Treasury debentures: more consultation needed
During budget time I wish to express my view that I believe it is
time for a shake-up of the cumbersome debenture-issuing process.
We all remember the shambles of November 2008 when the Government
suddenly issued a Special Issue of Monthly Pensioner Debentures
offering three and a half per cent - one and a half per cent higher
than the regular Monthly Pensioner Debentures existing at the time.
This created a huge and unnecessary administrative burden for the
hard-pressed Debentures Office staff and resulted in many pensioners
queuing up around the Treasury Building from well before 9 am in the
cold winter of that year.
Why was this "unnecessary"? Because the Government then proceeded to
increase the interest rate on the existing regular Monthly Pensioner
Debenture to the same level as that of the new Special Issue, which
meant that the exchange of hundreds - or possibly thousands - of
pensioners' certificates, which resulted in pensioners queueing at
the Debentures Counter and around Treasury Building for hours, could
have been easily avoided. How? Merely by raising the interest rate
on the existing regular Monthly Pensioner Debentures without issuing
a new Special with the higher rate. Elementary, surely.
The problem seems to be that decisions on new debenture issuance are
taken by Government consulting the Debentures Office staff, who are
the ones that have to carry out these massively wasteful exercises
in both paper and human resources no doubt including many hours of
overtime, or the long-suffering pensioners who need to queue up
endlessly - inside the building, if they're lucky - or stand outside
in the cold if it's winter and massive queues build up as was the
case in November 2008.
It will be interesting to see whether the Government announces the
issue of a further debenture with an attractive interest rate in
this month's budget. The latest auditor's report reveals that the
public debt required to finance the massive infrastructure and other
projects that are currently under way is being, in the main, funded
by pensioners through their purchases of debentures (as revealed in
Panorama on 9 April this year, pp. 2-3).
Government will have to maintain the momentum of funding borrowing
by continuing to attract pensioners' funds. They tried to tap the
'non-pensioner-specific' (i.e. where you don't have to be a
pensioner to invest) market in last year's budget but that backfired
when large numbers of pensioners rushed to transfer their savings
from pensioner debentures to the new three-year
'non-pensioner-specific' debenture paying 4 per cent interest
meaning that, instead of raising fresh funds, it ended up costing
the Government half a percentage point more in interest payable to
the many pensioners who transferred savings from the Special Issue
or from the regular Pensioner Debentures, both of which were paying,
and still pay, three and a half per cent.
No doubt in an attempt to try and avoid a repeat of the long queues
of November 2008, applications to transfer funds to the new
three-year 4 per cent 'non-pensioner-specific' issue in 2009 had to
be deposited in a box at the entrance to No. 6 Convent Place rather
than at the Treasury Department itself. Yet fast-track transfers
from the maturing April 2010 six per cent issue to the three-year
four per cent 'non-pensioner-specific' issue were to be delivered to
the Treasury and not No. 6. Confused? I'm not surprised. And there
must have been massive demand from pensioners to transfer to the 4
per cent debenture (that had really been aimed at attracting 'new
money' and not pensioner transfers) because applicants reportedly
did not receive approval of their applications for many months.
Government will have to come up with a clever ploy to attract more
funds to finance the burgeoning public debt without again
inconveniencing pensioners by obliging them to rush to transfer
their savings from one issue to a new one in another massive
wasteful paper exercise for them and for the long-suffering
Debentures Office staff. I think I know how this can be done
efficiently but will let the Government try and figure it out for
themselves. I just hope they don't make a mess of it again this
time. They cannot afford to again inconvenience the very people that
are funding a major share of Government borrowing.
Let's hope the Government takes the above into consideration, should
they decide to issue a further debenture in their budget this year.
Planning and consultation with relevant Debentures Office staff -
apparently conspicuously absent in recent debenture issues - should
M J Ashbey
In Defence of Democracy
One must make some pretty hard but justified criticisms of GBC
refusal to grant an interview to the leader of the opposition Joe
Bossano after his intervention at the United Nations before the
Committee of 24.
Its worth getting a few facts straight the purpose of having a
television and radio station in this country – which is paid by the
tax payers not Peter Caruana and his GSD party is for the purpose of
Citizens achieving the best possible result in news and information
in which both Government and opposition have the same right to it –
no more no less.
