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Kaimen Rigor review

Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial.

Westerberg M, Ludvigsson JF, Metcalfe C, Strömberg U, Blom J, Engstrand L, Hellström M, Löwbeer C, Steele R, Holmberg L, Forsberg A

DOI: 10.1038/s41591-026-04225-9
Record issued: 2026-08-15
Engine: 7.39.0
Exported: 2026-09-22

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/b5a5b193-b18c-41e4-98f3-fd69b32f7462 is authoritative.

Kaimen Rigor review

Kaimen Rigor reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated

Started at 5★ — deductions

IntegrityIntegrity concern ×3−1.5★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Biggest issues

01Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary efficacy claim is based on an increase in detection of early-stage (I–II) colorectal cancer, which is a surrogate for the ultimate clinical outcome of reduced CRC mortality. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD linking the screening intervention to the surrogate) nor cite validated evidence that an increase in stage I–II detection alone translates into reduced CRC mortality. The authors acknowledge that the trial duration is too short to detect a net benefit in CRC incidence or mortality, and that the excess early-stage cancers may represent overdiagnosis.
“The duration of the trial is likely too short to detect a net benefit of the prevention in terms of a lower CRC incidence in the intervention arms compared to controls and/or to determine if a part of the early-stage CRC excess risk in the intervention arms…”
Find in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary reported effect is an increase in stage I–II CRC detection (IRR 1.38 for colonoscopy, 1.19 for FIT), but the absolute rates are small (58.7 vs 42.5 per 100,000 person-years for colonoscopy) and the paper does not anchor this to a minimal clinically important difference or demonstrate that this translates into a meaningful clinical benefit. The authors note that the trial is underpowered for mortality and that the increase may represent overdiagnosis.
“The duration of the trial is likely too short to detect a net benefit of the prevention in terms of a lower CRC incidence in the intervention arms compared to controls and/or to determine if a part of the early-stage CRC excess risk in the intervention arms…”
Find in source

Findings by category

101ArithmeticNumerical inconsistencies 302OverreachOverstated conclusions 103AuthenticityData authenticity concerns 04DisclosureNone found 05AvailabilityNone found 06Copyedit6 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported randomized controlled trial. The methods are rigorous, ethical approvals are documented, and data/code availability is exemplary. The only notable issues are minor reporting gaps (no explicit CONSORT statement) and a few copyedit-level inconsistencies in numbers.

Both reviewers classified the study as interventional (RCT), and I adopt that classification. The evaluation covered the full text, with verification components for citations, statistics, reproducibility, and preregistration. Non-applicable sub-criteria (e.g., animal housing, cell lines) were excluded. The reviewers diverged only on whether the reporting guideline was 'reported but inadequate' or 'not reported'; I synthesized as 'reported but inadequate' since the paper follows a structured format but lacks an explicit CONSORT statement.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 2 tests: 2 consistent, 0 inconsistent; 2 via agent-written checks.

Agent-written checks— recomputed from reported CIs / ratios by code the agent wrote

CONSISTENTreported p = .400 · recomputed p = .377Reviewers 1, 2
IRR for CRC incidence in colonoscopy arm vs control
“incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91–1.28”
Find in source
Taken as given: The IRR is a ratio estimate with a 95% CI.; The CI is two-sided at 95%.
Method: Two-sided p-value derived from the estimate and CI assuming a normal distribution for the log IRR.
How we recomputed it: pCI(1.08, 0.91, 1.28, 1)
CONSISTENTreported p = .200 · recomputed p = .208Reviewers 1, 2
IRR for CRC incidence in FIT arm vs control
“IRR: 0.92, 95% CI: 0.81–1.05”
Find in source
Taken as given: The IRR is a ratio estimate with a 95% CI.; The CI is two-sided at 95%.
Method: Two-sided p-value derived from the estimate and CI assuming a normal distribution for the log IRR.
How we recomputed it: pCI(0.92, 0.81, 1.05, 1)

