Malta records lowest cancer mortality in EU

Malta has the lowest cancer mortality rate in the EU, having recorded a significant decline in cancer deaths over a 10-year span, according to the OECD.

From 247 deaths per 100,000 in 2011, the mortality rate dropped to 198 deaths per 100,000 in 2021, a significant decrease of 20%.

Malta’s cancer mortality rate is 16 points below the EU average of 235 deaths per 100,000.

This emerges from the European Cancer Inequalities Registry 2025 report, released by the OECD, an international organisation for economic co-operation and development.

However, despite Malta’s progress, the report highlights persistent challenges in prevention efforts, access to innovative cancer treatments, and healthcare inequalities, particularly affecting lower-income groups and migrants.

Malta also reported lower overall cancer incidence rates compared to other EU countries.  The incidence of lung, colorectal, prostate, and breast cancer is notably lower.

While the incidence rate among men in Malta is significantly lower (614 per 100,000 when compared to 684 in the EU), the incidence rate among women remains slightly higher than the EU average (494 per 100,000 in Malta compared to 488 in EU).

The gender gap in cancer incidence is also smaller than the EU average, with 40% more cases among men than women across the EU, compared to a 24% gap in Malta.

Uterine and thyroid cancers a concern

The decline in colorectal and breast cancer mortality is largely attributed to improved screening and early detection. However, the report stresses that more timely interventions are required to improve colorectal cancer care, particularly among women.

While Malta performs well overall, certain cancers remain a concern. The incidence of uterine cancer among women is 33% higher than the EU average, and thyroid cancer incidence is 31% higher. However, lung cancer rates among women are 45% lower than the EU average.

Malta has seen a sharp decrease in mastectomies, with the lowest rate of total mastectomies in the EU in 2021. The number of total mastectomies performed fell from 130 in 2013 to 67 in 2021, a 58% decline. Partial mastectomies also declined by 17% between 2018 and 2021.

Childhood cancer incidence rates in Malta are also lower than the EU average (6.8 per 100,000 children compared to 13.7 per 100,000 in the EU). Despite this, childhood cancer mortality in Malta is considerably higher, with an average of 3.4 deaths per 100,000 children, compared to 2.1 in the EU.

Malta lags in prevention efforts

Despite its low cancer mortality and incidence rates, Malta lags behind in prevention strategies. The report notes that only 1.2% of Malta’s health expenditure is dedicated to prevention – one of the lowest rates in the EU and far below the EU average of 6%.  The report calculates that Malta can prevent 2,377 cancer cases between now and 2050 if it manages to reach its targets on reducing obesity, air pollution, tobacco smoking and alcohol consumption.

Obesity a major concern

Obesity remains a major concern, with 63% of Maltese adults classified as overweight or obese.

This rate is higher among men (70%) than women (54%), with Malta’s female obesity rate nearly a quarter higher than the EU average. The issue is particularly pronounced among women with lower education levels. Childhood obesity is also a pressing issue, with the percentage of overweight adolescents in Malta 48% higher than the EU average. The problem is particularly acute among children from disadvantaged backgrounds, with those in the lowest income bracket being 11 percentage points more likely to be overweight.

While smoking rates among adults in Malta have remained stable at around 21% from 2008 to 2019 – unlike other EU countries, which have seen declines – youth smoking rates are among the lowest in the EU, with only 10% of adolescents reporting having smoked in the past 30 days in 2022.

Gaps in treatment and financial burdens

However, access to treatment remains a challenge due to financial constraints. The OECD report referred to the fact that in general Malta has the highest out-of-pocket health expenditure in the EU, with 7.7% of household consumption spent on healthcare, more than double the EU average of 3.2%.

In 2022, 26% of people reported out-of-pocket payments for non-covered pharmaceutical medications.

Moreover, while cancer diagnosis and treatment are largely free under the national health service, patients often have to pay for medicines not listed in the government formulary list, including many cancer drugs. However, certain oncology medicines not listed on the formulary are still provided by the government following approval by the Exceptional Medicinal Treatment board.

But Malta also has the lowest rate of biosimilar cancer medicine reimbursement in the EU, covering only 16% of biosimilar cancer treatments compared to the EU average of 65%.

The country faces challenges in procuring innovative cancer medicines due to its small market size and limited manufacturing capacity. To address this, Malta has been working with the World Health Organization to develop policies ensuring sustainable and affordable access to these medicines.

The Malta Community Chest Fund Foundation has also played a crucial role in covering costs, with its expenditure rising from under €1 million in 2015 to over €20 million in 2022.

The report also highlights gaps in cancer care for irregular migrants, who are often not captured by screening services. The National Health Systems Strategy for Malta 2023-2030 includes the establishment of an Immigrant Support Unit to provide holistic healthcare services for this demographic and improve their access to screenings and clinical programmes.

Screening programmes

The report also notes that despite the expansion of cancer screening programmes for breast, cervical and colorectal cancers, participation in public programmes remains low due to the high uptake of screening examinations in the private sector.

Moreover, inequality in participation in such programmes persists. In 2019, 74 % of Maltese women in the highest income quintile reported having had breast cancer screening in the past two years, whereas this was reported by only 51 % of women in the lowest quintile.

In 2023, 68% of LGBTIQ cisgender females, trans women, and intersex people aged 25-39 in Malta reported having had a cervical smear test in the previous five years. This was considerably higher than the 64% in the EU.

In 2022, only 16% of eligible women participated in cervical cancer screening – a rate much lower than in most other EU countries. But the report notes that many women in Malta have cervical screening tests in the private sector rather than utilize public screening programmes.

In the same year, a quarter of the eligible population in Malta was also screened for colorectal cancer.

Infrastructure, workforce and equipment shortfalls

Malta’s primary radiotherapy centre is the Sir Anthony Mamo Oncology Centre at Mater Dei Hospital. While the country has a Treatment Abroad service for patients requiring specialist care unavailable locally, it remains the only EU country without a brachytherapy unit, a treatment method using radioactive sources placed inside or near tumours.

Additionally, Malta lacks particle accelerators for light ion beam therapy, though such equipment remains rare across the EU due to its complexity.

A sizeable oncology workforce has always been a challenge for Malta, given its small population size.

In a 2023 OECD policy survey on cancer care performance, Malta reported a shortage of every medical profession listed, including general practitioners, oncologists, radiologists and radiographers, radiation therapists, medical physicists, inpatient and community oncology nurses, and survivorship coordinators. However, relative to new cancer cases, Malta has a high supply of physicians. In 2022, in relation to cancer incidence, Malta’s density of doctors is 28% higher the EU average and the density of nurses is 9% higher the EU average.