising expenses are covered by the Hungarian National Health Insurance Fund.
(see Question Nr. 6)
Rev. 2, Comment 2.
Why was the duration of the survey only 3 months, particular May, June, July, the
months of the highest working activity in the agriculture, which influence
remarkably the participation on any screening program (for example may explain
the higher rate of females (68.8%))?
Response to Rev. 2, Comment 2.
The time of the screening study was indifferent due to the fact that we questioned
individuals who appeared for lung screening anyway.
Rev. 2, Comment 3.
“The survey represents the adult population of Somogy County (n=170,000)
according to sex and age.”????
Response to Rev. 2, Comment 3.
Unfortunately it was a clerical error. The correct information: the survey represents the
adult population of Somogy County (n=170,000) according to age and place of
residence.
The preliminary study was worth conducting despite of the low participation rate.
Rev. 2, Comment 4.
I do not agree, that the 0.62% of the population of the concerned region can be
representative sample to draw relevant conclusion. It can be stated that this study
shows the preliminary results at the beginning of lung tumor screening.
Response to Rev. 2, Comment 4.
The study represents the preliminary results of comprehensive lung screening program.
Based on prior questionnaire surveys the number of participation seemed sufficient for
statistical analysis and defining conclusions.
Despite of the relatively small number of participants the statistical data show a
tendency that has been missing from the literature of medical communication and public
health.
Rev. 2, Comment 5.
What was the method of screening notification, screening campaign? A certain
number of the population of a defined region were invited via personal invitation
letter (perhaps attached to invitation for breast tumor screening – it can explain
the higher rate of females)?
What kind of other media and different type the of announcement were used?
The information which was provided and the method of spreading these
information has to be described in the manuscript in order to be able to evaluate
the role of the different tools and persons.
Response to Rev. 2, Comment 5.
In the first phase of our study we aimed to explore the background and underlying
causes of voluntary participation in lung screening. In order to achieve this we did not
use any mass media campaign or any means of notification.
Rev. 2, Comment 6.
“It is important that our study showed that higher proportion of smokers know
that participation is not free for everyone”
It is not understandable, please explain!
“and it is not outdated, less effective method”???
Response to Rev. 2, Comment 6.
As a supplement to our first answer we have to note that, people below 40 years of age
can only take part in lung screening (with chest X-ray) on their own expenses.
Higher proportion of smokers knows that participation in lung screening is not free for
everyone.
They also believe that the chest radiography is not outdated or less effective method in
lung screening.
Rev. 2, Comment 7.
The question that only 25.7% was smoker from the screening participants, should
be addressed.
Response to Rev. 2, Comment 7.
Participation in the study was voluntary, there was no influence for the smokers or nonsmokers to take part. Statistically ~ approximately 33% of the population of Somogy
County in this age group can be considered as smoker. The observed 25.7% is just
slightly lagging behind the official statistical data.
Rev. 2, Comment 8. Minor Essential Revisions
The questionnaire, which was used should be attached.
Response to Rev. 2, Comment 8.
We attach a copy of the original questionnaire in Hungarian.
Sincerely yours,
Prof. Imre Repa, MD
Mariann Moizs, MD