There is no statutory Policy – no law that binds the Chief Minister
or the board to an arbitrary decision on the use of radio or
television by the elected opposition to inform citizens on matters
of National importance.
This refusal represents a threat to GBC independence and the freedom
of the elected Opposition informing the electorate which they
represent of an important issue.
GBC must remain open to the free expression of views a spanning the
whole spectrum of Political Views and not into a mouthpiece for the
policies and propaganda of Government.
Unfortunately during the debate in Parliament on GBC objectives
clearly designed to control GBC were unveiled by the Chief Minister.
Though this is a disturbing issue perhaps I may be forgiven for now
seeking the readers attention to the intervention of the leader of
the Opposition at the United Nations.
For rarely has a politician in this country displayed so
determinedly and so justifiably its readiness to say to the 24
committee at the United Nations and indeed the world as the leader
of the Opposition Joe Bossano did on the subject of the right to
self determination and decolonisation when he said ‘it is not
Spain’s Territorial Interity that is under attack and requires your
protection, but ours…’
Unite the Union wishes to issue the following statement regarding
the UK Budget and the announcement in the House of Commons that the
Cameron Government will be implementing a two year pay freeze in the
This will have immense repercussions in Gibraltar for those workers
whose salaries and wages are derived from the parity concept. As we
have seen there will be a two year pay freeze in all public sector
salaries and wages. The only ones escaping from that measure both in
UK and locally are those public sector workers earning below £21,000
who will be getting a yearly £250 increase.
Some will be more fortunate in that industrial and non-industrials
in the Gibraltar Government have a three year deal that will be
respected and is set to end in August 2011. After that their wages
will be frozen.
Unite will continue our 'jobs for Gibraltarians' campaign aimed
primarily at the private sector, and advocating training schemes and
a system of fiscal incentives to private sector companies to
encourage the creation of employment opportunities for local
As predicted in my May Day message earlier this year, the election
of a Conservative administration in UK has meant a drastic reduction
in public expenditure.
The irony of this is that the crisis brought about in the
international banking sector as a result of the collapse of Lehman
Brothers in the US, led to a rescue package of the industry with
millions and millions of pounds from the public purse.
The public funds used all over Europe to maintain the banking
sector, meant that sooner rather than later, working people would be
called upon, as we are seeing now, to foot the bill for this policy.
A year later we are being told by the Chancellor of the Exchequer in
UK that massive spending cuts will be implemented in the public
sector. Once again working people and the lower paid sections will
be suffering the brunt of this capitalist crisis.
Yesterday was the international day of Public Services, which has
been ‘celebrated’ by a massive attack on the public sector. This is
not unique to UK. In other countries the situation is worse, and we
will soon be seeing Privatization of public sector assets across
Europe. Fortunately the Gibraltar Government is against
privatization and this has been stated publicly.
We should not forget that when the GSLP was in power, they
privatized nearly all public sector utilities and closed all
training centres. Unite is always against privatizations and
restrictions in public spending.
As Business Advisors to Gibsights we are proud to congratulate the
team for an outstanding success at the Young Enterprise (Yorkshire
Humber & Gibraltar) regional final held in Hull on the 17th June
2010. Gibsights, who had also previously won the Gibraltar
competition, will now represent the region at the UK finals of Young
Enterprise in London next month with the possibility of reaching the
European finals in Sardinia should they achieve victory once again.
The competition consists of student teams assisted by business
advisors and link teachers managing their very own companies and
selling a real product or service for an entire school year. This is
the second year Vasquez Consulting Ltd have participated as Business
advisors and Gibsights is now one of the best 11 teams of a total of
The Young Enterprise programme is a vital part of team development
at Vasquez Consulting Ltd. We have invested heavily by having both
our Directors working on a personal basis with the students,
mentoring them and passing on key business skills which will give
them an added advantage on the road to a successful career as well
as providing them with an enjoyable experience.
As Accountants & Business Consultants participation in the Young
Enterprise programme fits in very well with our business ethos and
we are committed to continue our support in the future. We hope our
input will give students the tools they require to succeed.
