Reviewer's report 
 Trends in Complementary/Alternative Medicine Use by Breast Cancer Survivors: Comparing Survey Title: 
Data from 1998 and 2005 
 1  29 November 2006 Version: Date: 
 Eileen Rakovitch Reviewer: 
Reviewer's report: 
General 
This is a descriptive study describing the use of CAM therapies among a random sample of women diagnosed with breast cancer. The findings corroborate other reports in the literature that CAM use is frequent among women with breast cancer. This study aims to compare the types of CAMs used among 
women diagnosed in 1998 to women surveyed in 2005. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
One major concern is in regards to the selection of the cohort that was surveyed. The investigators note 
that a random sample of women diagnosed with breast cancer was obtained from the Ontario Cancer Registry. 
1. How many women were sampled from the OCR? How was this determined? 
2. The surveys were sent in 1998 and 2005 yet the women surveyed were not diagnosed in the same years? It is noted in the manuscript that the women surveyed in 2005 were diagnosed in 2001 and 2003. 
The years of diagnosis for the subset surveyed in 1998 are not noted. Why weren't the surveys sent to 
women diagnosed in 1998 and 2005 respectively? 
3. page 7. Characteristics of CAM useres versus non-users. This paragraph is confusing and may be 
misleading. The logisitic regression did not identify any factors associated with CAM use. The finding that 
CAM users were more likely to have had chemotherapy etc is confounded by year. Women surveyed in 
2005 were more likely to have had chemotherapy, hormonal therapy, have higher education and use CAM. Therefore these differences are due to the impact of time rather than descriptive features of women who use CAM. Either this paragraph should be removed or the results of the logisitic regression should be 
included in the manuscript. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
1. page 6, line 3. The authors refer the reader to obtain additional information from a reference by Zick et al that is not published. 2. Page 8, 9. The author suggests that their findings indicate that CAM use has become the norm and that 
>10% of all women with breast cancer use green tea and/or special diets. The limitations of this study 
include recall bias (as noted by the investigators) as well as selection bias, since physicians may not have agreed to allow ill patients or patients with emotional difficulties to participate in this study. Therefore, the sample surveyed may not be representative of the population of women with breast cancer. These 
statements should be modified. 
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Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.