lowinternal contradiction
The number of individuals randomized to the primary colonoscopy arm is reported as 31,140 in the Methods, but the analysis includes 31,113. The difference is not explicitly explained.
“In total, 31,140 individuals were randomized to the primary colonoscopy arm; 60,300 individuals were randomized to the FIT×2 arm; and there were two control groups: 186,840 controls to the primary colonoscopy arm, out of which 120,600 individuals also were controls to the FIT×2 arm (FIT×2 controls).”
MethodsFind in source
lowinternal contradiction
The total number of randomized individuals is reported as 278,280, but the final analysis includes 278,051 after exclusions; this is explained but could be a source of confusion.
A total of 278,280 individuals were randomized. ... There were 278,051 unique individuals included in the final analyses
Abstractreviewer’s wording

Overstated conclusions

3 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

6 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

partialReviewers 1, 2
The increase in CRC detection implies a benefit of screening.
The increase in early-stage detection is suggestive of benefit, but the paper acknowledges that the trial duration is too short to confirm a net benefit in incidence or mortality.
Evidence: The paper states that the duration is too short to detect a net benefit.
“The duration of the trial is likely too short to detect a net benefit of the prevention in terms of a lower CRC incidence in the intervention arms compared to controls”
DiscussionFind in source
supportedReviewer 1
Colonoscopy and FIT screening increase the detection of early-stage colorectal cancers compared to usual care.
The paper reports higher incidence rates of stage I-II CRC in both intervention arms with statistically significant or borderline CIs.
Evidence: Table 2 shows IRR 1.38 (95% CI 1.09-1.74) for colonoscopy and IRR 1.19 (95% CI 0.99-1.43) for FIT for stage I-II CRC.
“Rates of stage I–II CRC were higher in the colonoscopy arm (IRR: 1.38, 95% CI: 1.09–1.74) and in the FIT arm (IRR: 1.19, 95% CI: 0.99–1.43) versus controls.”
AbstractFind in source
supportedReviewer 1
Screening is associated with a slight increase in adverse events during the first year.
The paper reports higher rates of gastrointestinal and cardiovascular events in the first year, which is consistent with the claim.
Evidence: Figure 3 and text describe higher event rates in the first year.
“Rates of cardiovascular and gastrointestinal events were slightly higher in the intervention arms during the first year and were subsequently more similar to controls.”
AbstractFind in source
supportedReviewer 1
The increase in adverse events suggests some initial harm.
The paper reports higher rates of adverse events in the first year, supporting the claim of initial harm.
Evidence: Figure 3 and text describe higher event rates in the first year.
“the increase in adverse events suggests some initial harm.”
AbstractFind in source
supportedReviewer 2
Colonoscopy or FIT screening increases the proportion of early-stage CRC diagnoses relative to usual care.
The claim is supported by the reported higher incidence rates of stage I-II CRC in the intervention arms compared to controls.
Evidence: Table 2 shows IRR for stage I-II CRC of 1.38 (95% CI 1.09-1.74) for colonoscopy and 1.19 (95% CI 0.99-1.43) for FIT.
“Rates of stage I–II CRC were higher in the colonoscopy arm (IRR: 1.38, 95% CI: 1.09–1.74) and in the FIT arm (IRR: 1.19, 95% CI: 0.99–1.43) versus controls.”
AbstractFind in source
supportedReviewer 2
Adverse events are slightly higher in the first year but similar later.
The claim is supported by the reported incidence rates and IRRs for cardiovascular and gastrointestinal events.
Evidence: Figure 3 and Table 3 show slightly higher rates in the first year, with IRRs near 1.0 at the end of follow-up.
“Rates of cardiovascular and gastrointestinal events were slightly higher in the intervention arms during the first year and were subsequently more similar to controls.”
AbstractFind in source

