Aspects to consider regarding breast cancer risk in trans men: A systematic review and risk management approach

Edvin Wahlström; Riccardo A. Audisio; Gennaro Selvaggi

doi:10.1371/journal.pone.0299333

Peer Review History

Original SubmissionDecember 11, 2023
8 Jan 2024 Decision Letter - Daniele Ugo Tari, Editor PONE-D-23-41281Aspects to consider regarding breast cancer risk in trans men: a literature review and risk management approach.PLOS ONE Dear Dr. Wahlström, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 22 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Kindly add "systematic review" to the title of your manuscript 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In general, this was an important review, although based on poor-quality research. There are a few corrections that need to be made to clarify the review. - Beginning with the Abstract, the Swiss chess model is mentioned a number of times, but never explained at all until near the end in the Risk Management section. A concise explanation of the model is needed at the beginning. There are also two words in the Abstract that need correcting - in Methods, "the diagnosis of breast had" the word "cancer" needs to be added. Near the end of the same paragraph, "aspects in this populous" needs to be corrected to "population." - In Materials and methods in Search methodology, "GD-related intervention" is used. Please define and spell out what GD stands for. - In Comparison and applicability, in the second paragraph, "CSH is an obvious..." Please define and spell out CSH. - In the Introduction, it is stated that the highest incidence of breast cancer is found in women aged 70 - 74 years. However, after checking the reference, this is very likely true only for Sweden; please verify that it is broadly applicable or clarify that this is only for Sweden. - It is curious that only the first author screened all articles, read all text, and gathered all statistics. There was no double-check by the other authors (what exactly did they do?) and is a risk of bias. It is also curious that no protocol was established and the review has not been registered anywhere. - Although the author is undoubtedly correct that there is more breast tissue remaining after CCM than after prophylactic mastectomy, it should still somewhat lower the risk of malignancy in trans men than in cis women at normal risk. Reviewer #2: In the references section, this reviewer noticed two typographical errors: Line 602, San Francisco is misspelled ("San fransisco" is incorrect) Line 604, the second author on the cited document is Goldberg, J (not Joshua G) ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0299333.r001
Revision 1
16 Jan 2024 Author Response Response to editor: 1: Format and style of the manuscript have been updated to adhere to guidelines. 2: Systematic review was added to the title. 3: The reference list have been reviewed. Reference nr 69 was changed beacuse of a published erratum concerning the original citation. Response to Reviewers First, the authors would like to thank the reviewers for their time and effort in reviewing this manuscript. Many valid and thoughtful points have been raised. Our responses can be found beneath. Reviewer #1: In general, this was an important review, although based on poor-quality research. There are a few corrections that need to be made to clarify the review. - Beginning with the Abstract, the Swiss chess model is mentioned a number of times, but never explained at all until near the end in the Risk Management section. A concise explanation of the model is needed at the beginning. There are also two words in the Abstract that need correcting - in Methods, "the diagnosis of breast had" the word "cancer" needs to be added. Near the end of the same paragraph, "aspects in this populous" needs to be corrected to "population." Response: A paragraph with the heading “Risk analysis” have been added to the materials and methods section explaining the swiss cheese model. The word cancer was added as suggested, populous were changed to population as well. #2 - In Materials and methods in Search methodology, "GD-related intervention" is used. Please define and spell out what GD stands for. Response: GD is defined as gender dysphoria in the second paragraph of the introduction. #3 - In Comparison and applicability, in the second paragraph, "CSH is an obvious..." Please define and spell out CSH. Response: CSH is mentioned and defined earlier in the manuscript in the last paragraph in “Cases of breast cancer in trans men”. However, we spelled it out again. #4- In the Introduction, it is stated that the highest incidence of breast cancer is found in women aged 70 - 74 years. However, after checking the reference, this is very likely true only for Sweden; please verify that it is broadly applicable or clarify that this is only for Sweden. Response: Yes, great point. We´ve changed the sentence to “For the Swedish population the highest incidence is found in women aged 70 to 74 years.3” #5 - It is curious that only the first author screened all articles, read all text, and gathered all statistics. There was no double-check by the other authors (what exactly did they do?) and is a risk of bias. It is also curious that no protocol was established, and the review has not been registered anywhere. Response: The inclusion/exclusion process were being conducted by the first author with supervision from the third author. Inclusion/exclusion criteria were clearly stated before initiation of the search. The population were also clearly defined as trans men having had some form of gender dysphoric intervention made. These criteria were strictly followed and no evident issues with inclusion/exclusion were found. In those cases, the third author would be available for discussion. The process was especially straight forward with regards to title and abstract screening. For transparency we provide all excluded articles from the full-text screening in the S1 table, with reasons for exclusions. Whilst no formal protocol was produced as a separate document before initiating the study, the search was clearly defined beforehand using the PICO approach. The problem/population = breast cancer in trans men. The intervention/risk = GD intervention. Comparison = cis women/trans men with no GD intervention. Outcome = breast cancer case. It is unfortunate that the study was not registered prospectively, as this could help to avoid future “unplanned duplication reviews”. However, we do not consider this fact to introduce any major bias since we´ve made effort to report on the search terms/methodology as transparent as possible to facilitate reproducibility. #6- Although the author is undoubtedly correct that there is more breast tissue remaining after CCM than after prophylactic mastectomy, it should still somewhat lower the risk of malignancy in trans men than in cis women at normal risk. Response: Yes, the CCM alone is probably risk-reducing and we cite Boice (reference nr 63) who shows that a breast reduction in cis women leads to a lower incidence in breast cancer. This is most likely true also for trans men. However, to what degree is impossible to say given the available evidence. Reviewer #2: In the references section, this reviewer noticed two typographical errors: #1 Line 602, San Francisco is misspelled ("San fransisco" is incorrect) Response: Corrected. #2 Line 604, the second author on the cited document is Goldberg, J (not Joshua G) Response: Yes, thanks for noticing. Corrected. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0299333.r002
9 Feb 2024 Decision Letter - Daniele Ugo Tari, Editor Aspects to consider regarding breast cancer risk in trans men: a systematic review and risk management approach. PONE-D-23-41281R1 Dear Dr. Wahlström, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Daniele Ugo Tari, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0299333.r003
Formally Accepted
26 Feb 2024 Acceptance Letter - Daniele Ugo Tari, Editor PONE-D-23-41281R1 PLOS ONE Dear Dr. Wahlström, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Daniele Ugo Tari Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0299333.r004

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