Title: Short-term aspirin and statin chemoprophylaxis did not reduce the risk of developing
advanced adenomatous polyps in Black patients
Version: 2 Date: 26 May 2021
Reviewer's report:
Thank you for the opportunity to review this manuscript on aspirin and statin mono or
dual chemoprophylaxis for prevention of advanced neoplasia. As the authors note, data on
chemoprevention is lacking in African Americans and work in this area is much needed. In
their paper, the authors review incidence of metachronous advanced neoplasia in an average risk
population and show that aspirin use, statin use, or both together did reduce advanced neoplasia
incidence compared to those who were not given any therapy. The paper is well-written.
I do have some major comments that should be addressed:
-Methods: I suspect that your group was rather heterogenous as your exclusion criteria was
limited to those with hereditary cancer syndromes and IBD. How about those with an advanced
lesion on baseline colonoscopy? Or having 8-9 polyps? Or 15 polyps but no referral for genetic
testing? Baseline colonoscopy groups should be stratified by risk status (e.g. those with a normal
colonoscopy, 1-2 polyps, or advanced lesions ,etc)
-Methods: Is data on sessile serrated lesions available? I recommend adding this.
-Medications: How was medication exposure determined? Data on length of use is important.
-Methods: it is unclear which colonoscopy was used as the index colonoscopy. And if an
individual had 5 colonoscopies, which was used for the surveillance interval – last colonoscopy?
First with a lesion?
-AAP arose in 19% of the cohort – this seems rather high for average risk colons. Please comment
on this.
-Methods: You astutely mention that comorbidities such as obesity and cardiovascular disease
are associated with increased risk for neoplasia. I recommend adjusting for some of these
variables as you have for BMI. The multivariate analysis could include Charleson Comorbidity
Index, or some of the factors utilized in metabolic syndrome, etc as an example.
Minor comments:
-How was poor bowel prep determined by endoscopy report – as in, which scales were used?
Title: Short-term aspirin and statin chemoprophylaxis did not reduce the risk of developing
advanced adenomatous polyps in Black patients
Version: 2 Date: 26 May 2021
Reviewer's report:
Thank you for the opportunity to review this manuscript on aspirin and statin mono or
dual chemoprophylaxis for prevention of advanced neoplasia. As the authors note, data on
chemoprevention is lacking in African Americans and work in this area is much needed. In
their paper, the authors review incidence of metachronous advanced neoplasia in an average risk
population and show that aspirin use, statin use, or both together did reduce advanced neoplasia
incidence compared to those who were not given any therapy. The paper is well-written.
I do have some major comments that should be addressed:
-Methods: I suspect that your group was rather heterogenous as your exclusion criteria was
limited to those with hereditary cancer syndromes and IBD. How about those with an advanced
lesion on baseline colonoscopy? Or having 8-9 polyps? Or 15 polyps but no referral for genetic
testing? Baseline colonoscopy groups should be stratified by risk status (e.g. those with a normal
colonoscopy, 1-2 polyps, or advanced lesions ,etc)
-Methods: Is data on sessile serrated lesions available? I recommend adding this.
-Medications: How was medication exposure determined? Data on length of use is important.
-Methods: it is unclear which colonoscopy was used as the index colonoscopy. And if an
individual had 5 colonoscopies, which was used for the surveillance interval – last colonoscopy?
First with a lesion?
-AAP arose in 19% of the cohort – this seems rather high for average risk colons. Please comment
on this.
-Methods: You astutely mention that comorbidities such as obesity and cardiovascular disease
are associated with increased risk for neoplasia. I recommend adjusting for some of these
variables as you have for BMI. The multivariate analysis could include Charleson Comorbidity
Index, or some of the factors utilized in metabolic syndrome, etc as an example.
Minor comments:
-How was poor bowel prep determined by endoscopy report – as in, which scales were used?
Please review this paper.
user
Title: Short-term aspirin and statin chemoprophylaxis did not reduce the risk of developing
advanced adenomatous polyps in Black patients
Version: 2 Date: 26 May 2021
Reviewer's report:
Thank you for the opportunity to review this manuscript on aspirin and statin mono or
dual chemoprophylaxis for prevention of advanced neoplasia. As the authors note, data on
chemoprevention is lacking in African Americans and work in this area is much needed. In
their paper, the authors review incidence of metachronous advanced neoplasia in an average risk
population and show that aspirin use, statin use, or both together did reduce advanced neoplasia
incidence compared to those who were not given any therapy. The paper is well-written.
I do have some major comments that should be addressed:
-Methods: I suspect that your group was rather heterogenous as your exclusion criteria was
limited to those with hereditary cancer syndromes and IBD. How about those with an advanced
lesion on baseline colonoscopy? Or having 8-9 polyps? Or 15 polyps but no referral for genetic
testing? Baseline colonoscopy groups should be stratified by risk status (e.g. those with a normal
colonoscopy, 1-2 polyps, or advanced lesions ,etc)
-Methods: Is data on sessile serrated lesions available? I recommend adding this.
-Medications: How was medication exposure determined? Data on length of use is important.
-Methods: it is unclear which colonoscopy was used as the index colonoscopy. And if an
individual had 5 colonoscopies, which was used for the surveillance interval – last colonoscopy?
First with a lesion?
-AAP arose in 19% of the cohort – this seems rather high for average risk colons. Please comment
on this.
-Methods: You astutely mention that comorbidities such as obesity and cardiovascular disease
are associated with increased risk for neoplasia. I recommend adjusting for some of these
variables as you have for BMI. The multivariate analysis could include Charleson Comorbidity
Index, or some of the factors utilized in metabolic syndrome, etc as an example.
Minor comments:
-How was poor bowel prep determined by endoscopy report – as in, which scales were used?
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