The temperature was relentless: the mercury had not gone below 36˚C for days and showed little sign of abating. Sandra Mercieca put her bag down when she got home from work one lunchtime and headed straight to bed. At first, she had blamed her lethargy on the heat, but deep down the bubbly 60-something knew this was not like her at all.

The screening kit

The day that she had to stop and put down her shopping bags to catch her breath, just 100 metres from her little local shop, she decided to do something about it.

She picked up the envelope on her kitchen table that had arrived some days before from the Colorectal Screening Unit and decided there and then to do the test and send it in for analysis.

Ms Mercieca regularly does screening tests, like mammograms and cervical smears, but she admits the colorectal test is not one of her favourites.

It involves putting sheets of paper into the toilet when nature calls and then rolling the tiny brush in the pack to scoop up a sample, which is then sealed in a plastic canister and mailed to the unit to be tested for traces of blood.

“And then I thought: ‘You know what, this is no worse than changing a baby’s dirty nappy…’ ”

She had already done it a few years ago after having put it off for a few days. Then the results had been clear, but this time… Well, she preferred not to think about it.

When she got a phone call from the screening unit on her way to work to tell her they had found abnormalities, she pulled over and stopped, stunned. It took a few minutes until she could drive off again.

She knew exactly what the phone call could mean, but the optimist in her was able to suppress the worrier until she had had a colonoscopy, a procedure for which a camera was inserted into her colon.

She went to Gozo with her daughter to have the colonoscopy done and remembers clearly thinking this would have a terrible impact on her children and the best way to make it easier for them was to be positive herself.

“When the doctor came and told me they had found cancer, I was actually very calm. It was my daughter who could not stop crying,” she recalls.

Having lost family and friends to cancer, she admits: “I always used to wonder how I would cope if I were told I had cancer. No one wants cancer. Being negative about it only makes it worse; either you wallow in self-pity or you carry on.

“I am a positive person but I guess I amazed myself.”

At times like this, the strangest thoughts pop into your head. For Ms Mercieca, her biggest concern was how to tell her son, singer-songwriter Matthew (Muxu), whom she was meant to visit in Vietnam a few weeks later.

“This was the hardest thing I had to do. I would chat to him on Skype wearing sunglasses, as he would otherwise have immediately been able to tell there was something wrong, but in the end, I could not face it and my daughter had to tell him. He and my niece jumped straight on a plane and were by my side when I went to Mater Dei Hospital on July 4,” she explains.

I look back to that day in spring when I decided to do the test – yucky or not – and thank heaven I did

For seven hours, using keyhole surgery, a team painstakingly removed part of her lower intestine and 18 lymph nodes.

Six weeks later, she was told she would not need either radiotherapy or chemotherapy. She went to rebook her trip to Vietnam that same day.

“My determination to take this trip of a lifetime really kept me going.”

She paused for the briefest beat and looked up: “You know, they had got the cancer at the very beginning before it spread.

“So I look back to that day in spring when I decided to do the test – yucky or not – and I thank heaven that I did,” she added with a beaming smile.

“You know, God puts us in a position where we can help others. This is why I am here talking to you.

“If just one person does the test because they read this, then I will be happy.”

The screening programme

The colorectal screening programme was set up in 2013 – one of the three EU-recommended national screening programmes – and was first targeted at 62-64-year-olds. It has since expanded to those aged 57 to 68 and will eventually be offered to those 50 to 70.

The unit first writes to people asking them if they would like to do the test – about 300 notices are mailed daily – and sends the kits by mail to those who agree. A person with a positive test is 12 to 40 times more likely to have colorectal cancer than a person with a negative test. The free test is done every two years.

Colorectal Screening Unit manager Stephanie Xuereb

The response rate is currently 45 per cent, but the unit manager, Stephanie Xuereb, would like to see that increase.

With a 60 per cent mortality rate, colorectal cancer is the third most common cancer in Malta and the most common cause of cancer death. It takes about 150 lives annually.

“It is common but it is very often a slow-growing cancer, so it is treatable for a window of several years. So, it is very important if it is found in the earlier stages,” she points out.

“The tests spot abnormalities, and we then look for polyps, many of which turn out to be completely harmless. But in some cases, the number, size or changes indicate they could lead to carcinoma, so they need to be removed.

“It is too soon to say how many lives the screening programme is saving, but with 10,000 invitations sent out every year, we are clearly making it much more likely to spot anything abnormal much earlier,” Ms Xuereb said.

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