Reviewer's report
Title:Epidemiology and outcome of cervical cancer in National Institute of
Oncology of Morocco
Version:7Date:17 August 2015
Reviewer: Alejandra Castanon
Reviewer's report:
Dear Editor,
I appreciate the opportunity to review the manuscript “Epidemiology and outcome
of cervical cancer in National Institute of Oncology of Morocco” by El Majjaoui et
al.
Major Compulsory Revisions
I found it difficult to assess the scientific validity of the study for the following
reasons:
1) As the manuscript stands there is not enough detail on the study design, nor
the cancer patients included in the study. In the discussion there is mention that
the study population from the Oncology institution comprises 37% of cancer
patients in Morocco. This needs to be discussed further in the methods. What
type of women is referred (or seen) at the institute, do they differ from other
women with cervical cancer in Morocco?
2) It was not clear whether the patients were consented into the study and then
followed up, i.e. was there study specific data collection forms including
questionnaires or was the data obtained from notes retrospectively?
As the manuscript stands it is hard to believe that the findings in the study
represent the cervical cancer picture in Morocco. The manuscript is very long
with a lot of information. It would seem to be that the strongest data is that on
prognostic factors for survival and the manuscript would benefit from focusing
solely on this issue.
Minor Essential Revisions are below:
The introduction would benefit from focusing on Morocco. In particular the first
paragraph in the discussion would fit nicely in the introduction and should be
removed from the discussion. The authors should say what is already known
about cervical cancer in Morocco and why this study is important/what it adds to
the literature. There should be mention of what screening is available, if any.
Currently this is mentioned in the conclusion only.
The authors should reduce their aims. As it stands there are too many and the
manuscript is too long as a result. The mesage is lost among the large amount of
data. The inclusion and exclusion criteria in the study is not clear, the same goes
for missing data. A similar flow chart as figure 2, but for the entire study would be
welcome.
More details are required in the methods of: study population, data sources and
definitions. For example why was the date of diagnosis or surgery used? Was the
date of diagnosis unknown for some women? How many? What is the definition
of “duration of evolution of symptoms”?
The results would benefit from being more focused. The text in the results
regarding Figure 1, does not correspond to what is displayed in Figure 1. In fact,
Figure 1 would be better if it was included in Table 1.
Discussion: would benefit from some structure. There is no mention of strengths
and limitations. There are results presented in the discussion which were not
mentioned in the result section. There are several comparisons to results from
other populations, but it is not clear that these populations are comparable to that
in Morocco. There are too many references in this manuscript. Most are not
needed and a few are very out of date and do not reflect current situation. For
example reference 21 is very old, new evidence from England suggests a
different cervical cancer picture. This reference could still be used in terms of
prognostic factors, but not for stage distribution.
Discretionary Revisions
Table 1: Needs a footnote to define “ND”. There are 96 women who presumably
did not disclose their marital status; they should be added to the table. Oral
contraception and genital infections should be removed as very few women
answered these questions and the information is therefore of little value.
Table 3: Should the title read “Findings upon clinical examination”? There is one
woman missing from “appearance of the tumor”. Under “state of the vagina –
invaded” there is an extra woman.
Level of interest: An article of limited interest
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.