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

INADEQUATESurrogate endpoint
The primary efficacy claim is based on an increase in detection of early-stage (I–II) colorectal cancer, which is a surrogate for the ultimate clinical outcome of reduced CRC mortality. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD linking the screening intervention to the surrogate) nor cite validated evidence that an increase in stage I–II detection alone translates into reduced CRC mortality. The authors acknowledge that the trial duration is too short to detect a net benefit in CRC incidence or mortality, and that the excess early-stage cancers may represent overdiagnosis.
“The duration of the trial is likely too short to detect a net benefit of the prevention in terms of a lower CRC incidence in the intervention arms compared to controls and/or to determine if a part of the early-stage CRC excess risk in the intervention arms represents an overdiagnosis of clinically insignificant CRCs.”
Find in source
INADEQUATEEffect size
The primary reported effect is an increase in stage I–II CRC detection (IRR 1.38 for colonoscopy, 1.19 for FIT), but the absolute rates are small (58.7 vs 42.5 per 100,000 person-years for colonoscopy) and the paper does not anchor this to a minimal clinically important difference or demonstrate that this translates into a meaningful clinical benefit. The authors note that the trial is underpowered for mortality and that the increase may represent overdiagnosis.
“The duration of the trial is likely too short to detect a net benefit of the prevention in terms of a lower CRC incidence in the intervention arms compared to controls and/or to determine if a part of the early-stage CRC excess risk in the intervention arms represents an overdiagnosis of clinically insignificant CRCs.”
Find in source

Data authenticity concerns

1 finding · worst low

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Other integrity concernAssessed

3 integrity concerns flagged (0 high).

lowother
The paper reports a higher rate of venous thromboembolism in the FIT arm (IRR 1.39) but does not discuss this in the abstract, which may be an oversight.
“the rate of venous thromboembolism was 60.1 in the FIT×2 arm compared to 43.3 in corresponding controls (IRR: 1.39, 95% CI: 1.16–1.66)”
ResultsFind in source

Reporting gaps

None found

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Checked — nothing surfaced.

Eight Dimensions8 pass

The introduction cites guidelines and prior trials (COLONPREV, NordICC) and notes the limited evidence from RCTs on primary colonoscopy and FIT versus usual care. The rationale for the study is logically derived from these gaps, and the study aims to quantify benefits and harms. Limitations of prior work are implicitly addressed by the trial's design (e.g., including a control arm).

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise by citing prior research on CRC screening and identifying gaps in evidence, particularly the lack of RCTs comparing FIT to usual care.

Evidence

paraphrase[Main, paragraph 1]

“There are several trials of colonoscopy screening, but few have examined FIT compared to usual care.”

“The aim of the present study was to assess if the randomization has resulted in the three arms being similar in terms of baseline demographic variables and medical history and to assess if the screening approaches resulted in a higher rate of diagnosis of CRC during the diagnostic phase, especially stage I–II CRC, compared to usual care.”

Main, paragraph 2Find in source

paraphrase[Discussion, paragraph 1]

“Paraphrase: The paper notes that other ongoing RCTs (COLONPREV, CONFIRM) lack a control arm, whereas SCREESCO includes a usual care control.”

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise by citing prior research on CRC screening and identifying the gap in evidence for FIT versus usual care.

Evidence

“The American College of Gastroenterology and the European Society of Gastrointestinal Endoscopy recommend CRC screening in individuals aged 50–75 years by colonoscopy or FIT”

Main, paragraph 1Find in source

“There are several trials of colonoscopy screening, but few have examined FIT compared to usual care”

Main, paragraph 2Find in source

paraphrase[Discussion, paragraph 1]

“The only ongoing RCTs other than the SCREESCO trial, involving both primary colonoscopy and FIT, are the Spanish trial COLONPREV and the American trial Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality from Colorectal Cancer (CONFIRM), neither of which has a control arm.”

Randomization used a randomized block method with stratification by year, region, and sex. The unit of randomization is the individual. Blinding was not possible due to the nature of the intervention, which is stated. Power calculations were performed for the primary endpoint (CRC mortality) and revised due to lower participation. Inclusion/exclusion criteria are pre-specified. Outlier handling is addressed through intention-to-screen analysis and censoring. Controls are the usual care arm. Independent replication is not applicable for a single pivotal trial.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous with clear randomization, pre-specified eligibility criteria, and a priori power calculations; blinding was not possible but is acknowledged.

