Are the limited finances for the national health system good enough a reason not to have cancer screening programmes?
Justyne Caruana
Prevention is better than cure – that is what doctors always preach and rightly so, because detecting an ailment in time is more conducive to a more effective and efficacious treatment.
Unfortunately, preventive mentality is not sufficiently ingrained in our minds and culture, and we tend to become health-conscious only and when sporadic tests are undergone and something is detected. Or else when we hear the bell toll for a relative, close friend or neighbour we tend to become health freaks until our grief for the loss subsides.
Unless and until there is such a change in mentality, it is imperative to have national screening programmes. In the case of women for example, breast and cervix cancer are most common, and considering our small population the victims are very high when compared to larger countries. Thanks to various support groups, awareness is on the increase but the level of women doing screening on a voluntary basis is still far from satisfactory. This is also due to the fact that many women are discouraged by waiting lists.
It is a known fact that since the resources are limited, hospital waiting lists are quite long. It takes months and even over a year to have a screening done. The procedure is that precedence is given to people already diagnosed with cancer. Consequently all others who want to do a screening as part of a preventive routine check-up have to line up for all this time. This obviously is very discouraging. Bearing in mind also that during the waiting time a lot of things may happen, including having cancer without knowing, when finally screening is done cancer has reached an advanced stage, prejudicing therefore the rate of successful and effective therapy and treatment.
We do have many women who opt to go to a private hospital to undergo regular screening as recommended by doctors. However, not everybody is in such a comfortable financial position to opt for private services. A recurrent comment you may hear is that if you want to speed up matters you can go to a private hospital. This is really obnoxious: as taxpayers we have every right to have an efficient service in place to suit our health needs.
When I first heard Prime Minister Lawrence Gonzi announcing the introduction of the national breast screening programme it was on the last budget prior to the election. This proposal was something which the Labour Party was already discussing way back in 1996-1998. However, when I heard the PM announcing it, I was honestly really happy about it. Subsequently, experts from the field intervened and labelled such an announcement as irresponsible, revealing that government had no plans so far. I interpreted the PM’s move as an electoral ploy intended to lure for votes. In fact, so far we have no breast screening programme and even though it is scheduled for later on this year, at this point I will take the St Thomas approach – when I see, I’ll believe.
Recently I a tabled a petition in Parliament, co-ordinated by the Action for Breast Cancer Foundation, with thousands of signatories calling on government not to drag its feet further on the introduction of the programme. If government is wary about the viability of the programme due to lack of participation, this petition is a living proof that all these women and many more are waiting to have the programme in place.
I was appalled to hear that following a memo from the EU regarding the recommendation to introduce cervix and bowel screening programmes, government replied that such recommendation will be considered only after and on the basis of experience acquired from breast screening programme. When will this be if so far we do not have the breast screening programme? How many more people must die because their cancer was not diagnosed in time? Is the death rate of terminal cancer patients not a relevant and reliable ‘experience’?
These are the recurring questions I keep asking myself and can find no sense in such a reply given by the Maltese government to the EU. It blatantly runs counter to preventive action. If government is concerned about the financial aspect and viability of such programmes, such preventive action in the long run is also beneficial in financial terms.
The bottom-line of all this is that each and every human life is precious and any other excuse or consideration for not introducing national screening programmes to save lives is inconceivable and unacceptable.
Justyne Caruana is Labour MP and spokesperson on family policy
John Dalli
Screening for asymptomatic disease has to be approached cautiously and carefully. Whilst any form of treatment always has to undergo research and evaluation to ensure the benefits outweigh the risks, this is all the more so for screening which involves exposure of presumed healthy people to a particular test or procedure to detect the presence of covert disease. It is for this reason that several guidelines and standards exist for the design, implementation and monitoring of screening programmes. This is also particularly true for cancer screening where the result of the test may bring about a big impact on a person’s life.
Cancer screening programmes have their supporters and their detractors. The debate around cancer screening has to some extent been sealed in favour of breast and cervical cancer and more recently for bowel cancer by the publication of a recommendation at European Union level that states that for these cancers there is sufficient evidence for national organised screening programmes to be introduced. However both European and international guidelines make it clear that if embarking on a cancer screening programme, one has either got to do it properly and professionally or cease and desist from doing it at all.
Earlier this year, the European Commission reported on the implementation of cancer screening programmes across the European Union. It should be noted that a number of countries, including the old EU 15 member States still do not have national cancer screening programmes and in many cancer screening is only being organised at a regional level. In the case of small countries such as Malta, clearly any cancer screening programme has to be organised at a national level.
Government has committed itself to introduce a mammography screening programme for women aged 50-59 years. Over the past year, we have planned and designed the setting up and implementation of this programme. We have identified suitable premises. We are in the process of procuring the necessary equipment. We have agreed upon the actual implementation with the key health professionals involved. We are training our health professionals who will be working behind the scenes to support this programme in the techniques needed for operation and interpretation which need to attain a very high level standard of quality for the screening programme to be successful.
I have come to understand that contrary to what popular impression may be, a breast screening programme does not start and end with a mammogram. Indeed the back up that is needed from the laboratories, from the surgeons and later on from the oncologists, is just as important as the radiology services, that is, the actual taking and interpreting of the mammogram. It is this service back up that needs to be in place and that is often more resource intensive than the screening examinations themselves.
It is understandable that people are impatient for this programme to be launched. There is a palpable feeling of expectation. But we will not sacrifice standards to win some weeks. We are taking the necessary steps to ensure that our programme will meet the stringent quality assurance guidelines that have been set at EU levels. We will need the participation of all those eligible to meet our success targets.
Some persons seem to be asking “Why focus only on breast cancer screening?” Our decision to start with breast cancer is based on the trends, patterns and consequences of breast cancer. Breast cancer is a common cancer, and is commonest in the 50-59 year cohort. Breast cancer carries a relatively high mortality with it and earlier diagnosis leads to significantly better outcomes. I feel that our decision to start with a breast cancer screening programme is fully justified.
Screening for breast cancer will not be the start and end of this Government’s plans in the area of cancer screening. We will learn from our experience in the design, planning and monitoring of this programme. We will apply this knowledge and experience from our locally implemented programme which will take into account the Maltese attitudes, culture and uptake to inform our decision and planning regarding other cancer screening programmes.
Cervical cancer and bowel cancer are both candidates for consideration for national screening programmes. Which to do first? When can we start? Who will be in the target group? What resources are required? How will be go about implementation? And how much will all of this cost our taxpayer? These are all questions that need to be answered. Once our breast cancer screening programme is underway, we shall start to carry out the feasibility assessments for these other two programmes. This is one important strand of work that will form part of our forthcoming national cancer strategy for the next five years.
Any comments?
If you wish your comments to be published in our Letters pages please click button below. Please write a contact number and a postal address where you may be contacted.
Search:
MALTATODAY
BUSINESSTODAY
Download MaltaToday Sunday issue front page in pdf file format
All the interviews from Reporter on MaltaToday's YouTube channel.
