Title: Breast cancer and microbiome: A systematic review highlighting challenges for clinical
translation
Version: 2 Date: 08 Dec 2024
Reviewer's report:
General Comments
The manuscript is a systematic review addressing the association between the microbiome and
breast cancer. The topic is relevant and timely, given the growing interest in microbiome research
and its potential translational applications in oncology. However, the manuscript suffers from
considerable heterogeneity in study methodologies and results, which the authors acknowledge,
limiting its impact. Suggestions for enhancing the paper’s clarity and scientific rigor are provided
below.
Specific Comments
1. Title and Abstract
Strengths: The title accurately reflects the content. The abstract is well-structured and
informative.
Suggestions: In the abstract, briefly mention the primary challenges identified (e.g., lack of
consistency, methodological heterogeneity) to provide a more comprehensive overview.
2. Introduction
Strengths: The introduction provides a clear rationale for the study, emphasizing the potential
clinical relevance of microbiome research in breast cancer.
Suggestions: The introduction could benefit from a more focused discussion of the gaps in the
current literature, such as the lack of standardization in data collection and analysis.
3. Methods
Strengths: The use of PRISMA guidelines enhances the reproducibility of the review. The search
strategy is comprehensive and well-documented.
Concerns:
The exclusion of non-English studies could introduce selection bias.
Lack of detail regarding how discrepancies between reviewers were resolved.
Suggestions: Provide examples of how conflicting reviewer judgments were reconciled.
Consider discussing the potential impact of excluding non-English studies.
4. Results
Strengths: The results are well-organized, with appropriate use of tables and figures to
summarize findings.
Concerns:
The narrative is occasionally repetitive, especially when discussing specific genera.
While heterogeneity is a key limitation, this aspect could be better quantified.
Suggestions:
Reduce redundancy in describing genera and their associations.
Include a summary table quantifying the degree of heterogeneity (e.g., I² statistics, where
possible).
5. Discussion
Strengths: The discussion provides a balanced interpretation of the findings, acknowledging
limitations.
Concerns:
Some recommendations for future research are overly general.
The role of potential confounders, such as diet and geography, is not deeply explored.
Suggestions: Expand on how confounding factors could be mitigated in future studies. Include
more actionable recommendations, such as specific standardization protocols.
6. References
Strengths: The references are recent and relevant.
Concerns: Some key studies (e.g., on standardization of microbiome analyses) appear to be
missing.
Suggestions: Incorporate more references on methodological standardization in microbiome
research.
Overall Assessment
The manuscript is a comprehensive review of the microbiome’s potential role in breast cancer. Its
strengths lie in its systematic approach and detailed synthesis of findings. However, significant
limitations in the reviewed studies (e.g., methodological heterogeneity, lack of raw data
availability) undermine the robustness of conclusions.
Recommendation: Major revision.
Priority Revisions:
Strengthen the discussion of methodological standardization.
Provide clearer recommendations for future research.
Address redundancy and streamline the results section.