Reviewer ’s report  
 
Title: Factors associated with ce rvical cancer screening among young unmarried Japanese women:  
results from an internet -based survey  
 
Version: 0 Date: 25 Jan 2018  
 
Reviewer: Marie Oscarsson  
 
Reviewer's report:  
Factors that are correlated with cervical cancer screening among unmarried a nd active Japanese 
women aged 20 -29 years: results from an internet -based survey  
Comments to the Author  
Thank you for inviting me to review this paper. Overal I found it clear and well -written account of 
a carefully and executed study. The work is potentia lly important. For successful prevention of 
cervical cancer, participation and high coverage rates in cervical cancer screening is of great 
importance. The paper describes the situation in Japan and compare the results with other studies 
from Japan. For th e international readers a more globally perspective in background and discussion 
had been interesting. However, the conditions are different all over the world and it's difficult to 
include other contexts. In summarize, the manuscript has great potential t o be improved and 
contributing an important perspective in this complex area.  
 
General remarks: The paper is interesting but the international reader need to know more about the 
organisation and context of cervical cancer screening in Japan. The general  r ecommendation of 
cervical cancer screening in Japan and worldwide need to be added in background or discussed in 
relation to one life -time Pap smear.  
 
TITEL  
Page 1, line 1 -3. The title is long and detailed. It could be shortened.  
BACKGROUND  
Page 4, line 63 . Cervical cancer is common. Please note incidence and mortality rates in Japan  
Page 4, line 68 -69. The rate of cervical cancer screening is >80%, and in Japan 42,1%. Do you 
men coverage rate (a Pap smear the last 3 or five years) or one life -time Pap smea r? 
Page 4, line 71. Please describe the setting in Japan. The international reader don't get any 
information about cervical cancer screening program. Is there anyone? Pregnant women are 
offered a Pap smear test, but if women visit their health centrals? Wh o takes the Pap smear, male 
physicians, females physicians, nurses, midwives ? Who gets the free coupon from local 
government and what does that mean? Please describe recommendations from government, for 
example recommended age intervals for cervical cance r screening.  
Page 5, line 76. HPV vaccine has been effective in reducing prevalence of disease. The reader can 
perceive that cervical cancer rates have decreased. It will take decades to show a reduction in HPV -
associated cancers from introduction of the H PV vaccination. Nonetheless, early results from US 
have shown 64% decrease in 4vHPV type prevalence among females aged 14 to 19 years and 34% 
decrease among those aged 20 to 24 years  
Page 5, line 77. Due to severe side effects. There is no scientific evide nce please add unconfirmed 
side effects.  
 
METHODS  
Sample and datacollection  
Page 7, line 118 -119. The inclusioncriteria at stage one is unclear. Potential respondents? Aget?  
Page 8, line 141. Possessions of medical and health -related licenses. Once again , please describe 
the context in Japan.  
Page 8, line 143. Income. Could you please use also dollar.  
Page 9, line 156. You used a 5 -points Likert -type but only four alternatives for the factors logistical 
barriers and perceived susceptibility. Please desc ribe the fifth alternative.  
Page 9, line 160 -161. Could you please explain how the three levels low, middle or high were 
calculated? They were divided into three parts, you had three statsment, and you used a 5 -poits 
Likert -scale . How was the sum calculat ed? 
 
RESULTS  
General comments. The result could be shortened as there is text in the results that is repeated and 
also is described in the method part. For example page11, line189 -193. 
Page 25, line 17 -26. Background table 1. Please explain why the women were divided into these 
age-groups as they are not equal, 22 -23, 24 -27, 28 -29. 
 
DISCUSSION  
Page 14, line 237 -138. The explanation "Higher level of education and health consciousness in 
the investigated group". The reader needs to know the level of education in Japan and a reference 
to high health consciousness among young women in Japan.  
Page 15, 268. You suggest promotional campaigns. It's difficult to measure effects of campaign 
but ea rlier studies have shown that it is often women who already have a Pap smear who repeat 
the test. For this section it may be useful for you to take part of the Cochrane review  "Interventions 
targeted at women to encourage the uptake of cervical screening" .  
 
Reference: Everett T1, Bryant A, Griffin MF, Martin -Hirsch PP, Forbes CA, Jepson RG. 
Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database 
Syst Rev. 2011 May 11;(5):CD002834. doi: 10.1002/14651858.CD002834.pub 2. 
 
General comments: An eloge for the methodological considerations.  
 
Best regards and good luck!  
 
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, please specify which controls are required in your comments to the authors.  
Yes 
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 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, fund ing, 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 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?  
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