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: 09 Dec 2019  
 
Reviewer: Sylvain Manfredi  
 
Review er's report:  
 
the aim of this article was to best select individuals for CRC screening referral, by using 
electronic healthcare records of UK. data used were clinical and biological data recorded by GPs. 
individuals have done a FOBT scr eening test and analysis was done for positive and negative 
FOBT. authors mixed diagnostic and screening strategies: in a screening intent the goal is to 
select asymptomatic individuals with average risk for CRC for colonoscopy referral. in a 
diagnostic in tent the goal is to not miss symptomatic individuals. so including data related to 
symptoms in an decision algorithm for screening is in my sense inadequate: individuals with 
symptoms or biological data suggesting cancer must had colonoscopy and no FOBT. t he only 
data of interest in a screening intent for asymptomatic individuals are diabete mellitus, tobaco 
and alcohol use, and BMI. for those individuals there are perhaps an interest to adapt the 
screening procedure: lower cut -off value for FIT? colonoscop y referral whatever the FOBT 
result ? analysis exclding all the symptomatic (clinically or biologically) individuals and focused 
on environnemental risk factors would be more usefull than the analysis done in this study.  
 
the methodology is too precise: 28 references is too much.  
 
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 requi red in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
addition al 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  
 
Quality of written English  
Please indicate the qual ity 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 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 t hat may in any way gain or 
lose financially from the publicatio n 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.  
 
no com peting interest to disclose  
 
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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Com mons 
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 in cluded 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: 09 Dec 2019  
 
Reviewer: Sylvain Manfredi  
 
Review er's report:  
 
the aim of this article was to best select individuals for CRC screening referral, by using 
electronic healthcare records of UK. data used were clinical and biological data recorded by GPs. 
individuals have done a FOBT scr eening test and analysis was done for positive and negative 
FOBT. authors mixed diagnostic and screening strategies: in a screening intent the goal is to 
select asymptomatic individuals with average risk for CRC for colonoscopy referral. in a 
diagnostic in tent the goal is to not miss symptomatic individuals. so including data related to 
symptoms in an decision algorithm for screening is in my sense inadequate: individuals with 
symptoms or biological data suggesting cancer must had colonoscopy and no FOBT. t he only 
data of interest in a screening intent for asymptomatic individuals are diabete mellitus, tobaco 
and alcohol use, and BMI. for those individuals there are perhaps an interest to adapt the 
screening procedure: lower cut -off value for FIT? colonoscop y referral whatever the FOBT 
result ? analysis exclding all the symptomatic (clinically or biologically) individuals and focused 
on environnemental risk factors would be more usefull than the analysis done in this study.  
 
the methodology is too precise: 28 references is too much.  
 
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 requi red in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
addition al 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  
 
Quality of written English  
Please indicate the qual ity 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 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 t hat may in any way gain or 
lose financially from the publicatio n 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.  
 
no com peting interest to disclose  
 
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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Com mons 
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 in cluded 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: 09 Dec 2019  
 
Reviewer: Sylvain Manfredi  
 
Review er's report:  
 
the aim of this article was to best select individuals for CRC screening referral, by using 
electronic healthcare records of UK. data used were clinical and biological data recorded by GPs. 
individuals have done a FOBT scr eening test and analysis was done for positive and negative 
FOBT. authors mixed diagnostic and screening strategies: in a screening intent the goal is to 
select asymptomatic individuals with average risk for CRC for colonoscopy referral. in a 
diagnostic in tent the goal is to not miss symptomatic individuals. so including data related to 
symptoms in an decision algorithm for screening is in my sense inadequate: individuals with 
symptoms or biological data suggesting cancer must had colonoscopy and no FOBT. t he only 
data of interest in a screening intent for asymptomatic individuals are diabete mellitus, tobaco 
and alcohol use, and BMI. for those individuals there are perhaps an interest to adapt the 
screening procedure: lower cut -off value for FIT? colonoscop y referral whatever the FOBT 
result ? analysis exclding all the symptomatic (clinically or biologically) individuals and focused 
on environnemental risk factors would be more usefull than the analysis done in this study.  
 
the methodology is too precise: 28 references is too much.  
 
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 requi red in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
addition al 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  
 
Quality of written English  
Please indicate the qual ity 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 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 t hat may in any way gain or 
lose financially from the publicatio n 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.  
 
no com peting interest to disclose  
 
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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Com mons 
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 in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open  peer review policy of the journal  
assistant