Review Reports

Round 1

Reviewer 1 Report

I think the authors have disadvantaged the data. Canada and BC in particular have very high rates of immigration/refugees. This will likely mitigate the reductions in cervical cancer diagnosed. 

Other studies in Ontario have documented high proportion of ICC have come from populations not born/native to Canada.

Not sure if the authors can get any such information from their data. For example if 30% of ICC comes from recent immigrants/refugees, one could not expect the decline in ICC to be as impressive as it should.

Author Response

Thank you for reviewing this manuscript and the thoughtful feedback. We agree with the reviewer’s comment; however immigration data was not available from the BC Cancer Registry. We recognize the importance of analyzing cervical cancer incidence trends by immigration status, particularly in BC, and have included this in the discussion on lines 216-219. If the reviewer wishes, we can include a comment on this in the limitations section.

Reviewer 2 Report

This manuscript focus on the incidence trends of invasive cervical cancer in British Columbia by age and stage-at-diagnosis, which is a meaningful topic to better understand the incidence of cervical cancer in British Columbia. While the statistics in this paper are only up to 2017, can the data of the following five years be supplemented? In addition, it is possible to supplement the HPV vaccine uptake rates by age and analyze the effect of the vaccine on cervical cancer incidence.

 

Author Response

Thank you for reviewing this manuscript and the thoughtful feedback.

Canadian cancer registries are 18-24 months behind real time. At the time the data request, which was during the pandemic, only data up to 2017 was being released. In addition, classification of cancer staging had changed in the 2018 diagnosis year from AJCC collaborative staging to AJCC TNM 8^th. Comparisons between the two staging systems are not consistent and therefore we decided to complete the whole paper’s analysis up to 2017 considering that the age- and stage-specific analyses were done to the end of the collaborative stage system.

In regards to the HPV vaccination uptake, this is a very important further analysis to conduct. However, the purpose of this paper was to describe age- and stage- specific trends in incidence and not necessarily focus on the impact of HPV vaccination on rates. We believe that this study contributes important findings to build upon such as investigating the impact of HPV vaccination on cervical cancer incidence rates, particularly the younger age groups where we will see the earliest effects. The impact of HPV immunization will likely not be evident in our results as school-based HPV immunization for girls was only implemented in 2008 in BC. The full impact of HPV vaccination on cervical cancer incidence will likely take decades to be evident.

Round 2

Reviewer 1 Report

could enter the immigration issue as a limitation, but not essential