Congratulations to Gibsights (Mark Moreno; Syanne Agius; Sarah
Martinez & Joel Williams) We also wish to thanks the Link Teachers
Roin Sampere & Daniel Benrimoj for their outstanding contribution
towards a magnificent team achievement.
Ramon Vasquez & Alfredo Vasquez;
Directors - Vasquez Consulting Ltd
I would like to refer to Mr. F. Buttigieg letter of
21st June 2010 titled 'BULLYING' referring to a lead- article that
appeared in another daily on Tuesday 15th June 2010, titled 'New
Coordinator against Bullying and Harassment at Work'
Although it is heartening to read that 'Unite the Union' has at last
taken an interest in 'Bullying' it may be a matter of 'too little,
too late,' as the pressure group 'Dignity at Work' has been
declaring for many years that in Gibraltar 1 in 3 employees are
suffering the consequences of bullying at work. This represents
31.8% of employees or well over 5000 (Five thousand) individuals
falling victims or being targets of workplace bullying and suffering
mental health alteration and deterioration of their general
It is not enough for the Union to appoint a new coordinator to
tackle harassment and bullying at the workplace. Mr. C. Sisarello
does not explain in detail what the Union's policy, modus-operandi,
principles or measures will be to tackle this problem.
Both organisations mentioned above are in agreement that new
legislation should be introduced to regulate this problem, but from
a personal point of view I would like to question the efficacy of
this potential measure. I would even go further and state that the
present professionals and organisations who have a vested interest
in the subject of 'Bullying; or 'Mobbing,' as it is also called, are
not dealing with this very difficult problem in the right way.
As far as introducing new legislation to control, curtail and punish
offenders is concerned would indeed be a very desirable measure. But
we all know that legislation alone cannot stop anything. There are
laws against violence, robberies, muggings, drugs etc. but they do
not seem to stop the occurrence of these crimes.
Psychologists, counsellors, Union Representatives and well-meaning
people may be able to offer some kind of therapy or official help to
these victims but they do not deal with the culprits of these abuses
i.e. the bullies. Nor does any kind of therapy or legal assistance
gives the victims of such mistreatment the courage to repel further
attacks by other bullies in future.
We must not fall into the trap of treating these victims of bullying
or mobbing as mental patients in need of counselling or psychiatric
In my estimation, it is very important that all children at school
who become victims of the proverbial school bully be taught some
kind of self-defence so that the child can learn from a very early
age to 'fight his own battles'
In life we are all alone. We all have to be tested. We all have to
fight our own battles. If parents, teachers, priests, policemen and
people in authority take away the natural challenges that come our
way and wrap us around a protective layer of cotton wool then we
will never learn to stand up for ourselves or develop as persons.
The school playground is the real testing ground for all children
and this is where bullying usually starts and carries on into the
workforce for many adult victims.
Bullies have no right to intimidate weaker or younger children, but
quite often the parents and teachers cannot do anything about it. It
has also been proven that a bully who takes advantage of a weaker
child or adult person is a 'coward' himself and needs to be taught a
When bullies are not tackled or challenged at their own level they
become stronger and more boisterous like little 'Hitlers' In fact,
if Hitler himself had been tackled at an early age he would not have
become the menace he represented to all humanity when he reached the
full plenitude of his manhood. I have often been surprised to notice
in all his photos and films that he had a perfectly shaped nose. It
is incredible that no one gave such an upstart a deviated septum.
The course of history might have been different if someone had
taught Hitler a lesson early in life.
Once again I have to reiterate that children must be taught
'assertiveness skills' and 'self-defence' from an early age. I am
not a defender or advocate of wanton violence, but when it comes to
defending one's honour, dignity, space and physical integrity the
words of Kenny Roger's song 'The Coward of the County' 'Sometimes
you have to fight if you're a man,' might apply.
When the crunch comes, it might be better to lose a job than your
dignity. As the saying goes. 'Una puerta se cierra y otra se abre.'
