Mario Stellini (March 16) is quite right in essentially saying "why not also include colo-rectal cancer screening when one is considering national screening programmes for breast and cervical cancers?" Somehow, lobbying groups around the world, including Malta, have been pressing politicians for cervical and breast (rather than for colo-rectal) screening.

In Malta, deaths from cervical cancer are very few compared with deaths from breast and colo-rectal cancers, and it would therefore make sense not to forget colo-rectal screening. Interestingly, although cervical screening has been available free on the Maltese NHS for 30 years, the vast majority of Maltese women prefer to go privately for cervical screening. This type of screening is called "opportunistic", because it needs to be initiated by the patient or suggested by her doctor during a check-up, and is not part of a national call and re-call programme. Opportunistic screening does not lower national mortality figures but might prevent mortality increases.

Controversy persists as to the ideal screening method for colo-rectal cancer (whether a simple cheap faecal test or an expensive flexible colonoscopy) but, in any case, it is hard to see how our NHS, in its present state of not coping with the demand for established disease, can take on national call and re-call screening programmes for various cancers in the very near future, without possibly partially farming them out to the private sector locally or abroad.