Evidence

“a randomized block method was used to assign 201,000 individuals born 1954–1956 without prior CRC diagnosis to once-only primary colonoscopy, two rounds of FIT 2 years apart (FIT×2) or a usual care control arm”

MethodsFind in source

“Masking was not possible due to the nature of the trial.”

MethodsFind in source

“A priori, the study was powered to detect a 17.5% decrease in CRC mortality at 15 years in individuals invited to colonoscopy compared to the control arm and a 15% decrease in individuals invited to FIT compared to the control arm”

MethodsFind in source

PASSReviewer 2· 95% conf

The trial design is rigorous with clear randomization, pre-specified eligibility, and power calculations, though blinding was not possible.

Evidence

MethodsFind in source

“Masking was not possible due to the nature of the trial.”

MethodsFind in source

Sex is reported for all arms with balanced proportions. Age is fixed at 60 years. Demographics include educational level, country of birth, and comorbidity indices. Health status is captured via Charlson Comorbidity Index and prior events. Species/strain and housing conditions are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Biological variables are well reported for a human trial: sex, age, and demographics are detailed; species/strain and housing are not applicable.

Evidence

“Men | 15,550 | (50.0) | 93,309 | (50.0) | 30,128 | (50.0) | 60,261 | (50.0)”

Table 1Find in source

“assigned 278,280 individuals aged 60 years”

AbstractFind in source

paraphrase[Table 1]

“Educational level | Low | 5,704 | (18.3) | 34,378 | (18.4) | 11,569 | (19.2) | 23,134 | (19.2)”

PASSReviewer 2· 90% conf

Biological variables are well reported for a human trial, including sex, age, and demographics.

Evidence

“Men | 15,550 | (50.0) | 93,309 | (50.0) | 30,128 | (50.0) | 60,261 | (50.0)”

Table 1Find in source

“assigned 278,280 individuals aged 60 years”

AbstractFind in source

paraphrase[Table 1]

“Educational level | Low | 5,704 | (18.3) | 34,378 | (18.4) | 11,569 | (19.2) | 23,134 | (19.2)”

The Stockholm Ethics Committee approved the study (2012/2058-31/3) and the review of medical charts (2015/1958-2). The Swedish Ethical Review Authority waived the need for informed consent for accessing pseudonymized register-based data (2022/01946-02 and 2022/06863-2). Written informed consent was obtained from invited individuals. Regulatory compliance is implied by adherence to Swedish ethical review processes.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approvals are clearly documented with named committees and protocol numbers, and informed consent is described.

Evidence

“The Stockholm Ethics Committee approved the study (2012/2058-31/3) and the review of medical charts (2015/1958-2).”

MethodsFind in source

“All individuals invited for screening signed a written informed consent for the procedure and for biobanking of samples.”

MethodsFind in source

“The Swedish Ethical Review Authority waived the need for informed consent for accessing pseudonymized register-based data (2022/01946-02 and 2022/06863-2).”

MethodsFind in source

PASSReviewer 2· 95% conf

Ethical approvals and consent are clearly documented.

Evidence

“The Stockholm Ethics Committee approved the study (2012/2058-31/3)”

MethodsFind in source

“All individuals invited for screening signed a written informed consent for the procedure and for biobanking of samples.”

MethodsFind in source

“The Swedish Ethical Review Authority waived the need for informed consent for accessing pseudonymized register-based data (2022/01946-02 and 2022/06863-2).”

MethodsFind in source

The FIT test uses a single OC-Sensor DIANA automated analyzer (Eiken Chemical). Colonoscopy is described as a procedure. Software used for analysis is R version 4.0.2 and Stata 13.1. Custom code is available on GitHub. Antibodies, cell lines, mycoplasma, and organisms are not applicable.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The investigational product (FIT kit and colonoscopy) is identified with manufacturer and analyzer; software is identified with version and code repository.

Evidence

“One central laboratory performed all FIT analyses using a single OC-Sensor DIANA automated analyzer (Eiken Chemical).”

MethodsFind in source

“Stata version 13.1 and R version 4.0.2 were used for power calculations. Analyses were performed using R version 4.0.2.”

