Correspondence (reply): In Reply

Büchter and colleagues assume on the basis of the title of our study (“Saarland gegen Darmkrebs – Machen Sie mit!“) that the interventions that we tested contradict current health policy aims. We disagree in this point. The supreme objective of health policy in colorectal cancer screening is to lower colorectal cancer incidence and mortality. Accordingly, in addition to the improvement of information offers, the objectives of the German National Cancer Plan (2) include primarily an improved uptake of the offered screening examinations. We focused on both of these objectives in our model project, which was planned in 2011 and conducted from 2012–2015. The information materials were developed at the time the study was being planned, on the basis of the information brochure of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) and with support from the experts of the Cancer Information Service (Krebsinformationsdienst, KID) at the German Cancer Research Center (Deutsches Krebsforschungszentrum).

We agree with the authors of the letter to the editor that everyone should receive balanced information about the benefits and risks and about the offers of colorectal cancer screening according to the claim that is anchored in the law on early detection and registration of cancer (KFRG). To the best of our knowledge and according to the experts involved, this was implemented in an adequate manner. Speaking of a missed opportunity in our study because we did not consider invitation letters and brochures that were developed in the meantime with the involvement of the correspondents from the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) and that were published in December 2016 seems inappropriate. Furthermore, our study materials were made available to the authors from IQWiG in the middle of 2016, and for this reason a balanced interpretation should have been possible for them.

With the SAMS study, we have, for the first time, presented comprehensive empirical data on the efficacy of different invitation schemes in Germany. Regardless of potential advantages and disadvantages of IQWiG’s information materials, which thus far have not been empirically tested in a comparable way, a reduction in the incidence and mortality of colorectal cancer should be the primary concern of all parties involved. A large proportion of the more than 60 000 new cases and the more than 25 000 deaths due to colorectal cancer in Germany per year could be prevented by improving the utilization of screening offers. The decline in colorectal cancer incidence and mortality that is becoming apparent (3) should be strengthened and accelerated as soon as possible by means of an organized screening program (4). Our study aimed to contribute robust empirical evidence to answer the question of how this may best be achieved. We are happy to make the study materials we used (invitation letters, brochures) available to the public and to Deutsches Ärzteblatt for publication as a web appendix.

We thank Mr Wenderlein for his comments that we read with interest, but which do not contribute new insights to the subject of our study.