Reviewer's report
Title:Factors associated with late stage at presentation among patients with
cervical cancer in Northwestern Tanzania.
Version:2Date:16 September 2015
Reviewer: Paolo Giorgi Rossi
Reviewer's report:
- Major Compulsory Revisions
Abstract
1) Methods: please describe how women were recruited.
2) Results: you can now give the 1-year survival rate of these women.
3) Conclusions: Please avoid the term “significant”
4) The first two sentences of the conclusion report the results again, this is not
useful in an abstract.
Background
5) Pag 3 line 51: please report the approximate number of cancers seen yearly at
BMC.
6) Pag 4 line 60: uremia is not the main cause for bad prognosis in late stage.
7) Pag 4 lines 61-65: this short presentation of the assessment tests needed for
cancer diagnosis end staging is not complete and not useful for your paper, I
suggest to drop it. You should exactly explain what you did in your study in the
methods.
8) Pag 5 line 82: I think this information is lacking not only for your hospital, but
for most of the west Africa.
9) Pag 5 lines 83-86: I think this sentence does not report exactly the aim of the
study, as expected at the end of the introduction. This is more adequate as a
rationale (introducing the aim) or as an introduction of the conclusions (I suggest
this second option).
Methods
10) Please specify if you included all the consecutive eligible cases in the period.
11) Not having a confirmed cancer is actually an exclusion criterion. All women
with suspected cancer are those asked to participate, but those without cancer
were excluded from the study.
12) Statistical analysis: I suggest to report only 95% CI where possible avoiding
the p-values.
Results
13) Please report the number of women who refused or cannot be recruited fro
any reason.
14) Pag 9 lines 158-159: this result has been reported in the previous paragraph.
15) Pag 10 lines 168-169: the sentence seems truncated.
Discussion
16) Pag 11 lines 189-90: you can make a fear comparison with the Morocco
study: the proportion of stage >=III is 45% in your study. Please make the
comment directly comparing the right numbers.
17) Some of the factors associated with late presentation in the univariate
analysis are strictly related with others and in some cases some are intermediate
factors. Not seeing a linkage after adjusting does not mean that there is not
causal link, for example not having self decision making could be an intermediate
factor of the marital status or of the educational level. This implies that both are
determinants but are on the same causal chain and cannot be evaluated in the
same multivariate model. The same for pre-referral visit and having an alternative
health practitioner. This aspect should be discussed.
Conclusions
18) They mostly repeat the results. I suggest to focus on how these results
should influence the policy makers, in particular it is interesting how to afford the
interference of alternative medicine in early diagnosis, not an easy issue!
- Discretionary Revisions
1) Please avoid some acronyms (for example BMC…)
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'