Title: Insights from age-stratified endoscopic detection metrics support initiating colorectal
cancer screening at age 45
Version: 3 Date: 14 Mar 2025
Reviewer's report:
This is a study that analyze adenoma detection rate between age 45-49.  This is an important
study to understand prevalence of polyps/precancerous lesions any younger population.  I have
several comments.
1) I think this can be presented as a brief report rather than a full original article.  It can
be rewritten to make it concise and appears to have redundancy.  Many sentences can be
summarized succinctly.  There appeared to his be multiple reputations.
2) Please provide the screening guidelines used in Israel.  Do patients start colonoscopy
screening/colon cancer screening by age 45?  When was this criterion changed, and provide
further details.
3) The inclusion criteria are not very clear.  It appears that more than 200,000 patients underwent
colonoscopy between the ages 45-49 between the year 2016 to 2022.  Looks like patients
with positive family history of cancer or polyps were excluded.  Who were these patients who
qualified for colonoscopy if they were not for screening or diagnostic purposes?
4) Please add recent references from cohort studies from United States that that have looked at
adenoma detection rate between age 45-49 (Aasma Shaukat's study)
5) It is unclear how the pathology of adenomas was assessed.  Where the text-based search used
or they were manually reviewed?  Page 12, last paragraph is not clear.  Where only 24% of cases
reviewed and found to have adenomas in ages 45-49 ?  If it is not done based on the text search,
unclear if we can say what was the true ADR in this cohort.
6) I would remove reference 48 as this is an abstract and not a full original article that has been
published in a peer-reviewed journal.
Title: Insights from age-stratified endoscopic detection metrics support initiating colorectal
cancer screening at age 45
Version: 3 Date: 14 Mar 2025
Reviewer's report:
This is a study that analyze adenoma detection rate between age 45-49.  This is an important
study to understand prevalence of polyps/precancerous lesions any younger population.  I have
several comments.
1) I think this can be presented as a brief report rather than a full original article.  It can
be rewritten to make it concise and appears to have redundancy.  Many sentences can be
summarized succinctly.  There appeared to his be multiple reputations.
2) Please provide the screening guidelines used in Israel.  Do patients start colonoscopy
screening/colon cancer screening by age 45?  When was this criterion changed, and provide
further details.
3) The inclusion criteria are not very clear.  It appears that more than 200,000 patients underwent
colonoscopy between the ages 45-49 between the year 2016 to 2022.  Looks like patients
with positive family history of cancer or polyps were excluded.  Who were these patients who
qualified for colonoscopy if they were not for screening or diagnostic purposes?
4) Please add recent references from cohort studies from United States that that have looked at
adenoma detection rate between age 45-49 (Aasma Shaukat's study)
5) It is unclear how the pathology of adenomas was assessed.  Where the text-based search used
or they were manually reviewed?  Page 12, last paragraph is not clear.  Where only 24% of cases
reviewed and found to have adenomas in ages 45-49 ?  If it is not done based on the text search,
unclear if we can say what was the true ADR in this cohort.
6) I would remove reference 48 as this is an abstract and not a full original article that has been
published in a peer-reviewed journal.
Please review this paper.
user
Title: Insights from age-stratified endoscopic detection metrics support initiating colorectal
cancer screening at age 45
Version: 3 Date: 14 Mar 2025
Reviewer's report:
This is a study that analyze adenoma detection rate between age 45-49.  This is an important
study to understand prevalence of polyps/precancerous lesions any younger population.  I have
several comments.
1) I think this can be presented as a brief report rather than a full original article.  It can
be rewritten to make it concise and appears to have redundancy.  Many sentences can be
summarized succinctly.  There appeared to his be multiple reputations.
2) Please provide the screening guidelines used in Israel.  Do patients start colonoscopy
screening/colon cancer screening by age 45?  When was this criterion changed, and provide
further details.
3) The inclusion criteria are not very clear.  It appears that more than 200,000 patients underwent
colonoscopy between the ages 45-49 between the year 2016 to 2022.  Looks like patients
with positive family history of cancer or polyps were excluded.  Who were these patients who
qualified for colonoscopy if they were not for screening or diagnostic purposes?
4) Please add recent references from cohort studies from United States that that have looked at
adenoma detection rate between age 45-49 (Aasma Shaukat's study)
5) It is unclear how the pathology of adenomas was assessed.  Where the text-based search used
or they were manually reviewed?  Page 12, last paragraph is not clear.  Where only 24% of cases
reviewed and found to have adenomas in ages 45-49 ?  If it is not done based on the text search,
unclear if we can say what was the true ADR in this cohort.
6) I would remove reference 48 as this is an abstract and not a full original article that has been
published in a peer-reviewed journal.
assistant