The Breast Cancer Screening and Timing of Breast MRI—Experience in a Genetic High-Risk Screening Clinic in a Comprehensive Cancer Center

Round 1

Reviewer 1 Report

Dear authors, 

Your manuscript is good.

The study is interesting taking in consideration that many surgeons around the world perform bilateral prophylactic mastectomy for patients with gene mutations. 

My main concern is that you have less than 20 references. You should compare your results with some relevant manuscripts from literature in the discussion part. Moreover, you should highlight 2-3 conclusions.  

Author Response

Response to Reviewer 1:

 

Thank you for the comments!

1. The study is interesting taking in consideration that many surgeons around the world perform bilateral prophylactic mastectomy for patients with gene mutations. 

Response to comment #1:

Based on the current recommendations (reference to National Comprehensive Cancer Network, i.e. NCCN), women with genetic risks for breast cancer choose either preventive mastectomy or high-risk screening with the addition of screening breast MRI. The evidence supporting preventive mastectomy is the strongest for the high penetrant genetic mutations, while the women carrying moderate-high risk genetic mutations are recommended to continue high-risk screening.  

2. My main concern is that you have less than 20 references. You should compare your results with some relevant manuscripts from literature in the discussion part. Moreover, you should highlight 2-3 conclusions.  

Response to comment #2:

Additional references are added in “Introduction” and “Discussion” .

     The section for conclusion is added:

“5. Conclusion:

Women with high-risk genetic predisposition to breast cancer often become aware about the risk at an age much older than the age recommended to begin enhanced screening with MRI. For women carrying high-risk genetic variants, it is likely beneficial to begin breast MRI immediately after the discovery of genetic high-risk, instead of beginning with mammogram, then followed by MRI 6 months later. In addition,  despite the extensive screening utilizing MRI, some early stage breast cancer were missed, highlighting the recommendations to undergo risk reduction mastectomy for women with high-risk PVs.”

Reviewer 2 Report

good work. the background appears appropriate.

line 21: THOSE CARRYING GERMLINE (to avoid repetition).

line 49: FOR WOMEN carrying
the discussion must however be deepened in the light of the most up-to-date references. the sources reported are numerically too scarce. I suggest you read the following papers

Kotsopoulos J. BRCA Mutations and Breast Cancer Prevention. Cancers (Basel). 2018 Dec 19;10(12):524. doi: 10.3390/cancers10120524. PMID: 30572612; PMCID: PMC6315560.

Partridge AH, Pagani O, Abulkhair O, Aebi S, Amant F, Azim HA Jr, Costa A, Delaloge S, Freilich G, Gentilini OD, Harbeck N, Kelly CM, Loibl S, Meirow D, Peccatori F, Kaufmann B, Cardoso F. First international consensus guidelines for breast cancer in young women (BCY1). Breast. 2014 Jun;23(3):209-20. doi: 10.1016/j.breast.2014.03.011. Epub 2014 Apr 24. PMID: 24767882.

Partridge AH, Pagani O, Abulkhair O, Aebi S, Amant F, Azim HA Jr, Costa A, Delaloge S, Freilich G, Gentilini OD, Harbeck N, Kelly CM, Loibl S, Meirow D, Peccatori F, Kaufmann B, Cardoso F. First international consensus guidelines for breast cancer in young women (BCY1). Breast. 2014 Jun;23(3):209-20. doi: 10.1016/j.breast.2014.03.011. Epub 2014 Apr 24. PMID: 24767882.

why are conclusions not foreseen after the discussion? is the policy of the Journal?

Author Response

Response to reviewer 2:

Thank you for the comments!

1. line 21: THOSE CARRYING GERMLINE (to avoid repetition).

Response to comment #1: Changed accordingly.

2. line 49: FOR WOMEN carrying

Response to comment #2: Changed accordingly.

3. The discussion must however be deepened in the light of the most up-to-date references. the sources reported are numerically too scarce. I suggest you read the following papers

Kotsopoulos J. BRCA Mutations and Breast Cancer Prevention. Cancers (Basel). 2018 Dec 19;10(12):524. doi: 10.3390/cancers10120524. PMID: 30572612; PMCID: PMC6315560.

Partridge AH, Pagani O, Abulkhair O, Aebi S, Amant F, Azim HA Jr, Costa A, Delaloge S, Freilich G, Gentilini OD, Harbeck N, Kelly CM, Loibl S, Meirow D, Peccatori F, Kaufmann B, Cardoso F. First international consensus guidelines for breast cancer in young women (BCY1). Breast. 2014 Jun;23(3):209-20. doi: 10.1016/j.breast.2014.03.011. Epub 2014 Apr 24. PMID: 24767882.

Response to comment #3

Thank you for providing the recent publications related to the subjects we discussed in this manuscript. I have added more information and added related references in “INTRODUCTION” AND “DISCUSSION”, hopefully this will satisfy the reader at a depth.

4. Why are conclusions not foreseen after the discussion? is the policy of the Journal?

Response to comment #4

The section for conclusion is added:

“5. Conclusion:

Women with high-risk genetic predisposition to breast cancer often become aware about the risk at an age much older than the age recommended to begin enhanced screening with MRI. For women carrying high-risk genetic variants, it is likely beneficial to begin breast MRI immediately after the discovery of genetic high-risk, instead of beginning with mammogram, then followed by MRI 6 months later. In addition, despite the extensive screening utilizing MRI, some early stage breast cancer were missed, highlighting the recommendations to undergo risk reduction mastectomy for women with high-risk PVs.”

Reviewer 3 Report

The manuscript was well designed with a good flow. It's easy to follow with minor language-related issues. Also, I suggest authors modify the citations of the web pages according to the guideline. 

The last paragraph of the introduction is a bit confusing; it's providing background information and ends without revealing the hypothesis. It would be preferable to emphasize the hypothesis of the study here. 

Tables should be revised and generated according to the scientific guidelines for better presentation. Also, that might be better to draw figures with more attention. 

On line 152, the result is repeated (90.4%) and can be removed. 

Please refer to guidelines for citing books at line 195. Also, correct reference 11.

Author Response

Response to Reviewer 3:

Thank you for the comments!

1. The manuscript was well designed with a good flow. It's easy to follow with minor language-related issues. Also, I suggest authors modify the citations of the web pages according to the guideline. 

Response to comment #1: Web page citations have been modified, at line #34, #69.

2. The last paragraph of the introduction is a bit confusing; it's providing background information and ends without revealing the hypothesis. It would be preferable to emphasize the hypothesis of the study here. 

Response to comment #2: To bring attention to the hypothesis “Giving the superiority of MRI, we suspect postponing the MRI 6 months later may delay the diagnosis of breast cancer undetectable by mammography”, we switched the position of the last two paragraphs.

3.  Tables should be revised and generated according to the scientific guidelines for better presentation. Also, that might be better to draw figures with more attention. 

Response to comment #3: Tables are revised according to the recommendations.

4. On line 152, the result is repeated (90.4%) and can be removed. 

Response to comment #4:  It is removed.

5. Please refer to guidelines for citing books at line 195. Also, correct reference 11.

Response to comment #5:  The style of citations is adjusted, in line #210