Lunar Walk and thanks
It is that time of the year again and the Lunar Walk fast
approaches... FRIDAY 2 JULY! Join us at Casemates from 9pm to
register and at midnight, Mayor Olga Zammit will launch us on our
way along Winston Churchill Avenue, to the airfield and around the
Western end of the runway and to end at Ocean Village for a well
earned drink...so get those walking shoes, pink gear and bras ready,
it's charity walking time.
So many people & companies have helped and supported us over the
year, as you may have seen via the media, THANK YOU! However we
would like to thank our 'quieter' supporters: Paul Ruiz & his
colleagues who cycled the whole Camino de Santiago for us and raised
£200; the Calentita night 'cake supremos' Sarah Sheehan, Nicole
Stevens, Lyanne Mor & Ivan Hernandez (plus the wonderful bakers:
Yvonne Sheehan, Moira Mor, Glenn Mor, Fiona Mascarenhas, Geraldine
Bell & Jennifer Poole for their delectable cakes) who raised £320,
deliciously well done!
Always in the best interest of the women of Gibraltar (and some
men), we are very happy to lobby for improved and increased services
for breast cancer & disease care; thank you for your continued
support and encouragement in allowing us to do this, your kind words
mean everything to us and give us the impetus to keep going.
Committee, Breast Cancer Support Gibraltar
Since September 2005 Dignity At Work Now (DAWN) has been campaigning
through its Ban Bullying Day for the eradication of bullying at
work. We work closely with employees, employers and others to this
DAWN have on many occasions encouraged and invited organizations to
deal with the issue of bullying. We therefore welcome the news that
Unite the union have finally decided to proactively tackle
harassment and bullying at work and also welcome the appointment of
Eddie Baglietto as Coordinator. We are happy that Unite will now use
its resources and power and join in the effort of the eradication of
this type of behaviour that is so prevalent in places of work.
The study undertaken by DAWN shows that 31.1% of employees consider
themselves being victims of bullying at work, that’s almost 1 in 3.
This means that over 5000 people are being bullied in Gibraltar
today (Vielma & Buttigieg, 2007). These finding are corroborated by
the numerous calls we get asking for help, advice or intervention.
As always, DAWN would like to reiterate that we are at the disposal
of our community as well as organizations like unions, businesses,
NGO’s and individuals. Needless to say DAWN is more than happy to
offering its knowledge and experience in dealing with bullying.
Given the recent tragic suicide of an employee of Barclays Bank who
we know was being a victim of bullying at work and was also a member
of Unite the Union, DAWN met with Barclays CEO, Franco Cassar on two
occasions to make him aware of the bullying situation that is going
on within the bank. We also offered Mr Cassar that if he really
wanted to know whether a problem exists within the bank that we
would undertake a study to measure bullying. This offer has been
sadly rejected by Barclays.
We are deeply concerned that so many employees are falling victims
of bullying and their health being seriously affected by its
devastating and chronic effects. For many years many have suffered
in silence because of the general collective denial together with
the negligence of employers and employees representatives.
Lack of anti-bullying policies and legislation on this issue largely
contributes to the continuance of bullying going unpunished. DAWN is
conscious of the amount of work still to be done and welcomes all
who wish to contribute to dignity in our places of work.
Francis P. Buttigieg
Chairman of DAWN
Feeling the pinch
Indeed we are suffering our economic recession well after mainland
Europe and traders have indeed felt the pinch. However, part of this
recession is due to the uncaring and arrogant behaviour of the Royal
Gibraltar Police FORCE.
Although I do not deliver personally with great regularity, I have
witnessed how police officers are especially hard on delivery
drivers. Many of these drivers strive to park without hindering or
obstructing other vehicles and pedestrians and are even careful not
to park on part of a zebra crossing. Many of these conscientious
drivers ask police officers who may be at the scene if they can park
to deliver goods and are told that they can but to hurry up. It is
to their surprise when they return to their vehicle and find the
mentioned constable in the process of issuing a parking ticket. When
asked why this action has been taken, the answer is that his
superior has just informed him to fine the vehicle and that he has
already started writing the ticket out and has to issue it as he
cannot cancel it.
