Letter to the Editor:

We agreed with Gulácsi et al. on their perception about our article that did not include those eastern European countries that have recently joined the European Union. It does not mean that we tried to provide partial information or that we wanted to diminish the information with other purposes. In fact, the title of our article when it was sent to be published was: “Screening for colon-rectal cancer in the Europe of fifteen, Norway and Switzerland. So equal, so different. Is it time for a common approach?” and so was the title of the oral communication presented in the Annual Meeting of HTAi held in Montreal last summer (Reference Gutiérrez-Ibarluzea, Asua and Latorre7). Even when we believed that this title was more accurate to the data provided in the article, we finally followed the suggestions of the reviewers to make the title short and comprehensive.

We also agreed with Gulácsi et al. on the importance of highlighting the characteristics of any other colorectal cancer screening programs in our continent and with the importance of establishing them, just in case they came from a profound analysis of the context to be implemented in, as it seems to be the case of Hungary (Reference Boncz, Sebestyén and Dózsa2;Reference Boncz, Sebestyen and Pinter3;Reference Csonka, Molnár, Németh and Ottó5). Nevertheless, our study did not want to describe the differences between all the programs in Europe, but that those differences were not based on real biological, epidemiological, or social dissimilarities among countries that affected colorectal cancer distribution (Reference Berrino, De Angelis and Sant1). Moreover, we highlighted that the differences found in the screening strategies (age-range, techniques, risk factors considered, and follow-up periods) were not justified in results obtained from research studies or regional-national cancer registries.

Our group (Osteba, Basque Office for HTA) has taken part in a recently published document on the situation of population screening programs in Spain (Reference Castells, Sala and Ascunce4). In the case of colorectal cancer, it was observed that the problem was the low response or participation rates (less than 50 percent in all the local experiences described) when comparing with other population screening programs such as breast cancer screening (response rate of more than 80 percent in all cases). These described low response rates were similar in other experiences all around the world and were against supporting widespread screening policies, at least in certain pathologies.

In any case, we should take into account those data and the new available technologies to know the prognosis and the risk to develop certain pathologies. For sure, those new technologies will play a crucial role in the future screening programs for cancer. Those new developments will carry on new practices and new problems especially those related with the management of information and the role that the patient should play in the final decision on a treatment (Reference Tejada, Rueda and Nicolás8).

Finally, in our opinion, we should support common strategies and joint projects among Health Technology Assessment Agencies and networks to promote on time and comprehensive information on decisions of this kind. This would help decision makers to produce the right decision at their context and would avoid certain unjustified dissimilarities as those described in our study (Reference Gutiérrez-Ibarluzea, Asua and Latorre6).