PONE-D-24-04284Availability and Geographic Access to Breast Cancer Pathology Services in GhanaPLOS ONE

Dear Dr. Sutherland,

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Academic Editor

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The study was supported by the University of Utah Center for Global Surgery through the Gardner & Holt Grant with no specific grant or award number. Additional funding included the National Cancer Institute (NCI) Grant # T32CA126607 (Price, M). We would also like to acknowledge the following persons and institutions for their immense contributions towards the success of the project: Dr. Alberta Biritwum-Nyarko and Mrs Irina Ofei both of the Ghana Health Services; the Director General of the Ghana Health Services, Dr. Patrick Kuma Aboagye; the Health Facilities Regulatory Agency, Ghana; the Ensign Global College; Dr. Moustafa Moustafa; Dr. Ousman Sanyang, Dr. Grace Ayensu-Danquah and Mr. Jonathan Nellermoe.

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Additional Editor Comments:

Congratulations to the Authors for a well written paper.

However, there are some few issues that require clarification.

Introduction - The authors laid a good background for the study and the rationale for the study was adequately explained.

Discussion - The authors made the claim that the concentration of pathologist in major referral centers facilitated efficient diagnostic services. Please justify this. Will a more equitable distribution of pathologist in-country rather lead to a more efficient diagnostic delivery system? Please clarify this further in your discussion.

With regards to the low reportage of ER/PR testing and Her-2/neu testing by health facilities, in spite of the availability of these tests at the referral centers, please clarify the following

1. Who were the respondents at the various health facilities?

2. Are these respondents health professionals with adequate knowledge/information on these tests and what they meant?

3. Will the knowledge or lack thereof of respondents influence the outcome obtained and could that be a possible limitation of your study?

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

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Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: 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 a cross-sectional survey of hospitals that assess pathology service- related parameters, including whether breast pathology was available on-site or via external referral, the number of pathology consultants and specialists, the availability of other diagnostic modealities including ER, PR and HER2 testing, and the time taken for the biopsy results to be ready.

The number of hospitals included (328 hospitals) and the duration (12 months) are ok for the data to be statistically of value.

The Geospatial mapping used to identify areas of limited access is informative and attractive.

The survey questions are adequate and clear.

The methodology in general is written orderly and with clear language.

Reviewer #2: The manuscript is well-written, and the data are clearly presented.

The conclusions of the study are clearly stated, and the discussion is comprehensive.

The authors may need to revise the manuscript for the very infrequent typo errors.

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Reviewer #1: Yes: Dalia Abd El-Kareem

Reviewer #2: Yes: Prof. Dr. Amal Abd El hafez

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Availability and Geographic Access to Breast Cancer Pathology Services in Ghana

PONE-D-24-04284R1

Dear Dr. Sutherland,

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.

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Kind regards,

Kekeli Kodjo Adanu, MB CHB, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Congratulations on this detailed and well written research on the availability of breast cancer pathology services in Ghana. This adds considerably to the scarce body of knowledge on the subject matter. Congratulations once again.

Reviewers' comments: