Title: A mobile app to improve adherence to colorectal cancer screening and post polypectomy
surveillance guidelines
Version: 3 Date: 29 Jan 2025
Reviewer's report:
This study showed the potential of a mobile app aiding healthcare professionals in decision
making for adherence to CRC screening and post-polypectomy surveillance guidelines. Given
the low uptake of CRC screening in some countries, and the highly reported over- and underuse
of surveillance colonoscopy in several countries, this study is of great importance.
I have some comments for improvement:
1. I noticed that the authors mostly cite US-based studies. I guess this is a result from the high
number of literature from the US. However, in some cases (not all) it would be of value to cite
studies from the same or a similar health care system or culture as the data comes from (i.e.
studies from Spain or Europe).
For example,
a.  In the introduction section: “However, significant overuse and underuse of colonoscopy have
been reported in multiple studies [7-10]”
b. And discussion: “Concerning results from a study in the US showed that almost 20% of
American adults have never been screened for CRC [17].”
The authors may critically review the manuscript if this is also applicable to other parts of the
manuscript.
2. The problems of overutilization. In the introduction and discussion you address the burden
of overutilization. I agree with your arguments, but you may want to address that although rare,
overutilization might even harm patients, because of the invasive nature of colonoscopy.
3. Distribution, advertising and accessibility of the app is not clear. Please consider adding
information to the methods and/ or discussion.
4. The increase of app usage. In the results and discussion you refer to an increase of app usage.
Cumulative numbers increase, which is obvious, as they would only stagnate if usage ended.
But just from Figure 2, it is hard to see an increase of daily consultations. If there is one, please
also add some numbers to the text. If not, please rephrase.
5. Discussion: Avoidance/ savings of screening and surveillance.
a. As you don’t have actual data on how many persons would have utilized the procedures
without the app and how many avoided it because of the app, I would suggest “softer” wording,
e.g. instead of “(c) 68.2% and 50% of patients could avoid colonoscopy for CRC screening and
surveillance” -> “(c) in 68.2% and 50% of patients the app recommended to avoid colonoscopy
for CRC screening and surveillance and recommended FOBT instead”
b.  “69% savings in screening colonoscopies and 29% savings in post-polypectomy surveillance
colonoscopies”  -> I don’t understand where these numbers come from?
Minor:
Please note that there are several typos and errors in usage of upper and lower case. For example
2400 (13%) had history of first-degree CRC before de age of 50” and several minor errors in
Table 2. Please critically review the manuscript and correct further typos and errors.
Title: A mobile app to improve adherence to colorectal cancer screening and post polypectomy
surveillance guidelines
Version: 3 Date: 29 Jan 2025
Reviewer's report:
This study showed the potential of a mobile app aiding healthcare professionals in decision
making for adherence to CRC screening and post-polypectomy surveillance guidelines. Given
the low uptake of CRC screening in some countries, and the highly reported over- and underuse
of surveillance colonoscopy in several countries, this study is of great importance.
I have some comments for improvement:
1. I noticed that the authors mostly cite US-based studies. I guess this is a result from the high
number of literature from the US. However, in some cases (not all) it would be of value to cite
studies from the same or a similar health care system or culture as the data comes from (i.e.
studies from Spain or Europe).
For example,
a.  In the introduction section: “However, significant overuse and underuse of colonoscopy have
been reported in multiple studies [7-10]”
b. And discussion: “Concerning results from a study in the US showed that almost 20% of
American adults have never been screened for CRC [17].”
The authors may critically review the manuscript if this is also applicable to other parts of the
manuscript.
2. The problems of overutilization. In the introduction and discussion you address the burden
of overutilization. I agree with your arguments, but you may want to address that although rare,
overutilization might even harm patients, because of the invasive nature of colonoscopy.
3. Distribution, advertising and accessibility of the app is not clear. Please consider adding
information to the methods and/ or discussion.
4. The increase of app usage. In the results and discussion you refer to an increase of app usage.
Cumulative numbers increase, which is obvious, as they would only stagnate if usage ended.
But just from Figure 2, it is hard to see an increase of daily consultations. If there is one, please
also add some numbers to the text. If not, please rephrase.
5. Discussion: Avoidance/ savings of screening and surveillance.
a. As you don’t have actual data on how many persons would have utilized the procedures
without the app and how many avoided it because of the app, I would suggest “softer” wording,
e.g. instead of “(c) 68.2% and 50% of patients could avoid colonoscopy for CRC screening and
surveillance” -> “(c) in 68.2% and 50% of patients the app recommended to avoid colonoscopy
for CRC screening and surveillance and recommended FOBT instead”
b.  “69% savings in screening colonoscopies and 29% savings in post-polypectomy surveillance
colonoscopies”  -> I don’t understand where these numbers come from?
Minor:
Please note that there are several typos and errors in usage of upper and lower case. For example
2400 (13%) had history of first-degree CRC before de age of 50” and several minor errors in
Table 2. Please critically review the manuscript and correct further typos and errors.
Please review this paper.
user
Title: A mobile app to improve adherence to colorectal cancer screening and post polypectomy
surveillance guidelines
Version: 3 Date: 29 Jan 2025
Reviewer's report:
This study showed the potential of a mobile app aiding healthcare professionals in decision
making for adherence to CRC screening and post-polypectomy surveillance guidelines. Given
the low uptake of CRC screening in some countries, and the highly reported over- and underuse
of surveillance colonoscopy in several countries, this study is of great importance.
I have some comments for improvement:
1. I noticed that the authors mostly cite US-based studies. I guess this is a result from the high
number of literature from the US. However, in some cases (not all) it would be of value to cite
studies from the same or a similar health care system or culture as the data comes from (i.e.
studies from Spain or Europe).
For example,
a.  In the introduction section: “However, significant overuse and underuse of colonoscopy have
been reported in multiple studies [7-10]”
b. And discussion: “Concerning results from a study in the US showed that almost 20% of
American adults have never been screened for CRC [17].”
The authors may critically review the manuscript if this is also applicable to other parts of the
manuscript.
2. The problems of overutilization. In the introduction and discussion you address the burden
of overutilization. I agree with your arguments, but you may want to address that although rare,
overutilization might even harm patients, because of the invasive nature of colonoscopy.
3. Distribution, advertising and accessibility of the app is not clear. Please consider adding
information to the methods and/ or discussion.
4. The increase of app usage. In the results and discussion you refer to an increase of app usage.
Cumulative numbers increase, which is obvious, as they would only stagnate if usage ended.
But just from Figure 2, it is hard to see an increase of daily consultations. If there is one, please
also add some numbers to the text. If not, please rephrase.
5. Discussion: Avoidance/ savings of screening and surveillance.
a. As you don’t have actual data on how many persons would have utilized the procedures
without the app and how many avoided it because of the app, I would suggest “softer” wording,
e.g. instead of “(c) 68.2% and 50% of patients could avoid colonoscopy for CRC screening and
surveillance” -> “(c) in 68.2% and 50% of patients the app recommended to avoid colonoscopy
for CRC screening and surveillance and recommended FOBT instead”
b.  “69% savings in screening colonoscopies and 29% savings in post-polypectomy surveillance
colonoscopies”  -> I don’t understand where these numbers come from?
Minor:
Please note that there are several typos and errors in usage of upper and lower case. For example
2400 (13%) had history of first-degree CRC before de age of 50” and several minor errors in
Table 2. Please critically review the manuscript and correct further typos and errors.
assistant