Regular stool tests and preventive colonoscopies can significantly reduce the number of colorectal cancers and deaths in Germany – with high participation, both strategies are almost equally effective. This is shown by a new simulation study by the German Cancer Research Center (DKFZ) on Colorectal Cancer Awareness Month in March.

In Germany, women and men aged 50 and over can choose between two preventive care options: an immunological test for hidden blood in the stool (FIT) every two years or up to two colonoscopies ten years apart. If the stool test is positive, a colonoscopy follows. Researchers led by Hermann Brenner from the DKFZ have compared the long-term effects of both methods using an established simulation model.

With consistent use, up to three quarters of all colorectal cancers can be prevented. The number of deaths from colorectal cancer can even be reduced by more than 80 percent – regardless of whether prevention is primarily via stool testing or colonoscopy. Particularly strong effects result from a combination, such as colonoscopies at a younger age and supplementary stool tests at an older age.

Preventive colonoscopy is more complex, but it detects and removes precancerous lesions directly. The stool test is less invasive, must be repeated more frequently and only results in an endoscopy if the result is positive. In terms of their long-term effectiveness against colorectal cancer, both approaches are comparable with regular participation.

The decisive factor is the high participation rate. The actual use of colorectal cancer screening in Germany is significantly lower than the rates in countries such as the Netherlands, Denmark or the USA. To increase participation, the researchers recommend well-organized programs with repeated in-person invitations, direct sending of stool tests, and easy appointment scheduling for colonoscopies.

Colorectal cancer remains one of the most common cancers in Germany and one of the leading causes of cancer-related death. The study underlines that an informed decision between the offers is possible and that any consistent screening makes a major contribution to cancer prevention.

The results have been published in the German Medical Journal (DOI: 10.3238/arztebl.m2025.0208).

Original Paper:

Dmitry Sergeev, Thomas Heisser, Michael Hoffmeister, Hermann Brenner: Colonoscopy versus test for blood in the stool versus no preventive examination – Comparative analysis of the long-term effects
German Medical Journal 2026, DOI: 10.3238/arztebl.m2025.0208

Editor: X-Press Journalistenbüro GbR

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