We know that Government is short of cash and that, according to the
Police Authority, there is a very low crime rate in Gibraltar but,
just because officers are placed on traffic duties and want to earn
their stripes as a means of promotion, they should use their
discretionary powers, if they have any. Why be so UNREASONABLE!! Why
don't they make sure that bikes and private cars are not parked on
loading bays for days on end, making the lives of people trying to
go about their usual business, a misery? Has this been tackled by
Government in their proposed traffic plan?
I hope that the powers that be do something about this unfair state
of affairs. It is a complete harassment of people who are trying to
do a decent day's job for a decent pay.
A Government that pleases Spain
It is no longer news to read that the Paramilitary Guardia Civil
vessels are continuously systematically invading our Territorial
waters and with arrogance provoking Gibraltar's maritime Police with
their 'third world' patrol vessels.
Then what was special about it? It was the fact that despite the
fighting tone adopted by the Chief Minister in Parliament a year
ago, that the Government intended to acquire vessels of a much
important size and capacity with which to exercise and by force
jurisdictional competence - the situation lamentable remains the
No policy decision has been taken by Government to acquire those
vessels for the Police which is deeply disturbing. Again it is
question of another broken promise in Government’s legacy of broken
promises to the people of Gibraltar.
What is abundantly also to be found here, however, is evidence that
no matter what the nature of the intimidation is or of those in
Spain who have traditionally challenged our right to our homeland
the Chief Minister is only too happy to accommodate and please
This process is manifestly no new phenomenon. We had the episode of
the paramilitary vessel who invaded our Territorial waters and
inside our harbour including our land and its crew detained, but two
hours later were let free without charges, clearly a degenerate
corruption of our laws to please Spain.
We also have the federation of local anglers waiting for legislation
to safeguard their right to freely fish without interference from
outsiders and the protection of our fishing grounds against the
invasion of Spanish Anglers.
I cannot, of course, leave this subject without referring that the
Government will now be introducing legislation, but I certainly take
no satisfaction from that the anglers from Spain will not be barred.
It would be foolish, however, to assume knowing the chief minister
that he would completely stop the Spanish anglers.
But due to the nature of our territorial size and seafront which
cannot be compared with other countries we therefore do not have the
same freedom of movement. There must certainly be restrictions and
limitations to those that come from Spain to balance this
A few words are also necessary about other aspects of government
policy to appease and please Spain. Laws on restrictions and
limitations on the sale of tobacco and subjecting ordinary citizens
going about their business, to surveillance which is obnoxious and
intolerable in a free and democratic country, all to please Spain.
There are also the many increases in prices on petrol and diesel
through the year. What it does mean however is that its shadow
darkens all areas of our cost of living.
GBC hiccup, and no apology
While in Gibraltar recently I soon became aware that GBC television
is not held in the highest esteem. But now I have confirmation, I
regret to say.
Before leaving at the weekend, I was watching last Friday what is
known as the Newswatch replay at around 11pm.
To my amazement, this news bulletin started abruptly which, itself,
drew my attention. But surely this was not the beginning of the
bulletin...no, it waan't!
After several minutes the programme was stopped, there was a short
filmed snippet about something or other, and then the Newswatch
started where it should have started in the first place - at the
beginning, and not half-way through as happened initially.
I was further surprised that there was no explanation for this
serious hiccup, much less any apology.
I say this because that same day, on one of our ITV channels, the
England match was also interrupted. The difference was that there
was someting of an uproar in England - and ITV had the decency of
Charles A. Horton
Turning the screw?
With His Excellency the Governor's words viz a viz the Bay
incursions hardly dry on paper, the Spanish government's reply is
This morning (the 9th) a Spanish naval vessel, the survey ship
TOFINO pennant No A 32 appeared in the Bay of Gibraltar and
conveniently sailed along the "median line". Could this have been an
innocent passage, or the start of the turning of the screw ?
What next ? Will they send the aircraft carrier Principe de Asturias
or will they resurrect " Smokey Joe".
Interesting time ahead !
Stupidity at its best by our Health Service
A friend of mine, whose wife, like mine is suffering from
Alzheimer's at St Bernard's hospital, requested that his wife should
be given physiotherapy treatment but has been told his wife is not a
patient at the hospital but that she is just waiting for a vacancy
at the Elderly Care Unit.
