Reviewer ’s report  
 
Title: Breast cancer in Iraq is associated with a unimodally distributed predominance of luminal 
type B over luminal type A surrogates from young to old age  
 
Version: 0 Date: 29 Oct 2016  
 
Reviewer: Ikechukwu Iloabachie  
 
Reviewer's report:  
 
This is an interesting paper and potentially useful one as it relates to adjuvant treatment of breast 
cancer. However I have the following comments.  
The paper can do with a review of the written English. In some areas the sentences were too long 
and had so many conjunctions that the meaning of the sentence was lost.  Short simple sentences 
may work better.  
It is not immediately clear from Table 4 how the classification into Luminal A and Luminal B 
tumors was done and why there is a discrepancy in the total number of ER+ tumors (both HER2 
positive and negative) and th e total number of Luminal A and Luminal B tumors. As this is the 
main theme of the paper, the classification into the luminal types and the basis for that should be 
clearly outlined in the results. I note that in a previous paper (the fifth reference in th e article) it 
had been published that ER+/PR+/HER2 - tumors are the most common subtype in Kurdish 
women and that the breast cancer in the middle East resembles that of the West. It would be 
interesting to point out what, if anything, has changed and the re ason for that.  
The need for poisson regression and logistic regression is not clear. The use of ASI as a 
dependent variable and year as an independent variable does not seem appropriate as the year 
does not contribute to the value of the ASI.  
The discus sion may be better started with the main findings of the study, especially one from 
which the title of the study was derived. There was no explanation offered for the difference in 
the pattern of the molecular subtypes between that in Iraq and the West. It  would have added 
more to the paper if the current thinking was mentioned. Could this be due to difference in life 
expectancy? It was also not mentioned what potential effect the observed pattern may have on 
management of patients.  
Are the methods appropriate and well described?  
If not, please spec ify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by t he data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, ple ase specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensi vely edited  
 
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