Malta’s ranking in a cancer survivors’ league from the Eurocare study group has given a misleading picture of the island’s cancer treatment service, due to regional data being extrapolated on a national basis.
The Eurocare-4 research study was presented in The Lancet Oncology earlier this week, revealing Malta’s survival rates for men on all forms of cancer to be fifth from last with 42.3 per cent, just ahead of England, Scotland and Northern Ireland. Women survival rates ranked mid-table with 54.6 per cent on all forms of cancer.
But Malta was one of the only European countries to submit national data from its cancer registry – and subsequently compared with regional data from other countries, which was ‘adapted’ to represent national data.
Sir Paul Boffa Hospital’s radiotherapy and oncology chairman Dr Stephen Brincat said the data may give a confusing picture.
“The reason is because Malta was one of only 12 national cancer registries that could provide data for the study. Countries like Germany, Italy, France, Switzerland, Spain, and Holland, on the other hand, only provided regional data covering a percentage of the population (1% France and Germany, 3% Spain, 24% Italy and Switzerland).”
Brincat said the data was taken over a regional registry and later extrapolated to national figures.
“Taking Italy as an example, data come largely from the wealthier northern regions with almost certainly better results than the national average. Many other European countries like Greece, Latvia, Hungary, Luxemburg, Cyprus, Estonia, Bulgaria, and Lithuania did not contribute to Eurocare-4, and are therefore ineligible for any comparison.”
Brincat in fact said Malta had the fastest treating times in Europe. “In order to avoid waiting lists for radiotherapy, something that is of the order of several weeks in many European countries, our department opens at 5.00am and often shuts at 11.00pm and the workers involved do not work on a shift basis. We have the fastest treating times in Europe!”
The Eurocare-4 rankings, based on cancer survivors after five years of treatment, were mainly picked up by the media over the survival rates for all cancer types.
“If one had to go for the simplest, and least informative figures, one would say that for all cancer types the European average five year survival was 44.8% for men (Malta 42.3%) and 54.6% for women (Malta 54.6%),” Brincat said.
However, he warned against the way statistics are interpreted. “If we required statistics for propaganda purposes we would say Malta experienced the largest improvement in five-year survival from prostate cancer from 33.6% (1990-94) to 71.2% (1995-99), and that we are world leaders in the treatment of testicular cancer since we have the best figures (98.3% 1995-99).
“This however would be a dishonest and useless interpretation of statistics. Impressive improvement in prostate cancer largely result from the diagnosis and treatment of many men with early prostate cancer picked up through PSA screening. Although present, prostate cancer would never have caused any problems during their lifetime. We can therefore only consider this to be over treatment based on our limited ability to predict which prostate cancers will be life threatening and which will not. Because ‘more advanced’ European countries and especially the US are even better at over treating prostate cancer than we are, their figures look better and help to push up male figures in general.”
As for differences in results for colorectal and breast cancer, variations largely reflect differences in stage at diagnosis, more than differences in outcome based on treatment.
“Probably since one-third of cancers have an environmental cause, one of the best ways to improve our results is by altering our lifestyle – reducing smoking, obesity, excessive alcohol and animal fat consumption and increasing exercise, as well as reducing sun exposure will do more than any new forms of treatment.”