Reviewer’s report
Title: 
Cardiometabolic Risk Factors, Physical Activity, and Postmenopausal
Breast Cancer Mortality: Results from the Women’s Health Initiative
Version: 
0 
Date: 
05 Jun 2021
Reviewer's report:
Thank you for the opportunity to review this manuscript. I realize it is a brief
report and I agree that the findings are appropriate for a brief report format.
However, the text is missing precision with regard to population and exposures
that would be very helpful in making the report interpretable. Up until the
limitations paragraph in the conclusion I didn't understand the timeline of the
measurements (PA/MET syn components) pre/post diagnosis in these breast
cancer survivors. Given this information the hypothesis as stated doesn't seem to
capture the analysis done. "We hypothesized that women with breast cancer
having more metabolic syndrome components would be more likely to benefit
from higher physical activity levels in terms of breast cancer outcomes." Yet, the
met syndrome components and the PA are pre-diagnosis exposures (thus not yet
women with breast cancer). Further, "benefit from higher PA levels" indicates
some sort of intervention or change in PA levels between assessment of met
syndrome and breast cancer outcomes. Ultimately, the authors assessed mortality
outcomes in breast cancer survivors based on their pre-diagnosis health levels
(stratified by PA and met syn), and the rationale is that being physically active
prior to diagnosis would mediate/decrease the mortality risk associated with
metabolic syndrome. Even though there is a significant word limit for brief
reports, the manuscript needs an additional level of judicious review to improve
clarity of rationale, hypothesis, and perhaps integration of methods on what was
done (or consider a full length manuscript).
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Is the study design appropriate to answer the research question (including the use
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