The primary outcome of this study is the construction of risk prediction models for significant bowel disease risk. These models will be created by combining colorectal cancer (CRC) genetic risk variants, novel biomarkers, genetic scores of other biomarkers, family history, demographic data, clinical and lifestyle factors. The models will be assessed to check their accuracy and suitability. These risk prediction models could potentially be used in primary care settings to assist in directing endoscopy resources to those who would benefit most. The study objectives are: To recruit 5,000 patients with bowel symptoms referred to NHS Lothian and South East Scotland Colorectal Surgery/Lower GI services through normal referral processes who are undergoing colonoscopy, CT colonography and/or clinic review. To develop and assess risk prediction models of colorectal cancer risk for patients with symptoms using combinations of identified risk factors. To estimate the public health impact and perform cost effectiveness analysis of the risk stratification. To engage proactively with policy makers to promote the translation of our findings into action. This article was published on 2024-09-24