Reproductive Outcomes in Young Breast Cancer Survivors Treated (15–39) in Ontario, Canada
Round 1
Reviewer 1 Report
I commend the authors for their brilliant effort on reporting oncofertility outcomes in adolescent and young adults with breast cancer. This was a retrospective cohort study using population level health and administrative databases in Ontario, Canada where the impact of breast cancer and treatment with chemotherapy on birth rates, infertility, premature ovarian insufficiency, and early menopause was evaluated. The authors showed a significant increase in infertility outcomes associated with both of those exposures. To my knowledge, this is the first study looking at this particular issue in a Canadian population sample. While there are a lot of limitations to using cross-linked population databases and administrative diagnostic codes - which the authors have acknowledged in their "Discussion" - this study highlights the very unique problem AYA women with breast cancer have to face that often goes unaddressed.
This study is a good first step to further, more granular studies teasing out the effect of chemo- vs. endocrine therapy, genetic mutations, and even social determinants of health variables on infertility outcomes.
I have a few very minor edits: -
- Pg. 8, line 164: Results do not match Fig. 2. It should read, "Infertility occurred in 9.1% of breast cancer patients who received chemotherapy, 11.8% of breast cancer patients who did not..."
- Pg. 8, line 177: Should read, "...those who were not..."
- Pg. 9, line 204: I would add that neoadjuvant or adjuvant chemotherapy are more often required in younger women.
- Pg. 9, line 210: Should read, "...as we found an increased risk..."
- Pg. 10, line 231: Should read, "...a record low in 2020 of 1.4 live births..."
- Pg. 10, line 237: Should read, "...chemotherapy possesses an increased rate..."
Author Response
Thank you for your careful review and suggested edits. We have made all suggested changes and changes have been tracked
Author Response File: 
Author Response.docx
Reviewer 2 Report
Introduction is well written and concise, which eases the reader to understand the objectives. It would be interesting to include the hypothese of your research.
Methods, results and discussion are also correctly written, and expose all the main findings of this study, discussing them with other interesting research.
Strenghts and limitations are as well clearly indicated, and the conclusion states the answer to the objectives of this study.
As I recommended first, the hypothesis at the end of the introduction would enhance the manuscript
Author Response
Thank you for your comments, please see new version with changes tracked.
