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 Zejtun . It is a situation which 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 Organization’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 amongst 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, which is caused by HPV, is a leading cause of cancer death among women in low-income countries. In developped 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 Zejtun (from 2004-7) where there is an age standardized 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 Zejtun (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 6 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 just 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 standardized 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 which are 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 comparible 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 come to supersede those of other developed countries. All resources should be put to good use as far as patient education in preventative measures and healthy lifestyle, tackling environmental issues including air, water ,seawater and food quality , minimizing pollutants and chemical carcinogens, making more available the cost-effective cancer screening procedures and ultimately creating a fully staffed oncology centre ,the sooner the better.
Dr Etienne Grech MD is a family doctor