Reviewer ’s report  
 
Title: Pathological profiles and clinical management challenges of breast cancer emerging in 
young women in Indonesia: a ho spital -based study  
 
Version: 0 Date: 06 Sep 2018  
 
Reviewer: Sarah J. Nechuta  
 
Reviewer's report:  
 
This report describes a cohort of Indonesian breast cancer patients from one hospital.  Data is 
limited on breast cancer characteristics, treatment, and survival patterns among breast cancer 
patients from Indonesian, and this report could  help to fill a gap. However, some major and 
minor revisions must be considered.  The major revision is that the analysis should compare 
young breast cancer patients <40 to the rest of the cohort, to add substance and value to the 
analysis and results. Cur rently, the analysis focuses on breast cancer patients <40 years of age, 
with a small sample size of 144. Conducting the analysis stratified by age (<40, 40+) years will 
provide additional important data for Indonesian breast cancer patients in the cohort,  and enable 
improved understanding of how breast cancer characteristics and survival differ for younger and 
older patients in Indonesia.  Further, the tables should present the hazard ratios and 95% 
confidence intervals for the associations evaluated, incl uding adjusted hazard ratios to be able to 
determine the independent contribution of the factors of interest.  
 
Minor Revisions include:  
1. Abstract says "In addition, fertility concern, genetic risk, and psychosocial needs were not 
yet specifically addre ssed during the course of cancer treatment" but no data on this are 
presented in the results.  
 
Introduction:  
2. Remove the word "is" from second sentence of paragraph 2 of the introduction "….annual 
mortality is over 500,000".  
 
3. Need to provide denomina tor and clarify "500,000" and "55,000" and "20,000" are mortality 
rates.  
 
4. The use of abbreviation is inconsistent, need to introduce the first time the word is used, and 
use consistently thereafter. For example "YBCs" in the second sentence of the first 
paragraph.  
 
5. Add "median age at diagnosis is 48 years old" after "while in Indonesia, ….." in place of "it 
is younger (48 years -old)"  to improve the grammar of the sentence (last sentence of the first 
paragraph).  
 
6. Replace "which may have contribute t o delayed diagnosis of breast cancer" with "which 
may contribute to a delayed diagnosis of breast cancer" to fix grimmer issues (fifth sentence 
of paragraph 2).  
 
7. Insert "a" between "in" and "tertiary" in first sentence of last paragraph of introduction.   
 
Methods  
8. Fourth paragraph and first sentence, add timing for smoking assessment and fix one 
grammatical error "Smoked" instead of "smoke" and "in their lifetime" at the end of the 
sentence.  
 
9. Luminal A should have a + after Her2  
 
10. Spell out Her2 and FISH and IHC before abbreviating  
 
11. The sentence describing the physical activity assessment is very unclear and has poor 
grammar, please rewrite.  
 
12. Provide some information on the validity of measure of physical activity for t his cohort.  
 
13. "Parity was determined by…" add "number of" before full term pregnancy.  
 
14. First sentence of the statistical analysis section, add "the" after "carrying out".  Also replace 
"carrying out" with "conducting".  
 
15. PFS is mentioned withou t describing what this stands for.  
  
Results  
16. First sentence of second paragraph, "Around 7%.." add "of" before "patients".  
 
17. In the treatment choice section, replace "attended" with "received" when referencing 
chemotherapy.  
 
Discussion  
18. The Discu ssion has lots of grammatical errors and is poorly written. Needs to be revised to 
improve writing and reduce errors.  
 
Tables  
19. How was urban and rural defined.  
 
20. Each table needs a clear title that describes the population and setting and sample siz e.   
 
21. What is "mSBR grading", please add footnote to describe.   
 
22. Where are the hazard ratios and confidence intervals described in the text? There is space to 
include in the tables. These provide important information.   
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 contr ols 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 recomme nd 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 t he quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s 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 a ny 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 com peting 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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