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MUNICH DECLARATION ON THE EARLY DETECTION OF COLORECTAL CANCER (issued on the occasion of the first interdisciplinary German conference on the early detection of colorectal cancer held in Munich in March 2001) Preamble In 2000, 30,000 of our fellow citizens died from colorectal cancer – that is 30,000 too many. Colorectal cancer can be prevented or cured if detected early. With the legal framework for the early detection of colorectal cancer which had been established 30 years ago neither a reduction in the numbers of newly diagnosed cases nor in the in the fatalities were achieved. Yet, when a public healthcare reform took place in 2000, the legal framework for the early detection of colorectal cancer was retained without any amendments. With more than 50,000 newly detected carcinomas every year, the frequency rate is high and the mortality rate being more than 50 percent. At the same time there is good evidence, that the fatality rate of colorectal cancer could be reduced remarkably by increasing participation in screening. Appropriate measures are available, and they are inexpensive. The early detection of colorectal cancer prevents suffering and preserves life. On the long run, it will also reduce healthcare costs and maintain the productivity of our fellow citizens. This is why it is a matter of urgency that more people learn about early detection of colorectal cancer and undergo an examination. This can only be achieved by a concerted action of all stakeholders. Which early detection measures for whom? It starts with an in-depth conversation with a doctor, who will ask about personal and family anamneses, thereby clarifying the patient’s individual risk. The doctor’s conversation is complemented by a faecal occult blood test (FOBT) carried out once a year beginning at the age of 45 yrs. If the stool test is positive, a full colonoscopy is necessary. Colonoscopy is the only method whereby the preliminary stages and early forms of colorectal cancer cannot only be identified immediately but also be removed. Thus, the FOBT can reduce the risk to contract the disease significantly. Concerning the rate of fatalities it is supposed to drop by 25 to 30 percent when the FOBT is done annually and followed by a colonoscopy clarifying the reason for a positive test. On the other hand, a reduction of 80 to 90 percent of fatal diseases could be achieved by offering people over 50 yrs who have an average risk for colorectal cancer a screening colonoscopy every 10 years. People who due to an inherited risk or an inflammatory bowel disease are at a higher risk to develop the disease must be alerted to their increased risk; in consultation with their doctor and in accordance with their specific situation appropriate screening measures should be planned and carried out. Requirements We call for the number of 30,000 patients, who die every year from colorectal cancer in Germany, to be reduced by half within the next five years, through early detection and the elimination of the preliminary stages and early forms of colorectal cancer. We demand that the numbers of people who participate in colorectal cancer screening is increased to at least 60 percent over the next three years. This can only be achieved by a joined endeavour of doctors, health policy-makers, public health insurers and patients. We need all those involved - healthcare policy-makers, public health insurers and professional medical associations - to join forces to make the public at large aware of the chances of early detection and motivate the at-risk groups to take part in screening. To support this, innovative awareness and education campaigns should be developed in public-private partnerships that are published in as many media as possible (print, TV, Radio, online, posters, leaflets, etc.). We demand that politicians amend the legal framework for the early detection of colorectal cancer and monitor its implementation. We call for doctors to talk to their patients about the chances of colorectal cancer screening and motivate them to take advantage of the offered screening measures. Conclusions Colorectal cancer can, unlike most other tumours, be diagnosed early and is, therefore, curable. The effectiveness of colorectal cancer screening is scientifically proven. Compared with the screening methods for some other cancers which are not quite as effective, colorectal cancer screening is also cost-efficient. We are in a position, to offer our fellow citizens scientifically proven and economically-manageable early detection methods, which eradicate individual risks. We must make use of them! Munich, March 2001 The Signatories: CHRISTA MAAR DAGMAR SCHIPANSKI President of the Felix Burda President of the German Cancer Aid, Foundation, Munich Bonn MEINHARD CLASSEN ROBERT FISCHER President of the Gastroenterology Board member and chairman of the Medical Society in Bavaria, Munich Committee of the German Cancer Aid WOLF SCHMIEGEL ROLF KREIENBERG German Society for Digestive and President of the German Cancer Society, Metabolic Diseases (board), Bochum Berlin JÜRGEN RIEMANN WOLFRAM DOMSCHKE President of the German Society for President of the German Society for Internal Medicine and of the Digestive and Metabolic Diseases Lebensblicke Foundation BERNDT BIRKNER KLAUS DIETER KOSSOW Professional Association of the Chairman of the Professional Association German Internists, of the German General Practitioners and gastroenterology department Family Doctors