PONE-D-20-39250

Factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana

PLOS ONE

Dear Dr. Keetile,

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Academic Editor

PLOS ONE

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5.Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works, some of which you are an author.

- https://doi.org/10.1186/s12889-019-7405-x

- https://doi.org/10.1016/j.socscimed.2017.12.013

- https://doi.org/10.7314/APJCP.2015.16.15.6697

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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

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

Reviewer #1: I Don't Know

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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

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

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Reviewer #1: No

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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: The data seems to have been made to fit a pre-determined conclusion i.e. that socioeconomic inequalities will exist in screening outcomes. This is intuitive and expected. The paper can be strengthened by thinking through the structural inequalities that exist underlying these differences in screening practices. i.e why do women with lower socioeconomic means have lower screening uptake? What can be causing this difference? What is the availability of cancer screening services? Could it be that there is no facility within a certain geographical radius? The structures underlying the distribution of inequality for the populations examined is not explored well.

In essence, the finding that these differences exist are no surprise since this topic has been studied repeatedly in many different countries. What can add to the literature is an examination of WHAT is driving these in the context of Botswana. Some clear next steps can then also be derived which are currently missing from the paper. The authors draw on other literature to cite a lack of awareness or lack of health insurance. But these can be applied more directly to the data for more substantive next steps.

Would also advise the author to keep consistent with use of language. Terms commonly used in the literature are social disadvantage, and how the authors then use this term should be clearly defined. The authors use different language such as poor and wealthy intermixed with disadvantaged.

In the introduction the authors mention the 'problem'. This problem needs to be explained more clearly and tied to the paper more directly.

The authors mention that Pap smears can reduce cervical cancer incidence, this is factually incorrect as Pap smears promote early detection.

Typo with mammography which is abbreviated as HIC in the manuscript.

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Reviewer #1: No

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PONE-D-20-39250R1

Factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana

PLOS ONE

Dear Dr. Keetile,

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 submit your revised manuscript by Jul 29 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #1: (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 #1: Yes

**********

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

Reviewer #1: 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 #1: Yes

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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 #1: 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 #1: Thank you for addressing the previous comments. The context of the study is now better understood. I still have some concerns around the use of language specifically. Given that the paper is describing socioeconomic inequalities, and that there is an abundance of critical literature that has contextualised this phenomenon, the authors must situate their paper in this body of work – and therefore most of my comments are related to how the authors describe their findings and position their work.

1. Labelling women as poor and wealthy detracts from the conditions leading to socioeconomic inequalities. It is better to use terms such as women living in marginalizing conditions, or women living in poverty. The term ‘poor’ women is used through out the paper and really should be avoided as it a non-critical label that otherizes.

2. In the introduction, authors mention that inequalities are inevitable – however, much contextual understanding now exists around cancer screening and the cancer care continuum which demonstrates that inequalities are indeed avoidable, unjust and unfair and that with the correct allocation of resources these inequalities can be reduced.

Finally, in the discussion the authors mention that health insurance can reduce financial barriers to screening – however, earlier in the paper it is mentioned that cancer screening in Botswana is a public health program provided at no cost to citizens. Please explain.

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Reviewer #1: Yes: Ambreen Sayani

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Factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana

PONE-D-20-39250R2

Dear Dr. Keetile,

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Academic Editor

PLOS ONE