Title: A risk scoring system for advanced colorectal neoplasia in high-risk participants to
improve current colorectal cancer screening in Tianjin, China
Version: 3 Date: 04 Oct 2022
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was with great pleasure that I read your work titled “A risk scoring system for advanced
colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in
Tianjin, China”
I commend the Authors on their well-researched and relevant work in the interesting field of
colorectal cancer screening, especially in resource limited settings.
The factors that have been included in the scoring system are recognized risk factors and
implementing these will be safe, inexpensive and convenient making it appropriate for the
purpose of screening. The odds ratio and thus the weights assigned to each risk factor in the
scoring system are consistent with contemporary understanding.
There are a few concerns that I have outlined below.
Minor
#1 There have been prior studies with various proposed scoring systems including some of the
risk factors considered in this paper. I am afraid this study suffers from lack of novelty.
Overall, the success of any screening program is multifactorial and depends on adherence,
awareness and willingness to proceed to the next step in case of a positive finding.
As the authors have mentioned, one of the main hurdles with the existing CRC screening
program in the geographic location where this study was conducted, is low adherence with
follow up.
Authors of this study propose that this scoring system could promote adherence to colonoscopy
recommendation. However, it is not clear how that could be.
# 2 There seems to be some inconsistencies with definitions.
For example, lines, 147,148, 149 “ACN was defined as CRC or advanced adenoma # 10 mm in
diameter or with villous components or high-grade dysplasia”.
However, under results, the authors mention that
“Of these, 14677 (49.7%) individuals were found to have CN, including 2324 (7.9%) and 462
(1.6%) diagnosed with ACN and CRC, respectively”
Based on the proposed definition by authors above, CRC would be included in ACN
# 3 Lines 209, 210, 211. Needs correction, clarity in discussion. Authors mention that “The
proportions of LR, MR and HR were 20.4% (6012/29504), 7.1% (1288/18208) and 12.2%
(1152/9463), respectively”.  This seems to be incorrect. I compared this to the data in Table 4.
The numbers 6012, 18208 and 9463 are the number of LR, MR and HR patients based on the
proposed scoring system, while the number 29504 is the total study population. The numbers
1288 and 1152 are patients with AN. Seems like for the above calculation, for MR and HR, it
should have been 18208/29504 and 9463/29504 respectively.
Title: A risk scoring system for advanced colorectal neoplasia in high-risk participants to
improve current colorectal cancer screening in Tianjin, China
Version: 3 Date: 04 Oct 2022
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was with great pleasure that I read your work titled “A risk scoring system for advanced
colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in
Tianjin, China”
I commend the Authors on their well-researched and relevant work in the interesting field of
colorectal cancer screening, especially in resource limited settings.
The factors that have been included in the scoring system are recognized risk factors and
implementing these will be safe, inexpensive and convenient making it appropriate for the
purpose of screening. The odds ratio and thus the weights assigned to each risk factor in the
scoring system are consistent with contemporary understanding.
There are a few concerns that I have outlined below.
Minor
#1 There have been prior studies with various proposed scoring systems including some of the
risk factors considered in this paper. I am afraid this study suffers from lack of novelty.
Overall, the success of any screening program is multifactorial and depends on adherence,
awareness and willingness to proceed to the next step in case of a positive finding.
As the authors have mentioned, one of the main hurdles with the existing CRC screening
program in the geographic location where this study was conducted, is low adherence with
follow up.
Authors of this study propose that this scoring system could promote adherence to colonoscopy
recommendation. However, it is not clear how that could be.
# 2 There seems to be some inconsistencies with definitions.
For example, lines, 147,148, 149 “ACN was defined as CRC or advanced adenoma # 10 mm in
diameter or with villous components or high-grade dysplasia”.
However, under results, the authors mention that
“Of these, 14677 (49.7%) individuals were found to have CN, including 2324 (7.9%) and 462
(1.6%) diagnosed with ACN and CRC, respectively”
Based on the proposed definition by authors above, CRC would be included in ACN
# 3 Lines 209, 210, 211. Needs correction, clarity in discussion. Authors mention that “The
proportions of LR, MR and HR were 20.4% (6012/29504), 7.1% (1288/18208) and 12.2%
(1152/9463), respectively”.  This seems to be incorrect. I compared this to the data in Table 4.
The numbers 6012, 18208 and 9463 are the number of LR, MR and HR patients based on the
proposed scoring system, while the number 29504 is the total study population. The numbers
1288 and 1152 are patients with AN. Seems like for the above calculation, for MR and HR, it
should have been 18208/29504 and 9463/29504 respectively.
Please review this paper.
user
Title: A risk scoring system for advanced colorectal neoplasia in high-risk participants to
improve current colorectal cancer screening in Tianjin, China
Version: 3 Date: 04 Oct 2022
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was with great pleasure that I read your work titled “A risk scoring system for advanced
colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in
Tianjin, China”
I commend the Authors on their well-researched and relevant work in the interesting field of
colorectal cancer screening, especially in resource limited settings.
The factors that have been included in the scoring system are recognized risk factors and
implementing these will be safe, inexpensive and convenient making it appropriate for the
purpose of screening. The odds ratio and thus the weights assigned to each risk factor in the
scoring system are consistent with contemporary understanding.
There are a few concerns that I have outlined below.
Minor
#1 There have been prior studies with various proposed scoring systems including some of the
risk factors considered in this paper. I am afraid this study suffers from lack of novelty.
Overall, the success of any screening program is multifactorial and depends on adherence,
awareness and willingness to proceed to the next step in case of a positive finding.
As the authors have mentioned, one of the main hurdles with the existing CRC screening
program in the geographic location where this study was conducted, is low adherence with
follow up.
Authors of this study propose that this scoring system could promote adherence to colonoscopy
recommendation. However, it is not clear how that could be.
# 2 There seems to be some inconsistencies with definitions.
For example, lines, 147,148, 149 “ACN was defined as CRC or advanced adenoma # 10 mm in
diameter or with villous components or high-grade dysplasia”.
However, under results, the authors mention that
“Of these, 14677 (49.7%) individuals were found to have CN, including 2324 (7.9%) and 462
(1.6%) diagnosed with ACN and CRC, respectively”
Based on the proposed definition by authors above, CRC would be included in ACN
# 3 Lines 209, 210, 211. Needs correction, clarity in discussion. Authors mention that “The
proportions of LR, MR and HR were 20.4% (6012/29504), 7.1% (1288/18208) and 12.2%
(1152/9463), respectively”.  This seems to be incorrect. I compared this to the data in Table 4.
The numbers 6012, 18208 and 9463 are the number of LR, MR and HR patients based on the
proposed scoring system, while the number 29504 is the total study population. The numbers
1288 and 1152 are patients with AN. Seems like for the above calculation, for MR and HR, it
should have been 18208/29504 and 9463/29504 respectively.
assistant