Review for 10.1186/s12876-025-03779-1 (2025)

Title: Clinical application and effectiveness analysis of modified Asia-Pacific colorectal cancer
screening score combined with fecal occult blood test for colorectal cancer screening in
asymptomatic population
Version: 0 Date: 24 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the regional focus on Wannan is vital, the introduction could briefly discuss national
initiatives or strategies in China related to CRC screening to underscore how this study fits into
broader public health goals. Comparing the region's high CRC incidence to national trends could
strengthen the justification for the study.
-The introduction mentions various demographic factors like BMI and smoking history but does
not elaborate on their specific roles in CRC detection. A brief explanation of how these risk
factors interact and how the modified APCS scoring system accounts for them could provide
additional clarity.
-While the inclusion criteria are well-defined, more information on the demographic
characteristics (e.g., age distribution, gender breakdown) of the participants could provide better
context. This information is crucial for understanding the applicability of the findings to different
subgroups.
-It would be helpful to explain how missing or incomplete data will be handled in the statistical
analysis. If any patients withdraw or are lost to follow-up, addressing how this would impact
the results would improve the methodology's robustness.
-The methodology mentions that individuals with a positive FOBT result are recommended to
undergo colonoscopy. It would be beneficial to define what constitutes a "positive" FOBT result
and whether any cutoff values or thresholds are applied.
-Although the study includes colonoscopy and pathology as the gold standard for CRC diagnosis,
it would be valuable to follow up with participants over time to assess the long-term effectiveness
of the combined screening approach in reducing CRC-related mortality and improving survival
rates.
-The mention that a family history of CRC did not show statistical significance in this study
may benefit from additional clarification. The discussion briefly attributes this to a small sample
size, but a deeper exploration of how sample size could influence statistical power, in this case,
would add transparency.
-It would also be helpful to clarify if there were any interactions between the different risk factors
(e.g., BMI and smoking history) that could influence CRC detection, rather than just reporting
their individual significance.
-The discussion points out that low adherence to FOBT limits its overall benefit for CRC
screening, but it could delve more into why adherence is low (e.g., issues with the test’s perceived
accuracy or patient reluctance) and potential solutions. For example, strategies to improve
patient compliance or education around FOBT could be included to strengthen the argument
for its use.
-While the discussion compares modified APCS with FOBT to Western colonoscopy-based
screening programs, it might be helpful to include some specific details about the cost-
effectiveness and resource allocation of these approaches, especially in settings with limited
healthcare resources. This could be a key point for regions looking to implement similar
screening strategies.