Screening can save lives by detecting cancers at an early stage and in some cases, even prevent cancers from developing in the first place. Cancer screening is intended for healthy people without any symptoms. Screening tests are aimed at identifying early signs that could indicate that a cancer may be developing. They can help to discover cancers at a very early stage, when treatments are more likely to be successful and the chances of survival are much better. In some cases, particularly in the screening for cancers of the cervix of the uterus and the large bowel (colorectum), it can even stop cancers from developing at all, by picking up early cellular changes than can then be treated to prevent them from turning into a full-blown or invasive cancer.

Screening investigations are possible in cancer sites and types where early cancer is detectable, preventable and readily treatable. Cancer screening can be carried out when a cancer has a pre-clinical detectable phase (before symptoms appear) during which it can be treated before progression to clinically demonstrable disease (when symptoms appear).  Screen-detected cancer cases should have a better outlook than those detected when symptoms appear because by that time the malignant tumour may have grown and started to spread and this can make the cancer harder to treat and cure.

On the other hand, none of the screening tests are perfect. Tests can miss some cancers and for this reason, it is always recommended that you learn to know your body and that you consult your doctor about any unusual changes even if you have attended for a screening investigation. Furthermore, each test has its inherent risks for overdiagnosis and overtreatment (such as when people need to be referred for additional tests and cancer is not found and when screening picks up cancers that left alone would not have grown or would grow very slowly). It is therefore very important that you make an informed choice on whether you attend for screening or not, such as by reading through the information that is attached to an invitation for screening and by consulting your doctor if you feel that you need further information and advice.    

There are two distinct types of screening methods. These are mainly organised population-based screening programs and opportunistic case-finding tests. The latter usually happens when an individual goes to see her or his healthcare provider for reasons that may be unrelated to the disease and cancer screening tests are offered. On the other hand, organised population-based cancer screening programmes invite members within set population age and gender groups to attend screening tests on a regular time basis.

A number of population-based cancer screening programmes have been shown to be effective in reducing the incidence or improving the prospects of cure and survival (prognosis) of three common cancers: cervical, breast and colorectal.  Common screening programmes include doing a Pap smear/ cervical smear test to detect potentially precancerous lesions and prevent cervical cancer, mammography to detect breast cancer and faecal occult blood test (FOBT) to detect colorectal cancer. In Malta, women aged between 50 - 67 years are called every 2-3 years for a mammography. Women and men aged between 57 - 68 years are invited every 2 years to do a FOBT and women aged 25-35 years are approached every 3 years for a smear test. The new National Cancer Plan includes measures that aim at the incremental expansion of each of these programmes over the next five years to allow them to send invites to more age groups and in the case of breast cancer screening to invite women every 2 years.

Uptake of screening has improved over the years although there are still individuals who refuse to turn up for their appointment after they receive and accept the invitation that is sent to them. Emotions like fear, anxiety and worry play an important part in screening uptake.  Some individuals are afraid of the results and prefer to stay in denial even though this could mean a worse prognosis later on if the disease is then diagnosed at later stages. 

Face your fear - the slogan of this year's Pink October Campaign.  We should be stronger than fear.  Fear can go both ways, forget everything and run or face everything and rise.  The choice is ours.  We are responsible for ourselves.  No one saves us but ourselves.

Dr Elaine Lautier is a Public Health Medicine Specialist Trainee                                                  

Dr Miriam Dalmas is a Consultant Public Health Medicine