Recent data published in the media drawn from statistics from the Health Information Unit demonstrates an increasing trend in the incidence of cancer in the last years and above average incidence rates in localities such as Mosta and Żejtun. It is a situation that needs thorough addressing and to do so one has to tackle all that is known to be a cause of the disease and apply strong principles of preventative medicine.
A quick perusal of the World Health Organisation’s website regarding cancer indicates that physical carcinogens, such as ultraviolet and ionizing radiation, chemical carcinogens, pollutants, including asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant) and biological carcinogens, such as infections from certain viruses, bacteria or parasites are among the main known causes of cancer around the world.
Additionally, tobacco use, alcohol use, low fruit and vegetable intake and chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, caused by HPV, is a leading cause of cancer death among women in low-income countries. In developed countries, tobacco use, alcohol use and being overweight or obese are major risk factors for cancer.
As everyone knows, Malta, particularly the southern harbour area, is afflicted by a large quantity of emissions from power plants and vehicles due to the heavy traffic in this densely populated zone. All this exposure to chemical carcinogens in theory increases the risk of cancer incidence.
The latest cancer statistics in Malta show a high incidence rate in Żejtun (from 2004-7) where there is an age standardised cancer incidence rate of 399.37 per 100,000 in males (cf. national average 341.19) and 298.58 per 100,000 for women (cf. national average 291.62). Congruently, there are also high mortality rates in Żejtun (2004-7) where we find a rate of 235.72 per 100,000 in males (cf. national average 195.33) and a rate of 145.04 in females (cf. national average 126.87).
Statistics for the six Maltese regions also reveal some patterns. For example, when male cancer incidence rates are considered, the southern harbour district has a rate of 373.09 deaths per 100,000 persons when compared to 303.4 for the northern district. This, again, is data for the years 2004-7, which has increased substantially from the previous readings of 2000-3 where rates were 315.96 in the southern harbour district and 299.08 for the northern region. The overall mortality rates have also increased but to a lesser extent than the incidence, owing to improving medical treatment for most forms of cancer. The figures given are age standardised so as to put the mean age of all the inhabitants in all towns and regions the same.
Regarding prevention, one has to counteract on all the things known to have an effect on the cause of cancer. One has to consider the lifestyle in certain areas, which may give rise to heavy smoking or drinking patterns and which would obviously have an effect both on the cancer incidence rate and the mortality rate.
Despite the fact that the cancer incidence and mortality rates in Malta are comparable to elsewhere in Europe, we are experiencing an increase in rates over the last years, which should be tackled so as not to arrive to the point that our rates supersede those of other developed countries. All resources should be put to good use in terms of patient education in preventative measures and healthy lifestyle, tackling environmental issues including air, water, seawater and food quality, minimising pollutants and chemical carcinogens, making the cost-effective cancer screening procedures more available and, ultimately, having a fully staffed oncology centre. The sooner the better.
Dr Grech is a family doctor.