Title: Investigating the Trends of Incidence Rates of Breast Cancer in Southern Iran: A
Population Based Survey
Version: 1 Date: 25 Aug 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The manuscript's objective was to explore the trends in breast cancer
incidence rates within a city in southern Iran. It presented basic descriptive findings concerning
the overall incidence rate and its variations among certain subgroups. However, certain essential
aspects were not sufficiently elucidated, contributing to a lack of clarity in the results and
interpretation of these results.
REQUESTED REVISIONS:
1. Please present the descriptive characteristics of the subjects in Table 1, including details such
as age and sex distribution, cancer locations/subtypes, and other pertinent information.
2. It is recommended to include the population figures for each age group within the city as well
as global figures in the manuscript or supplementary materials for reference.
3. Consolidate the existing Tables 1 and 2 into a single table. In this table, furnish both the
raw and standardized incidence rates (computed using person-years) for each age group. Also,
indicate the specific time period in the table's title.
4. In addition to the trend visualizations, it is advisable to furnish precise numerical outcomes
regarding the annual incidence figures and rates (both raw and age-standardized) for both the
overall cases and subgroup categories. These numerical data should either be incorporated within
the manuscript or included as supplementary materials.
5. The rationale behind opting for a maximum of one joinpoint in each regression model remains
unclear. A comprehensive explanation for this choice should be provided. As I know, Joinpoint
Regression software can generate results for various joinpoint scenarios.
6. Clarify within the manuscript which measures the APCs correspond to. Specify whether they
pertain to age-standardized incidence rates, age-specific rates, or incidence numbers. While
Figures 1-3 indicate this distinction for age-standardized and age-specific incidence rates, this
specification is absent in Figures 4-7.
7. In Figure 7, it's observed that the APCs for both the overall and truncated trends exhibit a
consistent pattern between 2001 and 2018. However, the representation of non-linear lines with
ascending trends raises a question. Could you please provide clarification on this depiction?
8. I'm curious about the choice of conducting a descriptive analysis rather than an exploratory
one, especially considering the data's foundation in a registry. Exploration could encompass
various biological and clinical variables like age at first birth, lifestyle factors, BMI, parity,
menarche age, menopause age, lactation history, hormonal therapy, etc.
9. It is recommended to include a description of the socioeconomic characteristics of the city in
Iran under study. Additionally, addressing potential limitations and biases that may influence the
findings drawn from this specific city would be valuable to ensure a well-rounded interpretation
of the results.
ADDITIONAL REQUESTS/SUGGESTIONS:
I strongly recommend the authors to rewrite the manuscript according to The Strengthening the
Reporting of Observational Studies in Epidemiology (STROBE) Statement.