Statistical analysisFind in source

“The code was written in R version 4.0.2 using RStudio and is available at https://github.com/MarcusWesterberg/CRCs-and-AEs-during-diagnostic-phase-of-SCREESCO”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Key resources are adequately identified, including the FIT analyzer and statistical software.

Evidence

“One central laboratory performed all FIT analyses using a single OC-Sensor DIANA automated analyzer (Eiken Chemical).”

MethodsFind in source

“Stata version 13.1 and R version 4.0.2 were used for power calculations. Analyses were performed using R version 4.0.2.”

Statistical analysisFind in source

Poisson regression models were used to compute incidence rate ratios with 95% CIs. The paper reports effect sizes with CIs, which is the primary reporting style. Exact p-values are not reported, but the analysis is estimation-based, so this is not a deficiency. Assumptions of equidispersion were checked. Data presentation includes per-group Ns and rates with CIs. Mathematical plausibility checks were not performed due to large N and continuous outcomes.

Sub-criteria

tests namedADEQUATE

exact p valuesN/A

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well-described; effect sizes are reported with confidence intervals, and software is identified.

Evidence

“We compare each intervention arm with the corresponding control arm concerning each of the outcomes using incidence rates and IRRs using Poisson regression models with 95% CIs.”

Statistical analysisFind in source

“incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91–1.28”

AbstractFind in source

“We assessed potential violations of equidispersion for each regression model and computed alternative CIs by use of robust standard errors.”

Statistical analysisFind in source

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well reported, with effect sizes and confidence intervals.

Evidence

“We compare each intervention arm with the corresponding control arm concerning each of the outcomes using incidence rates and IRRs using Poisson regression models with 95% CIs.”

Statistical analysisFind in source

“We assessed potential violations of equidispersion for each regression model and computed alternative CIs by use of robust standard errors.”

Statistical analysisFind in source

“incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91–1.28”

AbstractFind in source

The data availability statement explains that individual-level data cannot be shared publicly due to privacy and legislation, but provides a concrete route for access via the SCREESCO Steering Committee with conditions and timeframe. Code is available on GitHub. Repository deposit and accession numbers are not applicable for patient-level data.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data availability is clearly described with a managed-access mechanism, and code is shared in a public repository.

Evidence

“Selected deidentified individual participant data that underlie the results reported in this article (including in the supplementary materials) can, however, be made available to researchers after request to the SCREESCO Steering Committee.”

Data availabilityFind in source

“The code was written in R version 4.0.2 using RStudio and is available at https://github.com/MarcusWesterberg/CRCs-and-AEs-during-diagnostic-phase-of-SCREESCO”

Data availabilityFind in source

PASSReviewer 2· 95% conf

Data availability is well described with a managed access process, and code is shared in a public repository.

Evidence

Data availabilityFind in source

“The code was written in R version 4.0.2 using RStudio and is available at https://github.com/MarcusWesterberg/CRCs-and-AEs-during-diagnostic-phase-of-SCREESCO”

Data availabilityFind in source

The trial is registered (NCT02078804). Methods are detailed enough for replication. Limitations are explicitly discussed, including participation rates and potential misclassification. Conclusions are proportional, noting the diagnostic phase and future mortality outcomes. Funding and competing interests are declared. A reporting guideline is not explicitly mentioned, but the paper follows standard reporting.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineINADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The manuscript is transparent with trial registration, detailed methods, discussion of limitations, and proportional conclusions.

Evidence

“ClinicalTrials.gov: NCT02078804”

AbstractFind in source

“This study also has some limitations.”

Discussion ¶5Find in source

“Financial support was provided by the Swedish regions (A.F.), Regional Cancer Center Mellansverige (A.F.), the Swedish Cancer Society (A.F.; 2018/595 and 2021/1628), the Aleris Research and Development Fund (A.F.) and Eiken Chemical (A.F.).”

AcknowledgementsFind in source

PASSReviewer 2· 90% conf

Reporting is transparent with trial registration, protocol amendments, and limitations discussed.

Evidence

“ClinicalTrials.gov: NCT02078804”

AbstractFind in source

“This study also has some limitations.”

Discussion ¶5Find in source

AcknowledgementsFind in source

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

ClinicalTrials.gov

NCT02078804

Broken references and links

None found

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

Checked — nothing surfaced.

Checked 40 references by DOI: 1 verified — 39 no DOI (shown, not verified).

NO DOI
ACG clinical guidelines: colorectal cancer screening 2021
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Fecal immunochemical test positivity thresholds: an international survey of population-based screening programs
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Nordic colorectal cancer screening programmes: a comparison of organization, operation, and quality indicators
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Routine fecal occult blood screening and colorectal cancer mortality in Sweden
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colonoscopy vs. fecal immunochemical test in reducing mortality from colorectal cancer (CONFIRM): rationale for study design
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of colonoscopy screening on risks of colorectal cancer and related death
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effectiveness of colonoscopy screening vs sigmoidoscopy screening in colorectal cancer
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Baseline features and reasons for nonparticipation in the colonoscopy versus fecal immunochemical test in reducing mortality from colorectal cancer (CONFIRM) study, a colorectal cancer screening trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Impact of colorectal cancer screening on cancer-specific mortality in Europe: a systematic review
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): a pragmatic, randomised, controlled, non-inferiority trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian randomized controlled trial—SCORE
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Randomised study of screening for colorectal cancer with faecal-occult-blood test
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Randomised controlled trial of faecal-occult-blood screening for colorectal cancer
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Reducing mortality from colorectal cancer by screening for fecal occult blood
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Overdiagnosis in colorectal cancer screening: time to acknowledge a blind spot
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colonoscopy-related adverse events in patients with abnormal stool-based tests: a systematic review of literature and meta-analysis of outcomes
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The completeness of the Swedish Cancer Register – a sample survey for year 1998
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
External review and validation of the Swedish national inpatient register
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Colorectal cancer screening: a global overview of existing programmes
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Increased post-procedural non-gastrointestinal adverse events after outpatient colonoscopy in high-risk patients
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Age-specific rates and time-courses of gastrointestinal and nongastrointestinal complications associated with screening/surveillance colonoscopy
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Registers of the Swedish total population and their use in medical research
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The healthcare system in Sweden
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Evaluation of the Swedish Colorectal Cancer Registry: an overview of completeness, timeliness, comparability and validity
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The Swedish cause of death register
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Discriminative ability of the Charlson Comorbidity Index for long-term mortality in a general population: nationwide, population-based study of 10 million adults in Sweden
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
An aggregated comorbidity measure based on history of filled drug prescriptions: development and evaluation in two separate cohorts
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The first decade with the Swedish prescribed drug register – a systematic review of the output in the scientific literature
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

5 data/code links checked; 5 live.

datahttps://etikprovningsmyndigheten.seLIVEHTTP 200
Resolves, but the content could not be matched to the paper.
datahttps://www.socialstyrelsen.se/en/LIVEHTTP 200
Resolves, but the content could not be matched to the paper.
datahttps://www.scb.se/en/LIVEHTTP 200
Resolves, but the content could not be matched to the paper.
codeGitHubLIVEHTTP 200
https://github.com/MarcusWesterberg/CRCs-and-AEs-during-diagnostic-phase-of-SCREESCO
Resolves to GitHub (code repository).
codeGitHubLIVEHTTP 200
http://github.com/MarcusWesterberg/CRCs-and-AEs-during-diagnostic-phase-of-SCREESCO
Resolves to GitHub (code repository).

Copyediting

6 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 6 minor suggestions below.

6 copyedit issues flagged: mostly consistency, typo, clarity.

MINORtypoTable 1, 'Any prior cardiovascular or gastrointestinal event' row
“17,2738”
→ 17,2738 should likely be 172,738
Likely a typographical error in the control arm count.
MINORconsistencyAbstract and Methods
“278,280 individuals”
→ Ensure consistent use of the total randomized number throughout.
The abstract states 278,280 randomized, but the final analysis includes 278,051; this is explained but could be clarified.
MINORclarityMethods, Statistical analysis
“We assessed potential violations of equidispersion for each regression model and computed alternative CIs by use of robust standard errors.”
→ Clarify whether robust standard errors were used in the final analysis or only as sensitivity.
The sentence is slightly ambiguous about the final analysis approach.
MINORtypoAbstract
“fecal immunochemical testing (FIT) compared with usual care with no screening.”
→ Consider rephrasing for clarity: 'compared with usual care (no screening)'.
Minor clarity issue.
MINORconsistencyTable 1
“17,2738”
→ Should be '172,738'.
Typographical error in the number.
MINORconsistencyMethods, Power calculations
“31,140 individuals were randomized to the primary colonoscopy arm; 60,300 individuals were randomized to the FIT×2 arm”
→ Ensure these numbers match the final analysis numbers (31,113 and 60,267) and clarify the discrepancy.
Potential inconsistency between randomized and analyzed numbers.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust and methodologically sound. An informed reader should weigh the minor reporting gaps (no explicit CONSORT statement, minor number inconsistencies) and the fact that the primary mortality endpoint is not yet reported. No erratum is warranted for the copyedit issues, but the authors should consider a correction for the typo in Table 1 (17,2738) and clarify the randomized vs. analyzed numbers.

1.
HIGHcopyedit
Correct the typo in Table 1: change '17,2738' to '172,738' in the 'Any prior cardiovascular or gastrointestinal event' row.
This is a clear numerical typo that could mislead readers and should be corrected via an erratum.
2.
HIGHreporting
Add an explicit statement of adherence to CONSORT (or another reporting guideline) in the Methods or a Reporting Summary.
Both reviewers noted the absence of an explicit reporting guideline statement, which is a standard expectation for RCTs and would enhance transparency.
3.
MEDIUMreporting
Clarify the discrepancy between the number randomized (31,140 in Methods) and the number analyzed (31,113) in the primary colonoscopy arm, and similarly for the FIT arm (60,300 vs 60,267).
The integrity check flagged these internal contradictions; explaining the exclusions will prevent reader confusion.
4.
MEDIUMreporting
Clarify the total number randomized (278,280) versus the number analyzed (278,051) in the abstract or methods.
The copyedit noted this inconsistency; a brief explanation of exclusions would improve clarity.
5.
MEDIUMstatistics
Clarify in the Methods whether robust standard errors were used in the final analysis or only as a sensitivity check.
The copyedit flagged this ambiguity; specifying the primary analysis approach is important for reproducibility.
6.
MEDIUMreporting
Consider reporting exact p-values for key comparisons in addition to confidence intervals, or note that they are available on request.
Both reviewers suggested this to facilitate meta-analyses and provide more complete statistical reporting.
7.
MEDIUMdata code
Provide a DOI or versioned release for the GitHub code repository to ensure permanent access.
Reviewer 2 suggested this to improve long-term reproducibility.
8.
LOWreporting
Add a note on the generalizability of findings to other age groups, as the study only included 60-year-olds.
Reviewer 2 noted this limitation; a brief statement would help readers interpret the applicability.
9.
LOWreporting
Consider discussing the higher rate of venous thromboembolism in the FIT arm (IRR 1.39) in the abstract or discussion.
The integrity check noted this finding is not discussed in the abstract; highlighting it would improve balance.
10.
LOWcopyedit
Rephrase the abstract sentence 'fecal immunochemical testing (FIT) compared with usual care with no screening' to 'compared with usual care (no screening)' for clarity.
Minor clarity improvement suggested by the copyedit pass.

Full text (58,708 chars)Analyzed: Aug 15, 2026

RigorReviewer 1

RigorReviewer 2

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

ReproducibilityLink verification (liveness + content)· no model (rule-based)

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial.

Westerberg M, Ludvigsson JF, Metcalfe C, Strömberg U, Blom J, Engstrand L, Hellström M, Löwbeer C, Steele R, Holmberg L, Forsberg A

DOI

10.1038/s41591-026-04225-9

Record issued

2026-08-15

Engine

7.39.0

Exported

2026-09-22