Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 29 Jun 2019  
Reviewer: Diana Sacchi  
Reviewer's report:  
This paper by Soin et al. focuses on the "inappropriate" application of fecal occult blood test 
(FOBT), which is the most important test in colorectal cancer (CRC) screening, and is often 
included as the first step in a screening protocol due to its cost -effectiveness and non -
invasiveness.  
 
I would like to suggest minor points to consider in subsequent version:  
 Table 4; "inappropriate" column: "225 patients aged <75 years". As written in the paper, 
according with the American Cancer Society Colo rectal Cancer Screening Guidelines (ACS) 
(January 2018), the appropriateness of FOBT considered as one criterion age from 50 -75 
years. Thus, probably Authors would like to write "225 patients aged >75 years".  
 
 You have written in the article: "This st udy also highlights the burden of unnecessary 
procedures as a result of the inappropriate FOBT testing" and it could be absolutely true but 
it is not clearly demonstrated in your study. It would be interesting to know how many 
patients still have the indic ation to undergo a colonoscopy (or imaging tests to look for CRC) 
in the "potentially -inappropriate" group, despite the positive result of FOBT. Indeed, It is 
important in a cost -effectiveness point of view to not perform inappropriate FOBT but It is 
impor tant to consider in your study if the positive result of FOBT surely increases the 
number of subsequent procedures.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which co ntrols are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past  five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, fun ding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 29 Jun 2019  
Reviewer: Diana Sacchi  
Reviewer's report:  
This paper by Soin et al. focuses on the "inappropriate" application of fecal occult blood test 
(FOBT), which is the most important test in colorectal cancer (CRC) screening, and is often 
included as the first step in a screening protocol due to its cost -effectiveness and non -
invasiveness.  
 
I would like to suggest minor points to consider in subsequent version:  
 Table 4; "inappropriate" column: "225 patients aged <75 years". As written in the paper, 
according with the American Cancer Society Colo rectal Cancer Screening Guidelines (ACS) 
(January 2018), the appropriateness of FOBT considered as one criterion age from 50 -75 
years. Thus, probably Authors would like to write "225 patients aged >75 years".  
 
 You have written in the article: "This st udy also highlights the burden of unnecessary 
procedures as a result of the inappropriate FOBT testing" and it could be absolutely true but 
it is not clearly demonstrated in your study. It would be interesting to know how many 
patients still have the indic ation to undergo a colonoscopy (or imaging tests to look for CRC) 
in the "potentially -inappropriate" group, despite the positive result of FOBT. Indeed, It is 
important in a cost -effectiveness point of view to not perform inappropriate FOBT but It is 
impor tant to consider in your study if the positive result of FOBT surely increases the 
number of subsequent procedures.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which co ntrols are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past  five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, fun ding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Use and Abuse of Fecal Occult Blood Tests: A Community Hospital Experience  
Version: 0 Date: 29 Jun 2019  
Reviewer: Diana Sacchi  
Reviewer's report:  
This paper by Soin et al. focuses on the "inappropriate" application of fecal occult blood test 
(FOBT), which is the most important test in colorectal cancer (CRC) screening, and is often 
included as the first step in a screening protocol due to its cost -effectiveness and non -
invasiveness.  
 
I would like to suggest minor points to consider in subsequent version:  
 Table 4; "inappropriate" column: "225 patients aged <75 years". As written in the paper, 
according with the American Cancer Society Colo rectal Cancer Screening Guidelines (ACS) 
(January 2018), the appropriateness of FOBT considered as one criterion age from 50 -75 
years. Thus, probably Authors would like to write "225 patients aged >75 years".  
 
 You have written in the article: "This st udy also highlights the burden of unnecessary 
procedures as a result of the inappropriate FOBT testing" and it could be absolutely true but 
it is not clearly demonstrated in your study. It would be interesting to know how many 
patients still have the indic ation to undergo a colonoscopy (or imaging tests to look for CRC) 
in the "potentially -inappropriate" group, despite the positive result of FOBT. Indeed, It is 
important in a cost -effectiveness point of view to not perform inappropriate FOBT but It is 
impor tant to consider in your study if the positive result of FOBT surely increases the 
number of subsequent procedures.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which co ntrols are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past  five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, fun ding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal.  I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my r eport to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant