Reviewer's report
Title:Mammographic breast density evaluation in infertile and in parous woman.
Version:1Date:27 October 2014
Reviewer: Virginia Lope
Reviewer's report:
This study evaluates mammographic density (MD) in in a group of infertile
women compared with a control group of women with at least one previous
pregnancy. Results show higher mammographic density among infertile women.
As this phenotype is one of the strongest known risk factors for breast cancer,
and it appears to be affected by less risk factors than breast cancer, studies
focused in this biomarker are of special interest. However this study can be
substantially improved:
Major Compulsory Revisions
You have used ordinal logistic regression to calculate the risk of being classified
in higher MD categories (using Boyd scale). Have you checked the proportional
odds asumption?. You must be caution with the OR interpretation.
You should review all the references
A new table could be included with OR, 95% CI and P-values of Boyd and
BIRADS scales and with categories of the confounding factors (BMI, age, family
history , previous use HCT and age at menarche) (one adjusting by the others)
In the abstract you should describe the results obtained by the multivariate
analyses (OR)
Minor Essential Revisions
ABSTRACT:
Methods: “a control group of 154 women who had AT LEAST one previous
pregnancy..)´
Results: 66.9% instead 62.2% and 53.6% instead 52.6% (if the tables are
correct..)
BACKGROUND:
References must by revised:
1. References 26 and 27 can not be behind cites 28-30
2. Cites 26 and 30 are duplicated
3. Cite 31 is not written by Vachon et al
4. There are more recent citations to describe the association between
mammographic density and breast cancer risk (cites 28-30)
You describe results of your previous study. It has been published? If so, you
should cite it
METHODS:
How many children on average had the control group?. Parity (or having a
greater number of children) has been inversely associated with MD in many
previous studies, so the difference in MD between cases and control depends
much on this factor. You should explain this.
Which was the result of the Cohen’s Kappa coefficient?
There was missing data in the confounding factors?. How do you dealed with
them?
RESULTS:
Line 206: 52% instead 33.8%
Line 218: P<0.05 instead P>0.05
Line 220: be caution with the interpretation: The OR of being in group E/F vs
being in lower categories (A-D) was 1.89. (i.e. women in the E/F group registered
a 89% increase in the odds of being in high MD categories)
TABLES:
Table 1: replace (years+ SD) by (mean + SD)
In family history of BC and previous use of HCT add the number of women (n, %)
Add total number of cases and controls to the table.
Table2: You should include the number of women
Data in table 2 and 3 could be presented in a single table.
DISCUSSION:
You should check the references: cites 25 (line 262), 34 and 35 (line 232 and line
269) are not related with the text.
Line 259: “the risk of dense breast is ALMOST twice….”
Last paragraph: have you observed if the risk of having high MD is greater
among infertile women with ovulatory dysfunction than among infertile women
sine cause? (in women with endometriosis you can not do it due to the low
number of women..)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests