We appreciate the comments from Wernly et al. (1) on our cohort study in which we reported the benefit of colonoscopy screening according to individuals’ risk profiles. First, we agree that the effect size of the 8 risk factors constituting the risk profile in relation to colorectal cancer may vary and that using weighted scores can improve risk stratification. However, we chose the equal weighing approach to simplify 1) the interpretation of our findings (ie, 1-unit increase in the score represents an improvement in 1 risk factor); and 2) the public health message for potential clinical translation in the future. Also, a similar approach has been widely used by other groups in prior studies (2,3). Second, we agree that some of the 8 risk factors may have biological interactions. However, the primary goal of our study is to test the clinical translational potential of using the risk factor data to improve cancer prevention rather than to best capture the biological effect of these factors. Finally, regarding the comment on accounting for sex, because our 2 cohorts are sex-specific (the Nurses’ Health Study includes women only and the Health Professionals Follow-up Study includes men only), all our analyses were stratified by cohort, and we additionally showed our main finding for women and men separately in the supplementary data of our original study (see the Supplementary Materials, available online). Our definition of tall stature is also sex specific. Nonetheless, we would like to thank Wernly et al. (1) for their comments.
Funding
This work was supported by the American Cancer Society Mentored Research Scholar Grant (MRSG-17–220-01-NEC to M.S.) and the U.S. National Institutes of Health (NIH) grants [K99 CA215314 and R00 CA215314 to M.S.].
Notes
Role of the funder: The National Institutes of Health had no role in the design, conduct, analysis, or reporting of this study. The funding sources did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclosures: The authors have no disclosures.
Author contributions: Writing, original draft—KW, MS; writing, editing and revision—KW, MS.
Data Availability
No new data were generated or used for this response.
Contributor Information
Kai Wang, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Mingyang Song, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No new data were generated or used for this response.