28.
Duplicate of reference 27.
4 Matching Annotations
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alireza5969.github.io alireza5969.github.io
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early detection
Regarding the decline in age-standardized incidence rates, we expect that as diagnostic tools improve and early detection advances, more cases will be identified, which may lead to an increase in this indicator. I think it might be better to relate this factor to the improvement of preventive strategies.
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Discussion
Results currently under-discussed. - State outliers in Table 1 not discussed; New York largest declines; New Mexico's significant male prevalence increase; briefly discuss why these states merit targeted evaluation. - Non-fatal burden (YLDs) is absent from the discussion.
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Although cigarette smoking has historically been the predominant risk factor for BC (8), accumulating evidence indicates that a broader spectrum of carcinogenic exposures contributes to its incidence. These include arsenic-contaminated drinking water, occupational and cosmetic chemicals (such as those found in hair dyes), dietary factors, and widespread environmental pollutants (9). Notably, despite a sustained decline in cigarette smoking prevalence since 1998 (10) and the introduction of stricter regulations on aryl amines, BC incidence has not declined in parallel (11). This lack of concordance suggests that other environmental and occupational exposures may be driving contemporary disease patterns, particularly in regions with limited regulatory oversight. Elevated BC incidence in certain New England states, for example, has been partially attributed to environmental carcinogens such as arsenic contamination from private household wells (12,13). The interaction of these exposures with persistent regional and socioeconomic disparities represents a critical yet incompletely characterized public health concern, warranting focused surveillance, research, and policy attention.
This study does not quantify risk-factor contributions. I think it might be better to shorten this paragraph to 1–2 key examples and remove non-essential details.
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