Following Dr Mario Saliba's correspondence on breast screening (The Sunday Times, July 20), the Ministry for Social Policy wishes to make a few points.
Breast cancer, unfortunately, is the most common cancer among Maltese women (over 32 per cent of all cancers) and a statistically significant increase in local incidence of breast cancer is being observed by the department's monitoring offices. Five-year survival rates for Malta do not compare favourably and remain below the European average.
There is now clear scientific evidence that organised screening 'shifts' the stage of cancer presentation. In communities where an organised breast screening programme exists, breast cancer presents at an earlier stage in the disease. This shift results in fewer highly unpleasant and poorly tolerated treatments - treatments which incidentally incur a significant cost burden on our precious health resources. Mortality and five-year survival rates have improved in most European countries.
An extensive review of several large-scale studies from Europe and elsewhere has been completed by the ministry. Analysis of current (not 2000/1, as quoted by Dr Saliba) scientific evidence based on the benefits and cost- effectiveness of breast cancer screening is in favour of an organised screening programme. This is what has swayed public opinion from a diffident reluctance to one that recognises the wider benefits of breast screening for the health of the nation.
This belief is increasingly manifest in the vast majority of European member states. Malta is one of a tiny minority of EU countries without firm time frames for screening those women at risk from the disease (Commission Report on Cancer Screening in the European Union, 2008). The ministry wishes to find the resources to put this right.
An extensive internal consultation exercise with all stakeholders (including clinicians, other professionals, financial experts, public health physicians and public representative groups) has also been undertaken, as a critical part of the initial planning phases of this important project.
Dr Saliba may also wish to note that the Ministry for Social Policy has taken into account the European Guidelines on Quality Assurance for Breast Cancer Screening and Diagnosis (fourth edition) and will continue to be guided by this detailed and authoritative document at every stage of the project.
The ministry will not be drawn into a debate about the benefits or otherwise of breast screening but wishes to assure the public that the decision to take forward a national breast screening programme was never taken lightly or on a political whim as Dr Saliba implies.
The wider debate on breast screening has been ongoing for several years. The ministry has carefully listened to these views and will continue to thoughtfully engage in the project. In serving the Maltese public it will always strive to adapt to the changing health needs of the local community, in particular its more vulnerable sectors, and try to achieve this in a non-partisan manner.