{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:05:35Z","timestamp":1789740335015,"version":"4.0.1"},"reference-count":22,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Forschung, Technologie und Raumfahrt","doi-asserted-by":"publisher","award":["01KD2104A"],"award-info":[{"award-number":["01KD2104A"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Colorectal cancer (CRC) screening programmes have reduced CRC incidence and mortality in individuals aged 50 and older in many western countries, whereas they continue to rise among younger adults where CRC screening is not routinely available. In Germany, some insurance plans have started offering screening below age 50, but adherence has remained low and evidence on the preventive potential of CRC screening below age 50 remains limited. The Effekte postalischer und digitaler Einladung und Erinnerung auf die Teilnahme an der Darmkrebsfr\u00fcherkennung bei jungen Erwachsenen: Eine randomisierte, kontrollierte Studie trial aims to assess the effect of various invitation schemes on the use of faecal immunochemical test (FIT) and the number of polypectomies and early-detected CRCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a two-arm randomised controlled trial, 80\u2009000 individuals aged 45\u201349\u2009and 10\u2009000 individuals aged 40\u201341 covered by the BARMER health insurance are randomised 1:1. The intervention is an invitation and reminder via paper-based mail, the control is an invitation and reminder via email. Routine healthcare data are used to track FIT use and resulting diagnostic colonoscopies, polypectomies and CRC diagnoses. The primary composite endpoint is the proportion of insured individuals aged 45\u201349\u2009who underwent a polypectomy or received a CRC diagnosis within 12 months after receiving the initial invitation. Key secondary endpoints include the proportion of individuals who used the FIT, and the proportion of individuals with a positive FIT result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the ethics committee of the medical faculty of Heidelberg University (S-157\/2025). Results will be disseminated through peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>DRKS00037817.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-124980","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:30:15Z","timestamp":1789738215000},"page":"e124980","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["PETER: protocol for a randomised controlled trial of the effects of postal and digital invitations and reminders on participation in colorectal cancer screening among young adults"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3607-3498","authenticated-orcid":false,"given":"Leon","family":"Klimeck","sequence":"first","affiliation":[{"name":"Division of Clinical Epidemiology of Early Cancer Detection, DKFZ, Heidelberg, Germany"},{"name":"Ruprecht Karls Universit\u00e4t Heidelberg Medizinische Fakult\u00e4t Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Heisser","sequence":"additional","affiliation":[{"name":"Cancer Prevention Graduate School, German Cancer Research Centre, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utta","family":"Petzold","sequence":"additional","affiliation":[{"name":"BARMER Health Insurance, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Hennig","sequence":"additional","affiliation":[{"name":"BARMER Health Insurance, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hoffmeister","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology of Early Cancer Detection, DKFZ, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Brenner","sequence":"additional","affiliation":[{"name":"Cancer Prevention Graduate School, German Cancer Research Centre, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091806300637000_16.9.e124980.1","unstructured":"15. Robert Koch Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.v. Krebs in Deuschland f\u00fcr 2021-2023. 2025."},{"key":"2026091806300637000_16.9.e124980.2","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/0969141318789710","article-title":"Cost-effectiveness of colorectal cancer screening programmes using sigmoidoscopy and immunochemical faecal occult blood test","volume":"26","author":"Senore","year":"2019","journal-title":"J Med Screen"},{"key":"2026091806300637000_16.9.e124980.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00199-6"},{"key":"2026091806300637000_16.9.e124980.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00600-4"},{"key":"2026091806300637000_16.9.e124980.5","unstructured":"Gemeinsamer Bundesausschuss . Richtlinie f\u00fcr organisierte krebsfr\u00fcherkennungsprogramme. 2018. 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