In Reply

We thank our correspondents for their pleasant and mindful feedback to our review article (1).

As far as their criticisms are concerned, we have some comments of our own:

• Hannover Medical School is a sponsor of the multicenter HANSE Study. The HANSE Study is financed jointly by the German Center for Lung Research (DLZ) (2) www.hanse-lungencheck.de/download/flyer.pdf, and AstraZeneca. AstraZeneca supports the HANSE Study in the context of the Global Lung Ambition Alliance, a global association including, among others, AstraZeneca but also other businesses and the patient organization Global Lung Cancer Coalition. AstraZeneca does not have any influence on how the study is carried out scientifically; at no point in time are the company’s products mentioned during contact with participants.

• The HANSE Study’s flyer describes in several places the inclusion criteria of age and smoking consumption for the study. In order not to overload the information on the flyer—which constitutes the first information given to participants—with confusing details we carried out the required detailed checking of the inclusion criteria in a second step, on a web portal. This step too is described with a relevant figure on the flyer. Selection bias was therefore avoided as a result of this controlled study inclusion of participants.

• The question regarding the capacity for doctors to be medical partners in nationwide screening—especially the question of pulmonology capacities—is utterly justified. The recent draft bill from the Federal Ministry for the Environment, Nature Conservation, Nuclear safety, and Consumer Protection already lists GPs and specialists in internal medicine as partners in checking the inclusion criteria and providing the preliminary discussion for lung cancer screening (3). This is indeed a very welcome improvement of the health service density compared with the report from the German Federal Office for Radiation Protection (4).