Reviewer ’s report  
 
Title: Women's knowledge and attitudes towards cervical cancer prevent ion: A cross sectional 
study in Eastern Uganda  
 
Version: 1 Date: 11 May 2016  
 
Reviewer: Mari Nygård  
 
Reviewer's report:  
 
The study performed is clearly presented and described. it is very useful information which 
deserves to be published.  
The screening for cervical cancer targets asymptomatic women and aims to treat cancer 
precursors in order to abrupt disease progression from pre -invasive lesions to cancers. The 
presented data show that this aspect was not explored in depths.  Only very few questions asked 
allowed to separate the knowledge about screening only and there were ma ny questions asked 
about vaccination and early cervical cancer symptoms. The authors should reformulate the aim 
of the study, to make it coherent with the presented results, i.e. referring to "prevention" and not 
"screening". In the lines 86 -89:  
"…determi ne the women's knowledge and attitudes towards cervical cancer and screening as key 
precursors for utilization of cervical cancer screening services and the successful implementation 
of screening programmes..."  
 
There are several aspects which has to be co rrected, related to the context and and use of 
references.  
1) The very first sentence in  the Background (line 52 -53)  is outdated, for the ref 2, the  2nd 
edition of this report has been published by the WHO in 2014. Importantly, cervical cancer 
is no lo nger the second most common cancer worldwide. The authors might wish to refer to 
the "Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: 
GLOBOCAN 2008. Int J Cancer 2010;127(12):2893 -917."  
2) The authors should provide corr ect information regarding references 6 and 7: it is unclear 
what is meant and it is not possible to find these references.  
Consequently, the statement that cervical cancer incidence rate in Uganda was 42.7 cannot be 
confirmed, as in the ref  8 the given i ncidence rate is 45,6.  
 
3) Authors should correct either text or find correct reference for the following:  
Line 57 -58 
"Consequently, women with cervical cancer in this region are not identified until they are at an 
advanced stage of disease which is assoc iated with low survival rates"  
I agree with this statement, however, the Holowaty et al., is a paper which presents data for CIN 
progression NOT cancer survival. Please find a correct reference or modify your statement.  
 
4) Line 79. Ref 11 seems not to supp ort the statement "….sufficient knowledge about cervical 
cancer and screening programs increase acceptance, and uptake of available screening 
services .  
Consider to remove the Ref or replace the relevant.  
Regarding conclusion:  
Data presented do not supp ort the statement about relatively high knowledge about cervical 
cancer screening, as only 0,01% knew the frequency of screening (q 6) and 4.1% know the 
recommended screening age (q5) . The questions 5 and 6, were the only questions addressing 
knowledge sc reening only.  I would rather state that knowledge about screening was very low, 
while general awareness of cervical cancer was much higher and there was certainly positive 
attitude towards cervical cancer prevention. Answers to the q 4 and 5 in table 2 al so indicate that 
women don't have enough information how to act in order to reduce her risk to getting cancer. It 
might be that screening services are not available, or information about where to take a screening 
test, is not given to women.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work i nclude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript 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.  
 
I am able to assess the statistics  
 
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 stocks 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 receiv ed 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 i n 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' below  
 
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