My work entails fostering the right conditions for the development of breast screening services and identifying the many stakeholders who need to be involved. The supporting systems necessary for an effective and well-organised screening programme need to be put in place. Much planning and preparatory work has already been completed.
Our existing systems are run along ‘opportunistic’ lines with screening undertaken at the discretion of the patient and their personal physician.
The need for an organised and well-structured screening service has been brought into sharp focus since we joined the European Union. We now find that we are increasingly subject to guidelines on Quality Assurance (QA) standards from Europe.
My role is to guide the project along this path, and this role will continue to evolve as the project matures. Once a screening service is established, its performance has to be under constant review both locally (since it is paid for by the taxpayer) and at EU level. The EU guidelines are revised on a regular basis and I currently am part of the interface between the EU and the professionals providing the service. We are also required to regularly submit activity data and statistics to EU and other international bodies.
Establishing the cost-effectiveness of breast screening interventions is something I regard as a critical exercise. Our team has meticulously researched this and carefully evaluated the cost-benefits of investing resources into this important aspect of health care.
Mammography remains the best available tool for detecting breast cancer. It is also fundamental in investigating women with breast symptoms (usually by a combined ‘triple’ assessment – imaging, clinical evaluation and tissue sampling). There are no screening programmes in Europe which do not include mammography.
In Malta we plan to tentatively start breast screening in the 50- to 59-year age range. This age group is at higher risk and is more cost-effective in terms of money spent per detected cancer.
A national organised screening programme moves society towards a preventive culture and a vigilant attitude to avoiding disease. Organised screening is more efficient than “opportunistic” screening. A critical element of such a programme includes aggressive recall to target particularly those who are reluctant to undergo checks or cannot afford to do so.
Recent evidence has clearly shown that screening detects cancer at an earlier stage, resulting in potential savings from avoiding more expensive and invasive treatment for advanced cancer. Recent evidence also shows that a healthy lifestyle reduces your risk of developing all cancers, including breast cancer. Also, leading a healthy lifestyle, as well as having support from family and friends, enables one to better withstand the physical and psychological effects of illness.
However, there are more significant factors which affect the risk for breast cancer, namely age, family history or gene abnormalities.
The biggest risk for women for developing breast cancer is still age.
It has long been recognised that people who breastfeed or have several children have some protection from breast cancer.
The incidence of breast cancer is rising across all age groups and the reasons could be various. Data collection is now more accurate than in the past and modern histopathology accurately identifies cancers (which were previously not attributed to breast cancer) much more effectively.”
Dr Delicata is the project leader for the national breast screening programme.