Several online calculators estimate colorectal cancer risk, but their consistency is unknown. Our objectives were to quantify the variation in predicted risk and to determine which calculators are best used in the clinical setting.
We used the Google search engine to identify online colorectal cancer risk calculators and assessed each's output for 3 hypothetical screening scenarios (low-, average-, and high-risk), varied by age (50, 62, 75 years), sex, and race (Black, White), with risk levels based on risk-appropriate values for variables in each model. Estimated risks for models within a given scenario were rated as consistent or inconsistent based on comparison to either the absolute magnitude of difference or average lifetime risk of colorectal cancer. Summary statistics for consistent and inconsistent estimates were compared using Chi-square and Fisher's exact tests.
We identified 5 online colorectal cancer risk calculators. Inconsistencies were found in none of 5-year, 19% of 10-year, and 81% of lifetime colorectal cancer risk estimate comparisons (p<0.001). For a 50-year-old, 22% of risk estimate comparisons were inconsistent versus 33% for a 62-year-old, and 36% for a 75-year-old (p=0.14).
Online colorectal cancer risk models are more consistent in predicting colorectal cancer risk for 5- and 10-year time frames compared to lifetime. For a U.S. population, the National Cancer Institute's Colorectal Cancer Risk Assessment Tool is a rigorously developed calculator that can be used in the clinical setting to provide 5-year and lifetime risk estimates.
• Currently available colorectal cancer risk calculators are more consistent in estimating risk for shorter time frames than for longer time frames. • The methodology with which a model was developed, population of interest, and desired time frame for risk estimates should be considered when deciding which risk calculator to use for screening decision-making. • The National Cancer Institute Colorectal Cancer Risk Assessment Tool provides the most accurate estimates for a U.S. patient population.
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Accepted: August 9, 2022
Received in revised form: August 3, 2022
Received: September 19, 2021
Publication stageIn Press Journal Pre-Proof
Running Title: Colorectal Cancer Risk Calculators
© 2022 Published by Elsevier Inc.