PONE-D-21-10794

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city – lessons learned from the Amazon city of Manaus, Brazil

PLOS ONE

Dear Dr. Torres,

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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

Reviewer #4: Yes

Reviewer #5: 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: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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: This is an excellent study of an important health issue.

The authors had pointed out the important limitation of the study regarding the difficulty in ascertaining if some tests are actually repeated for the same women.

Overall, very well conducted and written study.

Reviewer #2: Dear Authors,

I liked the manuscript emphasizing the importance of vaccination, screening and post-diagnostic followup for cervical lesions. Your desciption of the the potential gaps and offer for possible solutions can reduce incidence and mortality related to cervical cancer. This is a well written manuscript.

Regards,

Reviewer #3: The paper presents very important issues related to the prevention of cervical cancer. The selected research area correlates with the epidemiology of cervical cancer. The authors presented detailed information on the population covered by preventive measures. Based on the analysis of the obtained data, they formulated adequate and realistic conclusions.

Reviewer #4: Torres et al. present a manuscript on the realities of cervical cancer prevention in Manaus, Brazil. The study is based on a combination of a variety of public health care records which mostly cannot be followed through on the individual level. The manuscript describes both vaccination coverage of adolescents and the current cytology-based screening program.

The manuscript is descriptive of the current situation without opportunity for extensive statistical analyses or comparisons, but it still is an interesting read. In general, the manuscript is well written, and the few statistical analyses are performed adequately.

I have only minor comments/suggestions:

- I would prefer to see the cytopathology labotory(ies) further depicted (page 4 line 90-91) in Material and Methods; cytopathology laboratories are also mentioned in the Discussion (page 16 line 324 and page 17 line 360) – is there one centralized laboratory or several? Likewise, the number of clinics providing colposcopy services would be interesting to know.

- page 5 line 100; It would be interesting to know the number of unsatisfactory screening cytology samples as this also can describe the quality of the screening system and, also, if this varies between areas (as does the proportion of HSIL+ cytology samples)

- Figure 2 is a bit hard to evaluate as the meaning of different colors is not provided (are different colors necessary?), some further explanation of the figure would be nice. Further discussion of the outliers, those exceeding 100% coverage, could also be of value in the discussion (as is partially for the Rural Zone already). The * on the x-axis definition is not explained anywhere.

Reviewer #5: It is an interesting manuscript focused on the real world cervical cancer screening strategy in a high prevalence low resource reality in Brazil. Data is well presented and argumented and in the discussion section the most important topics are pointed out and properly discussed.

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Reviewer #1: Yes: Nourah Al Qahtani

Reviewer #2: Yes: Funda Akpınar

Reviewer #3: No

Reviewer #4: No

Reviewer #5: Yes: Paolo Cristoforoni

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Attachments

Attachment

Submitted filename: Dear Editor.docx

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city – lessons learned from the Amazon city of Manaus, Brazil

PONE-D-21-10794R1

Dear Dr. Torres,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Luca Giannella

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #4: All comments have been addressed

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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 #4: Yes

**********

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

Reviewer #4: 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 #4: 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 #4: 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 #4: (No Response)

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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 #4: No