PONE-D-19-25407

Cervical cancer screening rates before and after the Great East Japan Earthquake in Miyagi prefecture, Japan

PLOS ONE

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: No

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: No

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: PLOS ONE Sept 2019

Maybe have an editor copy edit for grammar.

Abstract: say earthquake was a magnitude 9.0 to show the seriousness of the disaster.

Intro: authors say screening rates are low in Japan compared to other countries. What are the prevalence rates of cervical cancer in Japan compared to other countries? What about HPV vaccine rates?

Why was it called the 3.11 earthquake?

What is the evidence to support this line: However, the people affected by the disaster are

61 still unstable, and cannot afford to take care of their health.

Why study cervical cancer and not the other women’s health conditions? Not well justified

Table 1 is not useful to a reader unfamiliar with the region. A map would be more useful.

Methods: Is the Miyagi Cancer Society a reputable resource? How do they get their data? Is it a government agency?

Results: Why only mobile van data included? Seems like a significant limitation. Where do most people get cervical cancer screenings in this region?

Better visualizations would make the data more meaningful (a map rather than a long table, perhaps). AH OK, I see maps at the end. I like the figures. But better to label the map with the region name and the bar charts with region names. The “T-3” labels are hard to follow.

Discussion: what were the results from the pregnancy studies? I still don’t know why cervical cancer was the focus here. No solid health or financial justification has been provided. OK page 19-21 are good. Maybe more of this justification or background should be in the introduction.

What was the population decline?

Overall it’s a decent paper. Though I am still unclear if the magnitude of change in screening is clinically meaningful. Can that point be proven? For example, saying that in Katrina the mean time to diagnosis was 7 years compared to 4 before Katrina – that is clinically meaningful. Could something similar be said here?

Reviewer #2: It may be more universally understandable if the magnitude of the earthquake is given in the abstract, i.e., after the Great East Japan Earthquake to put in the parentheses (magnitude 11.0); if the authors decide to leave 3.11 earthquake in the parentheses, they should put it in quotations "3.11" or indicate in some other way that this is a colloquial, synonymous term. The authors do explain this in line 53, however (but the abstract is often the first paragraph read in a manuscript). Elsewhere in the manuscript (line 53, 59), it may be more clear if the authors refer to the earthquake as the Great East Japan Earthquake instead of the 3.11 earthquake.

In the abstract, the sentence "It is possible that a decrease in CCS-R will lead to the detection in the advanced stages of cancer." may be incorrect? Did the authors want to suggest that a decrease in CCS-R may lead to less detection of advanced stages of cancer?

In the first sentence of the introduction (line 36), please state why this recommendation is important (otherwise this sentence seems abrupt as an opening to this manuscript).

The introduction does not flow well in terms of the verbage used. Lines 41-45 should flow and lead into each other.

Lines 55-57 use past and present tense terms. Instead of "may need 10 years for reconstruction" perhaps the authors may consider using "the tsunami-hit area was predicted to necessitate 10 years for reconstruction."

Please give a time course in lines 57-61. How long after the earthquake did the mobile van service resume screening?

Line 62: please cite this publication within the manuscript using a standardized method such as MLA format (i.e., "In a study describing survey results regarding reproductive health after the 2008 Wenchuan earthquake in China, Liu et al. reported......")

Lines 69-71 is too nebulous and general of a statement to make. The authors should add in that the failure of health management in the specific context of natural disasters (or whatever they feel it is specifically pertaining to).

Line 72: "Japan fiscal year (FY; April 1 to March 31) 2009–FY2016" should be simplified to set years (i.e., 2009-2016).

Table 1 is too complex and slightly unnecessary. Perhaps a small color coded index included as a legend in Figure 1 with the names of the prefectures would suffice (with consideration to take out Table 1 entirely; the prefectures can remain in Table 2 since it also provides pertinent information).

Line 93: instead of "people," should this be "females"? Why is the CCS-R pertaining to those 20 years old and over - if this is a screening protocol in Japan then please state that here.

It would be useful to get an idea about the numbers affected since -3.0% etc...(e.g., line 113, line 121) may be difficult to interpret meaningfully to the reader. The authors should consider detailing the population numbers in the text and delineating the axes on the graphs in all of the figures themselves (including the supplementary ones) for whatever they represent (i.e., year, population in thousands etc...) instead of in the figure legend.

The authors may consider not stating: "no significant difference was found" in line 170 since the p value was 0.6303. Likewise, in line 180 it is stated that there was a significant decrease in the coastal area compared with that in other areas however this is difficult to interpret without a regression analysis (and consideration of determining a p value).

Lines 196-200 are unclear in their message?

Lines 204-206: even though the authors could not identify causes, are there any that could be hypothesized based on data from previous similar studies?

I was not able to easily find the information for reference #23. Is New Orlando, USA a city that was described in this study?

Line 218: what stage is being referred to? Lines 219-221 should be considered being combined.

Why is this important for clinical outcomes? Is there any data regarding how many cervical cancers were missed as a result of delayed screening (either from the authors data set or from any of the references)?

Lines 235-236 contain repeated information which was just mentioned in lines 232-234.

Lines 239-242 need to be written with a more clear introduction or transition. Lines 241-242 are unclear.

Consider writing a separate conclusion since lines 244-248 do not transition in a clear way since the discussion prior to it pertains to smoking a mental stress.

The conclusive remark (line 246-248) is meaningful however there is lack of data to support this claim. The authors should consider including evidence from the literature supporting why design and construction of a comprehensive medical system etc... would be beneficial.

Reviewer #3: The study utilized appropriate statistics in analyzing data collected from relevant sources. The conclusions drawn and recommendations made were based on the results of the study. However, the following observations and comments addressed.

1. The cervical cancer screening rate for Japan should be stated for adequate comparison with other countries (lines 40-41).

2. Recast the sentence on lines 50 - 51 removing 'screening for cervical cancer screening' so the sentence reads 'All mobile van screenings are population-based'.

3. Replace 'as per' with a standard English word or phrase (line 65).

4. Replace 'i.e' with the appropriate words (line 97).

5. Lines 196 - 197: Report in the past.

References.

6. Cross-check if the following articles are single-paged articles: reference nos [3], [14], [21], [39]; and provide the complete pages where missing.

7. Provide the year of publication for no [5], and page numbers for no [27]. Also check the correctness of the page number for reference no [38].

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Golda Ekenedo Ph.D.

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

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PONE-D-19-25407R1

Cervical cancer screening rates before and after the Great East Japan Earthquake in Miyagi Prefecture, Japan

PLOS ONE

Dear Dr. Ito,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The reviewer #3 addressed some minor comments about your revised manuscript. Please check the manuscript carefully.

We would appreciate receiving your revised manuscript by Mar 27 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Kenji Hashimoto, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: No

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

Reviewer #3: Authors should make the following corrections:

Lines 39 - 40; the data source should be appropriately referenced by including it in the reference list and represented with the reference number in block parenthesis in the text.

Line 113; the appropriate phrase for i.e, is 'that is', not e.g.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: Yes: Golda O. Ekenedo

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

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Attachments

Attachment

Submitted filename: PONE-D-19-25407_R1 (1).pdf

Cervical cancer screening rates before and after the Great East Japan Earthquake in Miyagi Prefecture, Japan

PONE-D-19-25407R2

Dear Dr. Ito,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Kenji Hashimoto, PhD

Section Editor

PLOS ONE

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