Government mulling outsourcing interventions

The possibility of private clinics participating in the national breast-screening programme, which could lead to further testing and possible surgery for some women, has not been ruled out by the government.

Nadine Delicata, the programme coordinator, said some interventions could be outsourced.

"The health division would consider outsourcing if services were competitively priced and met European standards and guidelines for surgical treatments and other interventions," she said.

The programme - which is expected to kick off next year with a €700,000 allocation for the first 12 months announced in last week's budget - will see the 30,000-odd women aged between 50 and 59 years called for breast screening over a three-year period.

Initial screening will be done through a mammogram but a number of women will be screened further through a combination of further X-ray images, magnified views, ultrasounds and guided tissue samples if required.

Dr Delicata said women found clear of breast cancer will be offered a screening mammogram every three years, with the possibility of the cycle being reviewed and adjusted.

She said there is clear scientific evidence of decreased mortality as a result of screening and subsequent earlier treatment.

"Breast screening programmes are universally recognised as an effective driver towards best practice and quality care in diagnosis and treatment of symptomatic cancer.

No country which launched such a programme has regretted it or decided to abandon it."

Although the national screening programme has been welcomed by breast care groups, more radiologists need to be employed before it can kick off. The president of the Malta Association of Radiologists, Sandra Zrinzo said there are only four consultant radiologists at Mater Dei Hospital and more are needed, especially since each mammogram had to be seen by two radiologists to ensure the test was double-checked.

Questioned about this, Dr Delicata admitted that there is a limited complement within both the symptomatic imaging and histopathology services. But the authorities have explored these problems and several solutions exist, she said.

"The allocated screening budget allows for flexible or sessional work. Once these plans are finalised, new screening posts will be advertised," Dr Delicata said.

Dr Zrinzo had told The Times that the new workload needed another two radiologists unless the consultants worked overtime.

The Society of Medical Radiographers has also outlined the need for more radiographers to perform mammograms and implement the necessary quality assurance measures ensuring high diagnostic images, while specially-trained radiographers could take the second mammogram reading.

Dr Delicata said the greatest challenge for the screening programme is reaching out to Maltese women who would otherwise not have a health check. The Breast Care Support Group has already highlighted the importance of promoting the programme and will be launching a campaign to urge women to be screened.