The only source of bright colours in a drab, grey office is the multi-coloured loomband on the wrist of the 38-year old man sitting at his desk.

Nicholas Refalo is looking at his computer screen, at a profile scan of the cranium; he is zooming in and out, studying what look like blots.

He then looks up and says: “I would like to be out of a job.”

The building we’re in is Boffa Hospital and Dr Refalo is one of the six oncologists on the island. He can only be out of a job if cancer becomes a thing of the past.

“I’d happily find something else to do,” he says again. He is smiling, but you can tell he means it.

Dr Refalo keeps a low profile, is very media shy – as attested by the lack of photo accompanying this piece – and is extremely wary of any sort of self-promotion.

He is making an exception for this interview because I ask him whether there are things people can do to prevent cancer.

“A good amount of cancer is preventable – probably the majority in fact,” he says.

First off, he says, people should stop smoking. Nine out of 10 men who have lung cancer are smokers.

He said that 90 per cent of people diagnosed with lung cancer succumb to it.

“Lung cancer is strongly linked to smoking, and I feel strongly about it – so if I could, I’d ban smoking.”

Smoking, he says, not only causes lung cancer, but cancers in other parts of the body as well as other health problems like heart diseases and emphysema.

If the country had to ban smoking “we’d see the effect” – he calculates that in about 20 years’ time lung cancer would be go down to 15 per cent of what it is now, therefore reducing it by 85 per cent.

“Plus, there are other benefits. At €5 per packet, you’d be saving yourself some €150 a month,” he says.

Second on the list: exercise. Thirty-minutes of exercise a day, even if it’s just a brisk walk, can prevent cancer.

“It’s not long since we came down from the trees and now we are sitting at a desk all day long – it’s not good for the body,” he says. Obesity, says Dr Refalo, is a high cancer risk.

“It is very prevalent here and it does not help that we are a small island and you can get around everywhere in a car.”

Third: a healthy diet. “Eat your vegetables, eat regular balanced meals,” he says.

Fourth: moderate your intake of alcohol.

Fifth: limit your sun exposure.

But, of course, there are no simple answers, he says. “Cancer is ubiquitous. It is the result of mutation and this is the price we pay as organisms for the ability to evolve.

“Now, evolution is generally a very slow process, typically taking effect over millenniums. However, our lifestyle has changed extremely quickly in the past 200 years and perhaps our bodies have been unable to fully adapt to such a rapid shift in lifestyle,” he says.

It’s not long since we came down from the trees and now we are sitting at a desk all day long – it’s not good for the body

What would be an ideal society, aimed at reducing cancer? He laughs, and takes his time to answer the question.

“Well, I certainly would hate to live in a land with fit, smoke-spurning, gym-going, broccoli-eating freaks for company, obsessing with calories and health!”

The real key, he says, is educating people and perhaps making changes to one’s lifestyle to include more physical activity without making it the be-all and end-all.

“Like cycling to work,” he suggests. “Or eating fewer pastizzi.”

That’s not easy, I point out, we have a pastizzerija at every corner.

“True... and you don’t even have to walk to get to it, you can park your car right in front of it,” he quips.

Malta follows the cancer patterns of the Western, affluent world: the most common cancer is breast cancer, followed by lung cancer, then colon, then prostate.

In the underdeveloped word, liver and cervical cancers are the most prevalent, as well as cancers linked to infections.

Is it just an impression that cancer is on the increase? Or is it because before it was not properly diagnosed?

Yes, he says, our means of detecting it have increased, and there is more awareness, but the incidence of cancer is rising and in Malta there are about 1,500 new cases of cancer every year.

“Each of us now has a one in three risk of developing cancer but of course you have to take into consideration the fact that we are living for more than 80 years... we are an ageing population,” he says.

By way of example, he says, a woman in her 20s has a one in 2,000 chance of breast cancer; by the time she’s 70, the risk would have gone up to one in 20.

“I am not saying I don’t have patients who are young, but the bulk of my patients are people who are past retirement age,” Dr Refalo says.

Cancer is a difficult subject even because we are victims of the way we live, he says.

Some things that would prevent cancer are culturally difficult today. Breast cancer, he says, is hormonal.

“For millenniums, women were breaking the cycle to become regularly pregnant at least about 10 times from the age of 15 to 45. But now the cycle gets only interrupted once or twice. Of course I’m not saying that women should start having 10 babies – I am merely highlighting the fact that some cancer reasons are cultural and we cannot change that.”

Stress is another factor. “Chronic stress and cancer are possibly linked although there is no evidence. But how can we stop stress?” Although we have freed up so much of our time “with all the gadgets that we have”, we want to squeeze every last minute of our day, he says.

It’s hard, he says, to control lifestyle factors. “Another possible cancer cause is the pesticides sprayed on food – there is definitely a lot of toxins in food – but it’s not easy to control that.”

What about sugar? Some research papers term sugar as cancer’s worst enemy and that cancer feeds on sugar.

According to the National Cancer Institute in the US, there is no concrete evidence. “It is true that sugar is a basic substrate for energy and for all cells, but if sugar was the culprit, if the patient completely cuts it out of his diet, then he should get better. But, sadly, he doesn’t,” he says.

He tells me as an afterthought that sometimes he wished relatives of cancer patients were not so strict about sugar. “You know, if you have cancer, you should be allowed to have a cream pastry if you want to... the way I see it, if you have a limited time to live, you should not deprive yourself of the things you crave.”

He said that these days most of his patients inform themselves thoroughly before each visit.

They go on the internet and read about everything and they are assertive about having tests carried out. They tell him that they will be drinking alkaline water, or litres of lemons, or eating apricot kernels or graviola, or they will be going on the Budwig diet, or a juicing diet, or that they’ll be buying blue scorpion venom. They go to him with lists of alternative therapies.

If the country had to ban smoking, in 20 years’ time lung cancer would be go down to 15 per cent of what it is now – reducing it by 85 per cent

He does not discredit these options but points out that in most cases they are usually based on observational studies with no proper scientific evidence.

“Also, there is an element of wanting to be in control of the situation, and I respect that,” he says.

He stressed that people who have cancer should try not to make their disease their life. “It changes your life overnight and it’s unfair, so it’s important to do what you set out to do.”

What is important, he stresses, is that we all work towards eradicating the stigma that cancer carries with it.

“It’s not like you get it because you sinned or something. It just happens. Within a couple of decades, two in five of us will have cancer. So don’t point fingers, because you could well be pointing at yourself,” he says.

He pauses, and then says: “But, stopping smoking would certainly help. It would make my life easier – and I’d happily be out of a job.”

Cancer in numbers

According to Cancer Research UK, around 40 per cent of cancers in women and 45 per cent in men could be prevented by a healthier lifestyle, including drinking less, smoking less and losing weight.

The biggest risk factor by far is smoking, which caused 23 per cent of cancers in men and 15.6 per cent in women.

Putting on too much weight was found to be a greater risk for breast cancer in women than drinking alcohol, and diet accounted for 9.2 per cent of all cancers if a lack of fruit and vegetables, too much salt and red meat and too little fibre were all included.