National Screening Programme

Time for a change: Learning about Colorectal Cancer

It truly is a time for a change. This year’s theme for the European Colorectal Cancer Awareness Month is #time4change and the team at MAPHM truly thinks that it’s the right time to learn about colorectal cancer. So let’s get started!

What is Colorectal Cancer (CRC)?

CRC is defined as carcinoma in the colon or rectum, usually being an adenocarcinoma (Bosman et al., 2010).  CRC is by large preventable, being primarily linked to lifestyle (Steward and Wild, 2014).  Furthermore, participation in organised CRC screening programmes has demonstrated a life-saving effect (Armaroli et al., 2015).

What is the prevalence of CRC?

CRC incidence is high in countries which follow the Western diet (diet high in calories, animal fat and consumption of red and processed meat) and lead a sedentary lifestyle (Steward and Wild, 2014).  CRC is the second most common cancer in Malta, affecting both men and women.  In 2015, 294 persons were diagnosed with CRC and 122 deaths were reported (Department of Health Information and Research, 2017).

Why is lifestyle so important?

A consistent association exists between smoking tobacco and CRC (Botteri et al., 2008, Liang et al., 2009).  There are also convincing associations between alcohol drinking and CRC as well as body fatness (and abdominal fatness) and CRC (World Cancer Research Fund, 2007).  Numerous studies have also shown an association between processed meat, red meat and CRC.  A high intake of red and processed meat is associated with a significantly increased risk of colorectal, colon and rectal cancers (Chan et al., 2011).  The increased risk associated with processed meat intake is higher than that with unprocessed red meat.  Through curing with salt in processed red meat, haem iron is nitrosylated (supporting carcinogenesis further; Norat et al., 2015).


On the other hand, the evidence for a protective role of dietary fibre on CRC is growing strong.  A meta-analysis (a large study comparing many different studies) by Aune et al. (2011) found out that a high intake of dietary fibre, in particular, from cereals (whole grains), was associated with a reduced risk of CRC. Physical activity (which needs neither be intense nor of long duration for benefits to be seen – Mc.Tiernan, 2011) has been found to be protective against colon cancer but appears to be unrelated to rectal cancer (Robsahm et al., 2013).


Learn more!

There are actions that you can take to reduce the risk for cancer. If you would like to learn more, please visit the European Code against Cancer and learn about the 12 ways to reduce your cancer risk. If you’re curious about Malta’s National Cancer Screening Programmes, have a look at their online presence here or their Facebook Page and learn about their activities.


Armaroli P., Villain P., Suonio E., Almonte M., Anttila A., Atkin W.S., Dean P.B., De Koning H.J., Dillner L., Herrero R., Kuipers E.J., Lansdrop-Vogelaar I., Minozzi S., Paci E., Regula J., Tornberg S., and Segnan N (2015).  European Code against Cancer, 4th edition:  Cancer screening.  Cancer Epidemiology, 39S:  S139 – S152.  Doi:  10.1016/j.canep.2015.10.021

Aune D., Chan D.S.M., Lau R., Vieira R., Greenwood D.C., Kampman E., Norat T. (2011).  Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies.  British Medical Journal, 343: d6617.  Doi:  10.1136/bmj.d6617

Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. (2010).  WHO Classification of Tumours of the Digestive System (4th ed.)  Lyon:  International Agency for Research on Cancer

Botteri E., Iodice S., Bagnardi V., Raimondi S.,  Lowenfels A.B.,  Maisonneuve P. (2008).  Smoking and Colorectal Cancer A Meta-analysis.  Journal of the American Medical Association, 300 (23):  2765 – 2778. Doi:  10.1001/jama.2008.839

Chan D.S.M., Lau R., Aune D., Vieira R., Greenwood D.C., Kampman E., Norat T. (2011).  Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies.  PLoS ONE 6(6): e20456. Doi:  10.1371/journal.pone.0020456

Department of Health Information and Research (2017).  Colorectum Cancers.  National Cancer Register.  Retrieved from:

Liang PS, ChenT, Giovannucci E.  (2009).   Cigarette smoking and colorectal cancer incidence and mortality: Systematic review and meta‐analysis.  International Journal of Cancer, 124 (10):  2406 – 2415.  Doi:  10.1002/ijc.24191

McTiernan A. ed. (2011).  Physical Activity, Dietary Calorie Restriction, and Cancer.  Springer Science and Business Media, LCC.

Norat T., Scoccianti C., Boutron-Ruault M.C., Anderson A., Berrino F., Cecchini M., Espina C., Key T., Leitzmann M., Powers H., Wiseman M., Romieu I. (2015).  European Code against Cancer 4th Edition:  Diet and cancer.  Cancer Epidemiology, 39S:  S56 – S66.  Doi:  10.1016/j.canep.2014.12.016.

Robsahm T.E., Aagnes B., Hjartaker A., Langseth H., Bray F.I., Larsen I.K. (2013).  Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies.  European Journal of Cancer Prevention, 22 (6): 492 – 505. Doi: 10.1097/CEJ.0b013e328360f434.

Stewart B.W. and Wild C.R., eds. (2014).  World Cancer Report 2014.  Lyon:  International Agency for Research on Cancer.

World Cancer Research Fund (2007).  Food, Nutrition, Physical Activity, and the Prevention of Cancer:  A Global Perspective.  Washington DC:  American Institute for Cancer Research.

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