"The effectiveness of screening in 2019 and beyond" was title the used for the Malta Colorectal Cancer Awareness Group conference held at San Anton Palace on Wednesday.

The evening event was due to be opened by H.E Marie Louise Preca, who was unfortunately too unwell to attend.

First to take to the stage, Public Health consultant Dr Stephanie Xuereb provided a comprehensive update on the National Colorectal Cancer screening programme in Malta.

Diagnosed in early stages, Dr Xuereb stressed a sharp increase in survival rates and the need to screen. She also highlighted the need for a "risk assessment tool" locally.

At present screening invites those aged 55-69, every two years. Acceptance rate is steadily increasing though remains low for those invited for the first round, currently, the participation rate sits at 55%, still low- however, she noted this was better than prior years. Barriers such as fear and embarrassment are considered to stop those from completing the screening test. Dr Xuereb pointed out the team's steps to increase participation such as reminders, direct mailing of the kit, results in a higher return response. During the past six years, the programme has sent 166,000 invitations, analysed 74,173 tests, and found 141 established cases of colorectal cancer to date.

Recent developments at the National Screening Centre include an extension of the target group invited for screening, the use of SMS reminders sent to previous non-attenders. One significant challenge facing the screening team is to obtain accurate demographic data, changes in address result in many screening invites being returned and not finding the correct participant successfully.

Next, to the stage, Professor Godfrey Grech provided an overview of local research outcomes and translation efforts.  He discussed a joint project between the UOM, National Screening Unit and Ministry of Public Health in the putting together a prospective cohort, as at present Malta does not have one. A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. "This is important, for us to be able to go back and test what we find" he added. Professor Grech also explained various biomedical advances such as the ongoing development of liquid biopsies to identify metastasis.

Following, Dr Mark Zammit Vincenti, Consultant gastrointestinal surgeon at Gozo hospital, discussed advances in colonoscopy and colorectal surgery.These include advances in technology HD cameras to improve quality/resolution and see the surface detail of polyps. Typically, white light images are used; however virtual chromoendoscopy proves better imaging due to filters to see surface image details on polyps which may require removal. Further technological advances such as the use of a scope guide, help navigate the complexity of bowels. Additionally, the use of scope retroflexion aids accurately identifying more polyps during colonoscopy.

Dr Zammit Vincenti also discussed surgical management, such as the benefits of multi-port laparoscopic surgery leaving less severe scarring on patients than open surgery. He made many comparisons to the UK in which surgeons' outcomes are published in the public domain. Dr Zammit Vincenti concluded, dedicated specialists should have outcomes measured and follow a patient centred approach.

Finally, Professor Schembri-Wismayer presented "ImmunRX: New modalities in Colorectal cancer". He discussed what happens when screening is missed and current advancements in immunotherapy. Prof Schembri-Wismayer explained his extensive research. He highlighted the need to collaborate with local vets to trial cancer treatments in dogs such as possible vaccine solutions to treat cancers.

The conference closed with a discussion panel moderated by Professor Charmaine Gauci where conference participants were invited to pose questions to the panel composed of the presenting speakers. The chairperson for the conference was Ms Marika Fleri.

The Malta Colorectal Cancer Awareness Group (MCRCAG) conference was supported and sponsored by Strummin, Vivian Corporation, Technoline, National Cancer Platform, National Blood Transfusion Service and the National Colorectal Cancer Screening Programme. For more information regarding MCRCAG call 99438446, [email protected], www.facebook.com/maltacolorectalawarenessgroup