PONE-D-25-31996Disparities and Trends of the Incidence and Mortality of Female-Specific Cancers in the United StatesPLOS ONE

Dear Dr. Li,

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PLOS ONE

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-DOI: 10.14309/ajg.0000000000003198

-https://doi.org/10.1016/j.eururo.2022.11.023

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 [This study was supported by the National Natural Science Foundation of China (grant 82202913 and 82372996) and the Natural Science Foundation of Chongqing (grant CSTB 2023 NSCQ-MSX0480).]. 

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4. In the online submission form, you indicated that [The data utilized in this study can be found in the Surveillance, Epidemiology, and End Results database Public-access SEER data (https://seer.cancer.gov/), National Center for Health Statistics (NCHS), and 2021 Global Burden of Disease (GBD) study (https://vizhub.healthdata.org/gbd-results/). Analytic code and any additional information required to reanalyze the data reported in this paper can be obtained from the corresponding author upon reasonable request, following the publication of this article.].

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Reviewers' comments:

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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

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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Reviewer #1: No

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: General Comments

This manuscript addresses a critically important topic concerning the racial, ethnic, and geographic disparities in incidence and mortality trends of six female-specific cancers in the United States. The authors utilize robust national databases (SEER and GBD) and appropriate statistical methods (Joinpoint regression, APC/AAPC) to evaluate temporal trends. The study is well-suited to inform health policy and cancer prevention strategies.

However, the manuscript requires substantial revisions to improve clarity, scientific rigor, and structure. Issues related to writing quality, data interpretation, and discussion of health disparities must be addressed before the paper is suitable for publication.

Specific Comments

1. Title and Abstract

•The abstract is dense with data and could overwhelm readers. Please prioritize key findings and move granular statistics to the results section.

•Clarify the study’s objective explicitly in the abstract.

•Language issues, such as “impacts on healthcare and economy,” should be revised for clarity (e.g., "healthcare systems and economic burden").

2. Introduction

•The background is informative but includes some redundancy. Streamline citations and focus on how this study fills gaps in existing literature. Also, use more current references.

•Define “disadvantaged populations” and consider referencing social determinants of health more explicitly to ground the disparities framework.

3. Methods

•Clarify statistical methods such as the Tiwari method and Joinpoint regression in plain terms for non-specialist readers.

•Ensure that all data sources and coding schemes (ICD-10, ICD-O-3) are clearly defined.

•The rationale for examining both long and short-term trends should be better justified.

4. Results

•The results section is overly technical and could benefit from subheadings and clearer narrative transitions (e.g., "Incidence by Race", "Mortality by State").

•Ensure all acronyms (e.g., AAPI, AIAN, AAPC) are defined at first use in each section.

•Avoid inconsistent reporting formats (e.g., confidence intervals vs. brackets vs. parentheses).

•Include visuals, such as maps or tables, referenced in the narrative for improved readability.

5. Discussion

•Expand the discussion on the root causes of disparities, including systemic inequities, access to screening and treatment, and socioeconomic factors.

•Avoid overstatements or causal implications. For instance, “urgent need” can be softened to “highlight the importance of...”

•Acknowledge the strengths of the study (e.g., large datasets, national scope).

6. Conclusion

•Strengthen the conclusion by offering specific recommendations or implications for policy, practice, or future research (e.g., expand HPV vaccination, improve Medicaid coverage).

•Emphasize the importance of equity-driven cancer control efforts.

7. Language and Style

•The manuscript would benefit from professional English editing to correct awkward phrasing, verb tense inconsistencies, and repetitive language.

•Suggested revision examples:

“Raised among AAPIs” → “Increased among Asian American and Pacific Islander populations”

“Had higher burdens” → “Experienced higher incidence and mortality rates”

Minor Issues

•Ensure that all figures and tables referenced (e.g., Table 4, Figures 1–4) are included and clearly labeled.

•Abbreviations should be consistent throughout (e.g., “FSCs” vs. “female-specific cancers”).

•Clarify any suppressed data points and include a rationale (e.g., <16 cases suppressed per SEER guidelines).

Summary

This study contributes significantly to the literature on cancer epidemiology and racial disparities in the U.S., but requires revision for clarity, completeness, and scientific precision. I recommend revision.

Reviewer #2: I've reviewed your manuscript, and I'm happy to report that it looks great! Here are some specific things that caught my attention:

- Your manuscript is technically sound, and the data presented support your conclusions. You've done a great job using high-quality population-based incidence and mortality data from reputable sources like SEER and GBD to investigate disparities and trends in female-specific cancers.

- Your study is a solid piece of scientific research that uses established databases and statistical analysis methods to get the job done. I appreciate that you've used Joinpoint Trend Analysis Software and the Tiwari method to estimate temporal trends and calculate rate ratios.

- Your statistical analysis looks rigorous and well-done. You've accounted for potential confounders and used standard epidemiological methods, which is great to see.

- Since you're using publicly available data from SEER and GBD, it's easy for readers to access the data underlying your findings. Kudos for transparency!

As for suggestions, I've got a few minor ones to help make your manuscript even stronger:

- Some of your sentences are a bit long and could be broken up for better readability. Consider taking a look at those to see where you can make some tweaks.

- Double-check your formatting and style throughout the manuscript to ensure consistency. It's a small thing, but it makes a big difference in the overall presentation.

- Your conclusion does a great job summarizing your main findings, but consider rephrasing some sentences to make them even clearer.

Overall, your manuscript is looking good, and with some minor revisions, it could be even stronger. Keep up the great work!

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Reviewer #1: Yes:  Adaiah Priscillia Soibi-Harry

Reviewer #2: Yes:  Dr. Adenekan Muisi Alli ( MBBS, MSC molecular genetics, FMCOG, FWACOG)

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Disparities and Trends of the Incidence and Mortality of Female-Specific Cancers in the United States

PONE-D-25-31996R1

Dear Dr. Li,

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,

Kehinde S. Okunade

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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Reviewers' comments: