Reviewer's report
Title:Consistency of risk factors for inadequate cervical cancer screening among
immigrants from different regions of origin
Version: 1Date:7 February 2011
Reviewer: Marc Arbyn
Reviewer's report:
GENERAL COMMENTS
This is a thoroughly documented report on cervical cancer screening attendance
among immigrant women with focus on the social and demographic predictors for
non-screening. The authors used hard data, which according to the international
literature, reflect much better the real screening coverage in a country or region
than survey-based sources using self-reports or interviews.
Some minor comments follow below.
The title is too complex
“Predictors for low attendance at cervical cancer screening among immigrant
women in Ontario (Canada)” would read better.
ABSTRACT.
Background. 2nd sentence could be rephrased more simply. … for instance “to
determine how predictors of low attendance at cervical cancer screening
(socioeconomic, demographic, health care use) varied by region of origin.”
Methods: add ‘Poisson’ to multivariate models.
Last sentence: drop 1st “having”
INTRODUCTION
To place the study more in an international context, the authors could refer to
recent estimates of cervical cancer in the world (Arbyn 2011 Ann Oncol, in
press). They could discuss later in the manuscript whether women immigrant
from regions/countries with a large burden of cervical cancer are less screened
than those coming from regions with a smaller burden.
A few figures could be cited on the current screening coverage in Canada or
Ontario.
METHODS
Listing the covariates in a bulleted table format would read more easily than in
long sentences.
The annex with all countries of the world can be dropped. A reference (web link)
to the WB classification system is sufficient.
Screened ”adequately” could be understood as having had a satisfactory pap
smear. Screened recently of screened less than 3 y ago are better terms.
RESULTS
Table 1.
Abbreviations RUB, ADG, … should be clarified at bottom of the table
The 2nd line of the variable “years in Canada 10+ years” is redundant since
equal to 100%-value (<10ye).
Table 2
Replace “inadequate screening” by “without Pap smear in last 3 years”. This
should be changed throughout the whole paper.
Where significant or not significant are used a p value should be added.
Also in the tables, p values could be added or significant findings could be
indicated (for instance by an *).. The absolute values could be deleted.
Table 3.
The table title can be shortened substantially. The variables do not need listing
since already labelled sufficiently in the row headers.
DISCUSSION
The fact that administratively traceable data instead of self reported data were
used is indeed a strong point. The authors could provide arguments by referring
to reports systematic overestimation of screening attendance in self-reports (fi:
Arbyn et al Prev Med 2009: 48: 438-43; Montano, Am. J. Public Health 1995: 85,
795–800).
For the international reader it would be interesting to explain shortly the
mechanisms used in Canada (or Ontario in particular) to reach women in
general: centrally organized invitations (organized screening as in some
European countries), or the women’s personal initiative or initiative or the
initiative of their physicians (opportunistic screening) and how these systems
could be improved to reach socially vulnerable women and in particular,
immigrant women.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'