Reviewer ’s report  
 
Title: Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 
2004  and 2014  
 
Version: 0 Date: 13 Dec 2019  
 
Reviewer: Mario Jorge Sobreira da Silva  
 
Reviewer's report:  
 
The manuscript aimed to evaluate the geographical accessibility of breast cancer patients to 
treatment in hospitals in Brazil. Two periods (2004 and 2014) were compared in order to identify 
changes in health system that could contribute to improvements in cancer care. The text is well 
described and presented the problem clearly. The methodology was a dequate to objectives of 
study.  
However, some questions should be better explained by the authors:  
1. Considering that there was an increase in the number of hospitalizations, how many would be 
related to surgical treatment and how many to clinical treatm ent? This information could help to 
understand if breast cancer treatment is being improved (with an increase in the number of 
surgeries, for example) or if more complications of cancer treatment are occurring due to 
increased hospitalizations.  
2. What fac tors would be related to maintenance of regional disparities?  
3. What are the possibilities of overcoming regional disparities?  
4. The authors point out that Ordinance No. 2,239 / 2005 may have contributed to expansion of 
cancer patient care network. Howev er, they do not mention the Ordinance No. 874/2013, which 
established the National Policy for Cancer Prevention and Control (PNPCC) in Brazil. What are 
contributions of PNPCC to organization of care and access to cancer patients to their treatment?  
5. On p age 10 the authors refer to Figure C, which was not found in the manuscript.  
 
Other minor issues:  
1. At times the authors use the term Midwest and at others Central -West. It is important to 
standardize the term.  
2. In the background the authors refer to th e estimated increase in incidence and mortality in 
developing countries. But it is unclear whether the estimates are for all cancers or only for breast 
cancer.  
3. The authors discuss the delay of cancer treatment and its impacts. However, the data surveyed  
do not support the discussion about delayed cancer treatment.  
4. In Figure 1, there are words that have not been translated into English.  
5. The last line of Table 2 is above Figure 2.  
6. Figure 2 and Figure 3 are named as Figure 1.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not re levant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stock s or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing  interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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