Reviewer ’s report  
 
Title: The use of electronic healthcare records for colorectal canc er screening referral decisions 
and risk prediction model development  
 
Version: 1 Date: 13 Nov 2019  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is a study aiming to identify potential predictors for colorectal cancer (CRC) and polyps in a 
screenin g population of 60 -74 years of age, by analysing the primary care records of 292,168 
patients who underwent faecal occult blood test (FOBT).  
 
 
Comments  
 
1. The paper is full of elevated statistics, often difficult to follow by the clinicians. I would prefer 
if they could be rewritten in a way so that the important messages are not lost by quoting so 
many numbers. Or at least they could be explained in a simpler way so that non -statisticians 
could understand what they are all about. I had to reach the Discussi on to get the message from 
all this elaborate statistical analysis. If I understood correctly, the proposed risk model 
(combined strategy) increased the sensitivity from 51 to 72%, but decreased the specificity from 
96 to 44%. If this is the case, the prop osed model is not useful for clinicians.  
 
2. Patients were included if they were 60 -74 years. However, most gastroenterological societies 
recommend that a screening colonoscopy should be performed from the age of 50 or lately from 
the age of 45, as there is  an increase in CRC from the age of 45. The authors should perform an 
analysis for the ages between 45 and 60, which might guide us clinicians more.  
 
3. Data from screening colonoscopies are missing and the two methods were not compared.  
 
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 controls are required in your comments to the authors.  
 
No 
 
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 th e manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Qual ity 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 re ceived reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly 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 w ay 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, funding, 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 o competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the websi te along with the authors' 
responses. I agree for my report 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 name d 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: The use of electronic healthcare records for colorectal canc er screening referral decisions 
and risk prediction model development  
 
Version: 1 Date: 13 Nov 2019  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is a study aiming to identify potential predictors for colorectal cancer (CRC) and polyps in a 
screenin g population of 60 -74 years of age, by analysing the primary care records of 292,168 
patients who underwent faecal occult blood test (FOBT).  
 
 
Comments  
 
1. The paper is full of elevated statistics, often difficult to follow by the clinicians. I would prefer 
if they could be rewritten in a way so that the important messages are not lost by quoting so 
many numbers. Or at least they could be explained in a simpler way so that non -statisticians 
could understand what they are all about. I had to reach the Discussi on to get the message from 
all this elaborate statistical analysis. If I understood correctly, the proposed risk model 
(combined strategy) increased the sensitivity from 51 to 72%, but decreased the specificity from 
96 to 44%. If this is the case, the prop osed model is not useful for clinicians.  
 
2. Patients were included if they were 60 -74 years. However, most gastroenterological societies 
recommend that a screening colonoscopy should be performed from the age of 50 or lately from 
the age of 45, as there is  an increase in CRC from the age of 45. The authors should perform an 
analysis for the ages between 45 and 60, which might guide us clinicians more.  
 
3. Data from screening colonoscopies are missing and the two methods were not compared.  
 
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 controls are required in your comments to the authors.  
 
No 
 
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 th e manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Qual ity 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 re ceived reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly 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 w ay 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, funding, 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 o competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the websi te along with the authors' 
responses. I agree for my report 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 name d 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: The use of electronic healthcare records for colorectal canc er screening referral decisions 
and risk prediction model development  
 
Version: 1 Date: 13 Nov 2019  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is a study aiming to identify potential predictors for colorectal cancer (CRC) and polyps in a 
screenin g population of 60 -74 years of age, by analysing the primary care records of 292,168 
patients who underwent faecal occult blood test (FOBT).  
 
 
Comments  
 
1. The paper is full of elevated statistics, often difficult to follow by the clinicians. I would prefer 
if they could be rewritten in a way so that the important messages are not lost by quoting so 
many numbers. Or at least they could be explained in a simpler way so that non -statisticians 
could understand what they are all about. I had to reach the Discussi on to get the message from 
all this elaborate statistical analysis. If I understood correctly, the proposed risk model 
(combined strategy) increased the sensitivity from 51 to 72%, but decreased the specificity from 
96 to 44%. If this is the case, the prop osed model is not useful for clinicians.  
 
2. Patients were included if they were 60 -74 years. However, most gastroenterological societies 
recommend that a screening colonoscopy should be performed from the age of 50 or lately from 
the age of 45, as there is  an increase in CRC from the age of 45. The authors should perform an 
analysis for the ages between 45 and 60, which might guide us clinicians more.  
 
3. Data from screening colonoscopies are missing and the two methods were not compared.  
 
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 controls are required in your comments to the authors.  
 
No 
 
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 th e manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Qual ity 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 re ceived reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly 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 w ay 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, funding, 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 o competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the websi te along with the authors' 
responses. I agree for my report 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 name d 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