Peer Review History

Original SubmissionOctober 1, 2019
Decision Letter - Pirkko L. Härkönen, Editor

PONE-D-19-27493

Descriptive Epidemiology of breast and gynecological cancer among patients attending Saint Paul’s Hospital Millennium Medical College, Ethiopia

PLOS ONE

Dear Dr Haimanot Hailu,

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.

Please consider carefully the detailed comments of the reviewers and revise the presentation of the statistical analyses according to the comments and other suggestions of Reviewer 1. Please also consider the critical comments of Reviewer 2 concerning the patient material and  the prevention, mechanisms and clinical characteristics of breast and gynecological cancers and revise the manuscript accordingly  that the acceptance of the manuscript could be reconsidered.

We would appreciate receiving your revised manuscript by January 31, 2020. 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,

Pirkko L. Härkönen, M.D., Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1)

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2)

We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.  

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following:

  • The name of the colleague or the details of the professional service that edited your manuscript
  • A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)
  • A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

3)

We noticed minor instances of text overlap with the following previous publication(s), which need to be addressed:

https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21262

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1016/S0020-7292%2803%2900225-X

http://etd.aau.edu.et/bitstream/handle/123456789/8425/1.TEFERI%20ATAKILTI.pdf?sequence=1

The text that needs to be addressed involves the Introduction section.

In your revision please ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

4)

In the ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records used in your retrospective study. Specifically, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information.

[Note: HTML markup is below. Please do not edit.]

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: Yes

Reviewer #2: No

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

**********

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

**********

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: The manuscript has been review and found to have merit for publication. The authors should address the issues identified and re-submit:

Gynecological cancer in the title should read: "gynecological cancers" instead of cancer.

In figure 1, cervical cancer which has the highest frequency was omitted. Kindly add that of cervical cancer cases. Secondly the title for figure 1 is not appropriate as these measures presented are not prevalence but rather proportional morbidity of breast and gynecological cancers presenting at SPHMMC. Change the title of the figure and write the appropriate title for figure 1.

Figure 2, the line graph used for presentation is not appropriate. The author should used a multi-bar graph to show the age distribution since this is not a time trend but rather age distribution. The title should change to the age distribution of breast and gynecological cancers presenting at SPHMMC, 2014 - 2018

There is no table or figure to show the distribution of the cases by place. I suggest the authors show the distribution by place using a spot map or any other appropriate presentation.

The authors indicated that, by 2028, the numbers of new cases are expected to double from 2018, increasing from 554 new cases to 1141 new cases per year (Figure 4). However the calculation or model used to arrive at that is not shown in the methods or results. The authors should clearly show the methodology and assumption in arriving at that projected figure.

The authors also indicated in the last paragraph of the results that,the association between the number of new cases and time was marginally statistically significant (P=0.054). I suggest this statement should be deleted as the p-value of 0.054 is not significant and that statement add nothing relevant to the results.

Reviewer #2: 1. It helps the reviewer, if page and line numbers would be placed

2. Semoraphic patterns: As to Oroma and Amtiara regions, do the figures of lower numbers of cancer cases reflect the distance to the hospital or rather a lower population.

3. Time trends: does the increase of cancer cases mean a real increase of cases or possibly better diagnotics and inceased remittance.

4. Discussion: I do not understand, how the early marriage or bigger number of life birts explain the high nb of cases of cervical cancer. Cervical cancer is a sexually transmitted infection (HP-virus) which is almost always involved in the development of cervical cancer. The possibility for transmission depends on nb of ontercourses without condom, nb of partners etc.

5. I do not understand what environmental factors you mean.

Last page: "Breast cancer and gynecological cancers are largely preventable diseases..." Cases of breast cancer can largely be prevented with mastectomies (in those 5-10% of women who have hereditary BRCA1 or 2 genes). Cervical cancer can be prevented by rigorous use of condoms or a vaccination before initiation of coital activities. The other gynecological cancers can not be prevented, except by surgically removing the gyn organs. Instead, with good early diagnostics and adequate forms of therapies, the number of deaths due to cancers can be prevented.

**********

6. 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 #1: Yes: Kofi Nyarko

Reviewer #2: No

[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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 1

We thank the reviewers for their valuable comments. The point by point response to reviewers is attached.

Attachments
Attachment
Submitted filename: Response to reviewers.docx
Decision Letter - Pirkko L. Härkönen, Editor

PONE-D-19-27493R1

Descriptive Epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College, Ethiopia

PLOS ONE

Dear Dr Haimanot Hailu,

Thank you for submitting your revised manuscript to PLOS ONE. The revised version addresses most of the points raised during the review process in an acceptable way. However, I would like to point out one concern and question  (point 5) raised by Reviewer 2.

The comment concerned one sentence in the "Conclusions" part: "Breast and gynecological cancers are largely preventable diseases".  The reviewer wanted to get this sentence justified and offered explanations. Although your reply is generally acceptable, it did not make the sentence more clear. Although breast cancer is generally considered to be largely influenced by the environmental factors, diet, life style, reproductive history etc,, there are no specific means to prevent the disease at the individual level. The same is true in case of ovarian cancer and other gynecological cancers. On the contrary, cervical cancer, besides the mode of sexual behaviour, can be be prevented to a great extent by vaccination. Therefore I would ask you to reconsider this sentence and to specify how and to which extent breast cancer and other gynecological cancers can be prevented.

We would appreciate receiving your revised manuscript by March 9, 2020. 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,

Pirkko L. Härkönen, M.D., Ph.D.

Academic Editor

PLOS ONE

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 2

Response: Thank you for your comment, its well understood. We have reconsidered and restated the sentence as follows. “General, nonspecific prevention mechanisms including change in life styles and early screening would help to minimize risk of majority of breast and gynecological cancers. However, specific measures like mastectomy may prevent breast cancer while cervical cancer can be prevented with safe sexual practices and vaccination.”

Attachments
Attachment
Submitted filename: Response to reviewers.docx
Decision Letter - Pirkko L. Härkönen, Editor

Descriptive Epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College, Ethiopia

PONE-D-19-27493R2

Dear Dr. Hailu,

We are pleased to inform you that your manuscript revised as reported 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.

Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

With kind regards,

Pirkko L. Härkönen, M.D., Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Pirkko L. Härkönen, Editor

PONE-D-19-27493R2

Descriptive Epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College, Ethiopia

Dear Dr. Hailu:

I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

For any other questions or concerns, please email plosone@plos.org.

Thank you for submitting your work to PLOS ONE.

With kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Pirkko L. Härkönen

Academic Editor

PLOS ONE

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .