Title: A population-based cross-sectional study on the situation of cervical cancer screening in
Liaoning, China
Version: 0 Date: 16 Jan 2023
Reviewer's report:
Abbreviations should be opened, such as medical insurance, (MI, NCMS) also in the tables.
Introduction: Please, give more details on the NCCSP in China: How is screening organized,
what is the primary test, how do you get the test, does it involve costs for the woman and how
much, how are further diagnostics and treatment organized. Are any follow-up procedures in
place even regionally? Any data registration? Regional differences – have you any feeling for
those? Who does screening? Doctor, nurse, midwife? In rural – access? Non-married, is there
a stigma?
Material: How many individuals were invited to the survey originally and how many responded
to the invitation? After attending, the material was checked and some responses were not
included. This was described as the response rate, however, we would need to know how many
women were initially contacted for interview.
Screening rate is used in the manuscript when in fact the proportion of those screened (%) was
meant. The rate would be numbers/personyears of follow-up.
From results or questions in place: If the person was not screened at all, did you not ask why this
was the case? Was it too expensive, too difficult, humiliating, not available, not known? This
would be an interesting part of the study to improve further activities.
If the individual was willing to go for screening, what would be the factors that would help in
gaining this – i.e. the minimum requirements? Cheaper, easier, information or what?
Another interesting group were those women, who were not screened but who were willing to
do so? How do they differ from those who were screened? I think this kind of cross tabulation
would be of interest.
Are socioeconomic variables, such as income, education, occupation related? So those with
high education also have high income (and better occupation) and better possibilities to attend
screening both from the point of understanding the meaning and having the money and
availability for this.
Discussion:
You could also relate to Nordic countries, where there are long standing experience on screening
programmes on national level. Not only in Norway, but also Finland, Denmark and Sweden.
E.g. in many of these, the incidence of CC and mortality has decreased materially after the first
years of screening (see: Nordcan 2.0).
In the discussion there was a chapter on:
“Physical examination is considered to be the main way for women to get CC screening,
while people without work have no chance to get screening through physical examination by
occupational way.”
It remains, however, unclear what is meant by this. CC screening is done using a smear from
cervix, not any physical examination. You may mean, that when a person goes for a regular (?)
check up (physical examination?) there could be a cervical smear at the same time. However, this
is not necessarily the way to increase screening, as screening can be organized without any such
contact, directly having access to the cervical smear with proper analyses and getting the results.
Mispelled references? E.g. ref 22 ReSEarch on implementation of Ljaws and regulations of
female workers health care in China.
Some language editing would be of benefit even if most can be read with no difficulty.