The Maltese national health service recently introduced a breast cancer screening programme and now plans to launch colon (large bowel) cancer screening for all from the age of 50 years (and up to the age of 74 years). This is in line with recommendations made by major national organisations such as the United States Preventive Services Task Force, the American Cancer Society and the Multi-Society Task Force on Colorectal Cancer. Colon cancer is actually more common than breast cancer and, in Malta, 180 new cases are picked up every year with about 100 deaths from this disease annually.

Such programmes seek to detect cancer at the earliest possible stage as, undoubtedly, this improves the outcome of medical treatment and mortality. They may even detect tumours in very early stages, even before actually becoming cancerous, at the stage where intervention is less invasive and more effective, possibly even curative. It is to be anticipated, therefore, that, in the same way the breast cancer screening programme has already led to just under 50 women being diagnosed with early stages of cancer, drastically raising their chances of survival, the colon cancer programme too will save scores of lives over the years.

The colon cancer screening programme has been in the pipeline for years and will now form part of Malta’s national cancer plan, which is expected to be released within the next few weeks. However, no details have yet been forthcoming as to how the screening process will work. It is expected the test will comprise a “faecal occult blood” process wherein a small sample of stool is placed on a card or similar surface and laboratory tested to determine whether blood is present or not. This would be in line with the 2003 EU Council Recommendation on Cancer Screening. Positive tests would then be screened using an endoscopic method.

Further medical details are worthy of explanation. Colon polyps are fleshy growths that occur on the inner lining of the colon. Polyps in the colon are extremely common and their incidence increases as individuals get older. It is estimated that 50 per cent of the people over the age of 60 will have at least one polyp. When certain types of polyps grow large enough, they can become cancerous and, therefore, screening for colon polyps and removing them before they become cancerous should markedly reduce the incidence of colon cancer. Once a polyp reaches two centimetres in size, the risk of cancer becomes over 20 per cent.

Therefore, it is advisable to remove polyps of any size, preferably when they are still small, in order to prevent their growth and progression to cancer. The polyps that become cancerous are called adenomatous polyps or adenomas and these account for about 75 per cent of all colon polyps. Any such anomalies found could potentially be dealt with there and then, at colonoscopy, by polyp removal, or referred for surgical intervention.

An individual with a first degree relative with an adenomatous polyp would have a 50 per cent greater risk of developing colonic cancer than an individual without a relative with polyps. The current estimate is that six per cent of the population will develop colon cancer. Diet can help in preventing this by avoiding foods high in fat and low in fibre and by taking adequate quantities of vitamins C and E along with vegetables such as broccoli and cauliflower.

Needless to say, all those eligible for the screening are strongly urged to take the step when the programme is eventually introduced. It could be a life saver.

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