Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 14 Jul 2019  
 
Reviewer: Holger Schäffler  
Reviewer's report:  
The fecal occult blood test is an important screening method in order to detect colorectal cancer. 
However, its misuse plays an important role in daily clinical practice. Soin et al have shown in 
their manuscript in a retrospective analysis of 729 pati ents, that no FOBT was used in order to 
screen for CRC. They also showed that it was mainly used to test for anemia. Use of 
inappropriate medication prior to testing was frequent.  
 
Although this retrospective study is interesting, several questions arise:  
1) Which test was used - gFOBT or iFOBT? Which manufacturer? Which specific test? Since 
the manuscript is based on this screening method, this should be described more precisely.  
 
2) The most common  indication for FOBT was anemia. Can the authors give mo re information 
about the anemia - were they microcytotic? Was iron -deficiency found? Did they check for 
vitamin B12 / folate efficiency ?  
 
3) 259 patients had a positive FOBT, but only 73 underwent diagnostic colonoscopy - The 
authors do not comment on this  gap. Why did only 73 patients receive a colonoscopy? Why 
did the rest of the patients not receive colonoscopy?  
 
4) The figure legends are not giving enough informations and should  be extended.  
 
5) The authors state, that no FOBT was performed for CRC scre ening. In Table 5 and also in 
the text they distinguish between appropriate and inappropriate FOBT testing. This should be 
discussed more carefully .  
 
6) Table 4 shows the study population. How many patients between 50 and 75 had bleeding and 
were on anti platelet therapy / oral anticoagulants?  
  
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 co ntrols 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 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 publi shed 
 
Declaration 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, fun ding, 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 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  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 14 Jul 2019  
 
Reviewer: Holger Schäffler  
Reviewer's report:  
The fecal occult blood test is an important screening method in order to detect colorectal cancer. 
However, its misuse plays an important role in daily clinical practice. Soin et al have shown in 
their manuscript in a retrospective analysis of 729 pati ents, that no FOBT was used in order to 
screen for CRC. They also showed that it was mainly used to test for anemia. Use of 
inappropriate medication prior to testing was frequent.  
 
Although this retrospective study is interesting, several questions arise:  
1) Which test was used - gFOBT or iFOBT? Which manufacturer? Which specific test? Since 
the manuscript is based on this screening method, this should be described more precisely.  
 
2) The most common  indication for FOBT was anemia. Can the authors give mo re information 
about the anemia - were they microcytotic? Was iron -deficiency found? Did they check for 
vitamin B12 / folate efficiency ?  
 
3) 259 patients had a positive FOBT, but only 73 underwent diagnostic colonoscopy - The 
authors do not comment on this  gap. Why did only 73 patients receive a colonoscopy? Why 
did the rest of the patients not receive colonoscopy?  
 
4) The figure legends are not giving enough informations and should  be extended.  
 
5) The authors state, that no FOBT was performed for CRC scre ening. In Table 5 and also in 
the text they distinguish between appropriate and inappropriate FOBT testing. This should be 
discussed more carefully .  
 
6) Table 4 shows the study population. How many patients between 50 and 75 had bleeding and 
were on anti platelet therapy / oral anticoagulants?  
  
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 co ntrols 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 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 publi shed 
 
Declaration 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, fun ding, 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 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  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 14 Jul 2019  
 
Reviewer: Holger Schäffler  
Reviewer's report:  
The fecal occult blood test is an important screening method in order to detect colorectal cancer. 
However, its misuse plays an important role in daily clinical practice. Soin et al have shown in 
their manuscript in a retrospective analysis of 729 pati ents, that no FOBT was used in order to 
screen for CRC. They also showed that it was mainly used to test for anemia. Use of 
inappropriate medication prior to testing was frequent.  
 
Although this retrospective study is interesting, several questions arise:  
1) Which test was used - gFOBT or iFOBT? Which manufacturer? Which specific test? Since 
the manuscript is based on this screening method, this should be described more precisely.  
 
2) The most common  indication for FOBT was anemia. Can the authors give mo re information 
about the anemia - were they microcytotic? Was iron -deficiency found? Did they check for 
vitamin B12 / folate efficiency ?  
 
3) 259 patients had a positive FOBT, but only 73 underwent diagnostic colonoscopy - The 
authors do not comment on this  gap. Why did only 73 patients receive a colonoscopy? Why 
did the rest of the patients not receive colonoscopy?  
 
4) The figure legends are not giving enough informations and should  be extended.  
 
5) The authors state, that no FOBT was performed for CRC scre ening. In Table 5 and also in 
the text they distinguish between appropriate and inappropriate FOBT testing. This should be 
discussed more carefully .  
 
6) Table 4 shows the study population. How many patients between 50 and 75 had bleeding and 
were on anti platelet therapy / oral anticoagulants?  
  
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 co ntrols 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 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 publi shed 
 
Declaration 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, fun ding, 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 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  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant