BRCA Testing for Patients Treated in Italy: A National Survey of Breast Centers Associated with Senonetwork

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

Your paper is interesting and it can be considered a stimulus towards a more in-depth analysis of the argument. By proposing a web-based survey, you aim to evaluate the impact of genetic testing on Italian BUs' activities. Furthermore, you briefly proposed an overview of its impact on novel therapies.

Your purpose is mainly descriptive. Nevertheless, even if the paper is well written, I think that you should briefly elaborate on how to overcome the difficulties faced by BUs on genetic testing.

Furthermore, you reported that in 99.1% of centers, the presence of a pathogenic variant influenced treatment and that 93.6% of centers believed that somatic variants would be of utility for therapeutic purpose. If this latter aspect has been partly justified in the discussion section, I can't find any mention about how the finding of the mutation has influenced the treatment in the BUs. I think that it can be a useful addition to your work to better understand the impact of genetic testing on current clinical practice.

Author Response

Comment 1: Dear Authors,

Your paper is interesting and it can be considered a stimulus towards a more in-depth analysis of the argument. By proposing a web-based survey, you aim to evaluate the impact of genetic testing on Italian BUs' activities. Furthermore, you briefly proposed an overview of its impact on novel therapies.

Your purpose is mainly descriptive. Nevertheless, even if the paper is well written, I think that you should briefly elaborate on how to overcome the difficulties faced by BUs on genetic testing.

Response 1: We thank the reviewer for the comment. 

We modified the last part of Discussion section accordingly.

Comment 2: Furthermore, you reported that in 99.1% of centers, the presence of a pathogenic variant influenced treatment and that 93.6% of centers believed that somatic variants would be of utility for therapeutic purpose. If this latter aspect has been partly justified in the discussion section, I can't find any mention about how the finding of the mutation has influenced the treatment in the BUs. I think that it can be a useful addition to your work to better understand the impact of genetic testing on current clinical practice.

Response 2: 

We thank the reviewer for the comment. 

We modified the last part of Discussion section and added two additional references accordingly.

Reviewer 2 Report

Comments and Suggestions for Authors

This study conducted a 16-question web-based survey about the BRCA testing to 153 BUs, which account for more than 95% of women treated every year in Italy for breast cancer. Of them, 109 BUs responded and participated in the survey. This study summarized the characteristics of the BUs across Italy and identified some key challenges in BRCA testing. The manuscript is well-written in general. I only have some minor concerns.

Results, line 124: Among the 109 of 153 BUs participating in the survey, 22.0% were located in Lombardy. What is the distribution by region for all 153 BUs? If the distributions of all 153 BUs and the 109 participating BUs are listed to compare, it’s better to show whether there might be some selection bias. If there are other known characteristics about the 153 BUs, maybe the number of cases yearly, it can be compared as well.

Discussion, line 311: As mentioned above, if distributions of some certain known characteristics of all 153 BUs and the 109 participating BUs can be compared, the concern of selection bias might be partially addressed.

Author Response

Comment: 

This study conducted a 16-question web-based survey about the BRCA testing to 153 BUs, which account for more than 95% of women treated every year in Italy for breast cancer. Of them, 109 BUs responded and participated in the survey. This study summarized the characteristics of the BUs across Italy and identified some key challenges in BRCA testing. The manuscript is well-written in general. I only have some minor concerns.

Results, line 124: Among the 109 of 153 BUs participating in the survey, 22.0% were located in Lombardy. What is the distribution by region for all 153 BUs? If the distributions of all 153 BUs and the 109 participating BUs are listed to compare, it’s better to show whether there might be some selection bias. If there are other known characteristics about the 153 BUs, maybe the number of cases yearly, it can be compared as well.

Discussion, line 311: As mentioned above, if distributions of some certain known characteristics of all 153 BUs and the 109 participating BUs can be compared, the concern of selection bias might be partially addressed.

Response: 

Dear Reviewer,

Thank you for your comment. We appreciate your feedback on potential selection bias in our study.

Regarding the regional distribution of Breast Units, Lombardy indeed has the highest number of BUs in Italy, with 32 registered units. This region treats approximately one-third of all breast cancer cases in the country annually, which explains why 22.0% of our survey respondents are from Lombardy. The proportional representation of BUs from Lombardy in our survey aligns with its overall proportion in Italy, indicating that our sample is representative.

For further details, you can refer to the following link (Elenco Centri di Senologia - SENONETWORK), which lists all BUs by region. This regional representation reflects the actual distribution and capacity of BUs in Italy, supporting the representativeness of our sample and addressing concerns of selection bias.

Sincerely,

Damiano Gentile, MD, FEBS