As part of the Ministry of Health, the Malta Screening Service has an acknowledged reputation in breast cancer surveillance and screening, with IT infrastructures and e-health systems developed specifically for community health care delivery . It believes in fastidious adherence to timely programme delivery. Web-based technologies for cancer eHealth surveillance maximised use of local talent through public-private entrepreneurship. EU/ WHO experts have hailed it a ‘model for other screening services’. Its credibility rests on service specifications compliant with EU Guidelines and QA standards.
Malta like Sicily is in the unique geopolitical position of being both an EU member and strongly rooted in a changing Mediterranean cultural landscape. They share common hurdles in reducing their cancer risk and may not blueprint well-established programmes from Northern EU countries but use fresh innovative approaches. Change in public awareness attitudes will accelerate the trend to a patient-centric ‘preventative’ health culture and wellness in these societies. E-technologies are the keystone of modern health to deliver smarter, safe and more efficient treatments. The MFH runs an annual budget of €380 million with qualified auditors, financial controllers and accredited accountants.
Vision and Mission
The National Health Screening Programme aims to provide an effective screening service to the highest quality assurance possible, in order to diagnose and treat as many cancers as possible at the earliest possible stage.
The National Breast Screening Programme (NBSP) aims to reduce the number of deaths from breast cancer in Malta through early detection of disease, inviting well women aged 50 to 59 for free screening mammograms every 3 years.
The National Colorectal Cancer Screening Programme aims to reduce the number of deaths from colorectal cancer in Malta through early detection of disease, inviting asymptomatic men and women age 60 to 64 for immuno-faecal occult blood testing every 2 years.
The National Breast Screening Programme (NBSP) has now successfully concluded its third year of operation, having been launched in October 2009. The current target cohort population is women in Malta and Gozo aged 50-59. At the current capacity and resources, this cohort will be screened over a three year cycle, which is being concluded. The acceptance rate has increased gradually through 2012, with an average uptake rate of 63% of women invited, compared to 56% in 2010 and 60% in 2011. Following an initial investment of 1.6 million euro as capital outlay, recurrent operational expenditure averages about 0.7 million euro per year.
The National Colorectal Cancer Screening programme was launched in November 2012 as outlined in the National Cancer Plan 2011-15. This has been closely modelled on the National Breast Screening Programme and offers organised population-based screening for colorectal cancer via immuno faecal occult blood testing to males and females age 60-64 over a 2-year cycle. Activity figures for 2013 show an encouraging 42% uptake by the Maltese public. The capital outlay for the colorectal cancer screening programme is around 1 million euro and includes capacity building, purchasing of equipment, ICT development as well as a refurbishment project of a historic adjacent building at Lascaris Wharf to expand office space for the screening services to meet the increasing demand.
Performance Review and Analysis
The NSP continued to work closely with family doctors, encouraging their active participation in the screening pathway to the clear benefit of all screening clients.
Government has continued to invest in the IT infrastructure that is required to support this service. The screening portal is a custom-built screening software modality that enables the screening service to build its demographic database, schedule appointments and clinics, generate invitations, recall and outcome letters, reports and other functionalities pertinent to health screening services. Phase 3 of the system, including the colorectal cancer screening programme, was concluded in 2012 and deployed early 2013. Work is currently underway with regards to connectivity with MDH systems.
The invite system works strictly on basis of date of birth, ensuring nation-wide cost-effectiveness, fairness and transparency, and has been very well received by both the general public and family doctors.
The Malta Screening Service actively participates in European networks for cancer screening programmes. These include the Euromed Project on Cancer Screening and Early Diagnosis, the European School of Screening Management and the European Partnership for Action Against Cancer.The programme team have been invited to present their methodologies to International meetings, and sharing their expertise within EU screening guidelines groups for major cancers. They participate in steering fora including Italy-led partnerships of European, Eastern and North African Regions, IT/business communities (Innovations in eHealth surveillance for cancer, Centre for Parliamentary Studies, Brussels 2011), Commonwealth meetings (CAPAM, Commonwealth Ass for Public Administration & Management, 2009), and featured in the UK 2010 annual screening report.
The breast screening service adopts a multidisciplinary approach and collaborates closely with the breast care team at Mater Dei Hospital to provide a seamless service to screening customers. The Screening Facility currently also accommodates specialised assessment clinics for patients referred from Mater Dei Hospital that require further assessment, carried out in dedicated sessions outside of screening hours
In December 2012 the National Breast Screening programme underwent an external evaluation/review. This was conducted by IRAC and European experts – the outcomes of this assessment will prove invaluable in shaping future expansion.