Reviewer ’s report  
 
Title: Not so FAST. Commentary on the article “Appraisal of  the faecal haemoglobin, age and 
sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational 
study ” 
 
Version: 0 Date: 18 Apr 2020  
 
Reviewer's report:  
 
Referring to the rationale for adopting FIT as triage test among patients wit h lower GI 
symptoms, the authors are commenting the results of the Scottish prospective observational 
study, aimed to evaluate the diagnostic performance of a risk score combining FIT results with 
age and sex. They have clearly outlined the challenges pose d by the adoption of triage strategies 
to decide about TC referral of patients presenting with clinical symptoms, showing the 
contribution of th e study to that specific field.  
 
I have just two comments:  
On page 5, lines 48 -51, the text might be more explic it, saying that that the results of the study 
validating the model (developed with the contribution of the authors) needed to be validated in 
prospective primary healthcare studies evaluating symptomatic patients. The study by Digby et 
al is reporting the results of such validation.  
 
Also, although, based on the NPV figure, the authors conclude that the FAST test is useful to 
identify subjects with a CRC risk similar to the risk of severe TC complications, they should also 
comment on the main conclusion of the study,  
" As a result of this study, we cannot support use of the published FAST score formula to assist 
in deciding who to refer for colonoscopy, since SBD was missed in those who had been referred 
using f -Hb and other considerations ….": which might suggest that the proposed score still 
shows important limitations  
 
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 fro m 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, 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 al l 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 i ncluded  
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 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 named report can be included as confidential comments  
to the editors, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Not so FAST. Commentary on the article “Appraisal of  the faecal haemoglobin, age and 
sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational 
study ” 
 
Version: 0 Date: 18 Apr 2020  
 
Reviewer's report:  
 
Referring to the rationale for adopting FIT as triage test among patients wit h lower GI 
symptoms, the authors are commenting the results of the Scottish prospective observational 
study, aimed to evaluate the diagnostic performance of a risk score combining FIT results with 
age and sex. They have clearly outlined the challenges pose d by the adoption of triage strategies 
to decide about TC referral of patients presenting with clinical symptoms, showing the 
contribution of th e study to that specific field.  
 
I have just two comments:  
On page 5, lines 48 -51, the text might be more explic it, saying that that the results of the study 
validating the model (developed with the contribution of the authors) needed to be validated in 
prospective primary healthcare studies evaluating symptomatic patients. The study by Digby et 
al is reporting the results of such validation.  
 
Also, although, based on the NPV figure, the authors conclude that the FAST test is useful to 
identify subjects with a CRC risk similar to the risk of severe TC complications, they should also 
comment on the main conclusion of the study,  
" As a result of this study, we cannot support use of the published FAST score formula to assist 
in deciding who to refer for colonoscopy, since SBD was missed in those who had been referred 
using f -Hb and other considerations ….": which might suggest that the proposed score still 
shows important limitations  
 
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 fro m 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, 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 al l 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 i ncluded  
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 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 named report can be included as confidential comments  
to the editors, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Not so FAST. Commentary on the article “Appraisal of  the faecal haemoglobin, age and 
sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational 
study ” 
 
Version: 0 Date: 18 Apr 2020  
 
Reviewer's report:  
 
Referring to the rationale for adopting FIT as triage test among patients wit h lower GI 
symptoms, the authors are commenting the results of the Scottish prospective observational 
study, aimed to evaluate the diagnostic performance of a risk score combining FIT results with 
age and sex. They have clearly outlined the challenges pose d by the adoption of triage strategies 
to decide about TC referral of patients presenting with clinical symptoms, showing the 
contribution of th e study to that specific field.  
 
I have just two comments:  
On page 5, lines 48 -51, the text might be more explic it, saying that that the results of the study 
validating the model (developed with the contribution of the authors) needed to be validated in 
prospective primary healthcare studies evaluating symptomatic patients. The study by Digby et 
al is reporting the results of such validation.  
 
Also, although, based on the NPV figure, the authors conclude that the FAST test is useful to 
identify subjects with a CRC risk similar to the risk of severe TC complications, they should also 
comment on the main conclusion of the study,  
" As a result of this study, we cannot support use of the published FAST score formula to assist 
in deciding who to refer for colonoscopy, since SBD was missed in those who had been referred 
using f -Hb and other considerations ….": which might suggest that the proposed score still 
shows important limitations  
 
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 fro m 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, 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 al l 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 i ncluded  
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 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 named report can be included as confidential comments  
to the editors, which will not be publis hed. 
 
I agree to the open peer review policy of the journal  
assistant