The author replies.

Bowel Cancer Awareness Campaign significantly increased the demand for colorectal services and has the potential for more favorable oncological outcomes. We are surprised by the results published and are cautious regarding the positive impact of the awareness campaign. our study noted no significant increase in the number of detected cancers over 3 months. We acknowledge that our review may be influenced by the shortened time and seasonal variations in referral patterns, although this is unlikely to affect results so drastically. Furthermore, we demonstrated a reduction in the proportion of patients with both colorectal polyps and cancer detected after the launch of the campaign owing to the large increase in the number of referrals that were normal. We found no evidence to support the theory that cancers were detected at an earlier stage after the initiation of the campaign. these findings echo those of the bowel cancer awareness campaign pilot study that also demonstrated no increase in the overall number of new diagnoses of colorectal cancer or change in the stage at diagnosis compared with the previous year. We agree with the authors’ comments stating that their unit may have taken patients that would have presented to surrounding hospitals. the authors state that their unit increased capacity by recruiting 2 additional colorectal surgeons and introducing weekend and evening sessions. When considering 2-week-wait referrals for suspected cancer, both patients and general physicians will choose units with the shortest waiting times. Consequently, although the number of cancers detected in 1 unit may increase, those detected in others may fall. When assessing the impact of a campaign on service demands, finances and cost implications must be considered. We agree with the authors’ finding regarding the increased burden on both radiology and endoscopy services. our study noted that the cost per cancer detected rose by 27% to £9662.72 (Us$16,248.75). in summary, we agree that more research is needed to establish the true impact of the National Bowel Cancer Awareness Campaign with a longer-term study, but we urge a multicenter format with financial implications included.