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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