James Debono Malta is one of just two EU member states to lack a screening programme for cervical cancer, along with Cyprus, and has no plans for one either.
The information has emerged from a memo by the European Commission on the implementation of a Council recommendation on cancer screening.
In its official reply to the Commission, the social policy ministry said it will only consider screening for cervical and bowel cancers on the basis of “experience gained through implementing the breast screening programme. This will help guide decisions on the planning and design of other screening programmes for other cancers.”
Along with eight other states, Malta also has no plans for a screening programme for bowel cancer which affects both men and women.
The Commission is recommending breast screening for all women aged 50-69; faecal occult blood screening for bowel cancer for men and women aged 50-74; and pap smears for cervical abnormalities, starting between the ages of 20 and 30.
Malta’s breast screening programme is expected to be launched in September, but will be initially be limited to women aged 50 to 59 and will only be extended to women aged 60-69 years in subsequent cycles.
But there no concrete plans on a screening programme for either bowel or cervical cancer.
Infection by a sexually transmitted human papillomavirus (HPY) is the cause of nearly all cases of cervical cancer, typically transmitted through sexual contact.
At an annual infection rate of 2.5 cases per 100,000 women, incidence of cervical cancer in Malta is not particularly high and well below the European average of 10 per 10,000 women.
Between 1992 and 2002, 132 cases of cervical cancer were reported – 49 women lost their lives to the disease.
Public healthcare centres in Malta have been offering free screening for the cancer since 1978 to those who request it, but to date no organised national programme exists, which means women perform the tests on their doctor’s or their own initiative.
Studies show this is a very ineffective way of reaching out towards those most at risk.
Asked about its plans, the Health Department told MaltaToday a discussion on the way forward on both cervical and bowel cancer will feature in its cancer strategy for the coming years.
The spokesperson said the department was presently focused on launching the breast cancer screening programme as soon as possible. “The experience gained in the launching and running of the programme will be helpful to inform planning for any other cancer screening programmes.”
Abroad, incidence and mortality from cervical cancer decreased sharply following the introduction of well-run screening programmes. In Iceland, mortality rates declined by 80% for more than 20 years; in Finland and Sweden by 50% and 34%, respectively.
Germany, Italy, France, Austria and Sweden have also introduced vaccination against cervical cancer as part of their national free health programmes.
In Malta, this vaccine only comes at a cost from the private sector.
Health and inequality
If a national programme is introduced all women would be invited to conduct the test at regular intervals.
A National Health Interview Survey in 2002 revealed that 41% of women had never done a smear test. A further 14% did not have one in the previous three years.
In 2006, a study published in the Malta Medical Journal revealed that only 10% of those diagnosed by the disease had had regular smear tests.
And although 44 out of the 132 victims of cervical cancer between 1992 and 2002 hailed from the inner harbour region, only 36% of women from this region had a smear test in the previous three years.
On the other hand, regions reporting a higher rate of screening also reported a lower incidence of the disease. Only 11 cases of cervical cancer hailed from the northern region where 53% of women were screened in the previous three.
The study found that while mortality rates had decreased in countries which introduced screening programmes, in Malta the rate had remained stable.
Zminijietna, the left-wing NGO, has also said that limited access to a state-funded screening programme will increase social inequalities in health.
“Low income and poverty are key factors amongst others in ill-health. This is also true of cancer deaths. Many cannot afford the hefty fees demanded by the private sector. We call for the introduction of universal public schemes such as free cervical vaccination, and free and prompt breast cancer screening for all women irrespective of age,” the organisation said in a statement.
The group said EU data shows 35% of women with breast cancer are below 55 years of age, and 12% are under 45.
Health director-general Ray Busuttil had warned last year, at a press conference marking European Immunisation Week, that an immunisation programme against HPV was not the ultimate solution, as other methods of prevention were also available, including screening.
CERVICAL CANCER SCREENING
The Papanicolaou test (namely, the Pap smear) is a screening test used in gynaecology to detect premalignant and malignant (cancerous) processes in the ectocervic. The test was invented by and named after prominent Greek doctor Georgios Papanikolaou.
In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes, which are usually caused by sexually transmitted human papillomaviruses (HPVs).
It is generally recommended that females who have had sex seek regular Pap smear testing. Guidelines on frequency vary, from annually to every five years.
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