Prof. Joseph Muscat, in his letter of March 12, asserted that "The breast screening programme must be set up in earnest while cervical and colorectal screening should be put on a back-burner as they are less cost-effective". I wish to point out that most studies have shown colorectal cancer screening is just as cost-effective as breast cancer screening.

One study states: "The estimates of cost per quality-adjusted life-year gained from colorectal cancer screening show the procedure to be of similar cost-effectiveness to breast cancer screening in the short term. Over the longer term, however, the estimates for colorectal cancer screening appear superior." (D. K. Whynes et al 1998). The figures given for cost per year of life saved vary according to which tests are used during cancer screening. They average between "$10,000 to $25,000 for most strategies compared with no screening and this compares favourably with other commonly endorsed preventive health care interventions, such as screening mammography for women over age 50 or treatment of moderate hypertension." (M. Pignone et al 2002)

What is not shown in these studies is the fact that the removal of polyps performed during these colon cancer screening procedures may actually prevent the emergence of the cancer in the first place. Therefore a "screening" colonoscopy may be both preventive and therapeutic as opposed to a mammogram which basically just informs us if the cancer is present or not. This fact may actually make us underestimate the actual cost-effectiveness of colon cancer screening.

I do believe it is high time an effective colon cancer screening strategy is set up in Malta. Colon cancer is the second most common cancer in this country and can be effectively combated by screening. All European countries with the exception of Malta have now set up pilot screening studies to initiate screening for this terrible and potentially preventable disease. Not even Albania has "put it on a backburner". Most of them already have effective screening programmes in place.

I am not qualified to speak about the cost effectiveness of cervical cancer screening.