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Almost half of new cancer patients diagnosed at stage four, GHA finds

Around four in 10 cancer cases in Gibraltar could be prevented and up to 48% of new patients are diagnosed with advanced stage four disease, the GHA's clinical director of cancer services Dr David Ballesteros said this week.

The figures, revealed at the latest public session of the GHA Board held at City Hall, come days ahead of World Cancer Day this Saturday.

The audience, which included cancer charities, heard Dr Ballesteros stress the importance of prevention and early diagnosis, and the GHA’s increased work in this field.

He delivered a breakdown of the 105 new cancer cases in Gibraltar in 2022.

The GHA diagnosed 21% with breast cancer, 20% with lung cancer, 13% with colon, 13% with urology, 11% with gynae, and 10% with upper gastroinestinal and hepato-pancreato-biliary which includes oesophageal cancer, stomach cancer, bowel cancer, pancreatic cancer and liver cancer.

But the GHA’s research has found most cases in Gibraltar could be prevented if healthy lifestyles were adopted.

These lifestyle changes include exercise, limiting alcohol and stopping smoking.

Dr Ballesteros listed how the top lifestyle risks for cancer were smoking, alcohol use, high body-mass index, unsafe sex, high fasting plasma glucose (sugar in the blood), pollution, asbestos, diet low in grains, diet low in milk, and second-hand smoke.

The GHA has found that 57% of cancer patients were former smokers, 57% are overweight or obese, 54% are women, 39% are 70 years old or older, and 32% have a family history of cancer.

"We know more cases could be prevented if we tried a healthy lifestyle of stopping smoking, [maintaining a] healthy weight, balanced diet, vaccinations etc," Dr Ballesteros said.

Cancer activity - meaning clinics, treatments and support - increased more than three times in five years at the GHA.

For Dr Ballesteros, the GHA is not just seeing more patients, but their service and the number of clinics and treatments is on the increase.

This means that patients in Gibraltar are receiving more support, the GHA says.

With a growing and ageing population, Dr Ballesteros said, the GHA is also diagnosing more complex cases.

This is mainly because of patients are living longer with health problems.

The GHA has also found that almost half of new patients are diagnosed with advanced disease at stage four.

"This is a sad number, about 48% new patients present with a stage four disease, which in some stages might represent an incurable disease, [and] we are trying to reduce this to 25%," Dr Ballesteros said, highlighting the importance of awareness and screening.

The average age of cancer presentation in Gibraltar is 65 years, and information from a GHA audit found that 99% patients who died had an advanced disease.

Over the past two years in Gibraltar, 104 patients have died with cancer.

Some 28% of these patients had lung cancer, 14% had hepato-pancreato-biliary (liver and pancreas), 12% had colon cancer and 11% urology.

Last year also saw 187 patients undergo chemotherapy in Gibraltar.


Dr Ballesteros said when St Thomas' Hospital London reviewed the GHA's cancer services it was clear the current cancer unit was very small.

He added NHS estimates show that chemotherapy will increase 53% in the coming years, and he said the GHA's lifestyle survey showed that people were overweight, drink alcohol, a quarter of people smoked and a quarter did little exercise.

"All of this creates additional pressure in the future for cancer," Dr Ballesteros said.

This expected increase, coupled with the lifestyle changes, has meant that the GHA is expanding its service.

The GHA's new cancer unit will prepare the hospital for the decade ahead, and Dr Ballesteros said an area has been identified for a new unit.

"We are in the process of emptying that area," he said in answer to the public's questions.

"We have requested funding for the new cancer unit, we already made some initial contact with the architect, who just came last week."

"So we are moving forward."

He said progress is ongoing and there's space on the fifth floor, but an opening date has not yet been finalised.


Dr Ballesteros said there has been a radical upgrade in cancer screening and prevention in years past.

He pointed to genome testing and liquid biopsy being the key to prevention in the future.

"Essentially if you are born after 1960, you have 50% chance to develop a cancer,” he said.

“So the projected new cases has increased and the ideal pathway is to get a diagnosis within four weeks."

Although screening is key, to reduce the risks patients should be mindful of their lifestyles.

Dr Ballesteros described how often local patients will blame pollution, despite being smokers.

Director of Public Health, Dr Helen Carter, joined in the question-and-answer session, citing a lack of awareness for poor diet and little exercise when it comes to cancer.

"There's quite a lack of awareness around that, as much as smoking and alcohol, obesity is a risk factor as well," she said.

"Looking at our cancers there, breast cancer has the highest prevalence, you're increasing your risk with age, alcohol, tobacco, obesity, it all multiples up and increases your risk."

Dr Carter said she is working to develop a public health strategy to try and look at what an upscale in prevention can look like in Gibraltar.

Dr Ballesteros said the GHA also plans to review its palliative care service for patients.

"We cannot forget that palliative care is very important for our patients and we have to review our strategy perhaps and to reinforce our partnership with Cancer Relief and Social Services," Dr Ballesteros said.

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