In Reply

We thank Dr Völkel and colleagues for their interest in our study. We share their view that epidemiological as well as clinical cancer registry data are essential tools for monitoring and evaluating advances in the prevention, early detection, and therapy of cancer disorders. In their chain of argumentation of the contribution of prevention and therapy to the observed fall in colorectal cancer mortality the authors overlooked, however, that the fall in mortality of up to 40% that we described in our study does not represent a reduction in death rates in patients with colorectal cancer but a reduction in death rates in Germany relative to the total population (1). This fall is largely explained by the only minimally less pronounced drop in colorectal cancer incidence rates, which is the result of advances in prevention, not advances in treatment. Obviously, therapeutic advances may have contributed to the fact that mortality fell somewhat more than the incidence, although even these differences are partly due to screening and the associated earlier detection of tumors. With regard to the evidence for the very high potential and the urgency of better utilization of screening to reduce colorectal cancer mortality, we refer to meta-analyses of epidemiological observational studies and randomized trials (2) as well as studies at the national and international levels (3, 4) that were recently published in collaboration with epidemiological cancer registries. Among others, these studies show a much more pronounced drop in mortality due to colorectal cancer in Germany than in countries with comparable advances in therapy but without comparable colorectal cancer screening programs, such as Norway and Sweden (4).