My wife has been in hospital for the last two years and now she
cannot walk, move her head to either side nor lift it up. She is
confined to a seat where she cannot move. In other words, this
patient is becoming a vegetable.
I am convinced that a mass murderer in a prison cell is treated and
looked after better.
J L Soiza
Action on air pollution!
The European Commission has warned Gibraltar that air pollution
levels are above acceptable levels and represent a health risk. If
action is not taken the Commission may issue action against
Gibraltar. This is not a simple legal issue of compliance. Ignoring
these warnings endangers the health of our citizens. Government
needs to act to bring the levels of air pollution down. There are
ways of doing so.
The major sources of man-made air pollution include the combustion
of fuels, such as petrol/diesel by vehicles; energy generation from
power plants and industrial activities such as building, mining,
manufacturing of cement, ceramic and bricks.
The effects of inhaling particulate matter have been widely studied
in humans and animals and include asthma, lung cancer, heart disease
and premature death. It has been suggested that air pollution is
related as a cause to brain damage as that found in Alzheimer
Particulate matter pollution is estimated to cause 200,000 deaths
per year in Europe. For this reason the EU has set standards for
particulate matter concentrations in urban areas.
There will be a tendency for many to try and blame this increase in
particulate pollution in Gibraltar with natural processes such as
airborne dust brought by southerly winds from the Sahara. However,
increases in traffic, a boom in construction, extremely polluting
generating stations that posses no electrostatic precipitators and a
neighbouring petrochemical refinery are more likely sources of this
type of pollution.
There are different methods in which particulate matter pollution
can be tackled. A simple and effective way is by planting coniferous
trees, which have been demonstrated to actively trap particulate
matter. Traffic management, improvement of our public transport and
the promotion of hybrid technology and electrical vehicles would
also help reduce particulate pollution.
Better regulation of what has seemed to be a ‘free for all’ in
construction in recent years would also have resulted in less of
this type of pollution being emitted.
Also the use of electrostatic precipitators in generating stations
would reduce the emission of these sooty particles into the
environment. Government must ensure that sensible policies that aim
to reduce this harmful pollutant are implemented in order to
minimise the health hazards associated with this as well as
preventing embarrassing and costly litigation at a European level.
Government should not pay lip-service to environmental measures by
supporting World Environment Day but then failing to act in this
important area. The issue of minimising air pollution is crucial for
the improvement of health of our citizens.
The Government needs to take measures to bring down the dangerous
levels of pollutants being emitted in Gibraltar. We are setting out
some constructive suggestions which would help to deal with this
problem. It is now up to Government to act.
Dr Gavin Gafan
PDP environment spokesman.
Having met with John Cortes and Eric Shaw from GOHNS, I had pleasure
in joining them to condemn the proposed dolphinarium planned for
inclusion in the redevelopment of Rosia Bay.
The American company Ocean Embassy, also planned to open one of
these facilities at Playa Coronoa in San Carlos; this was abandoned
due to public opposition and through a note sent to the Aquatic
Resources Authority of Panama.
The same can happen for the proposals by Ocean Embassy to build a
dolphinarium here in Gibraltar, but not without public awareness and
subsequent opposition and action.
The link to youtube below is a video of dolphins in captivity and
their experiences to get there, please watch it and see what will
happen to our native dolphins should this project come to fruition:
Now see 'Dolphin Safari's' website footage of the beautiful mammals
in their proper, natural environment:
Now take action! As well as showing your support for GOHNS
(Gibraltar Ornithogical and Natural History Society) by joining
through their website at
http://www.gonhs.org/contact.htm . Forward this email to all in
your contact list and friends, or join the facebook based support
Dolphins are probably the next most intelligent mammal to us, there
are many recorded instances of them helping people in distress who
may have perished otherwise. Let's try to repay them by uniting in
opposition to the senseless and unnecessary cruelty in a world where
we are aware of the importance of conservation and preservation. We
have a duty as custodians of our world to protect it and slow the
damage done by modern times and human convenience and 'pleasures'.
Support the cause further when in Gibraltar and other places where
these magnificent animals are indigenous, by going on a trip to see
them in their natural habitat.
Imminent Breast Screening Programme
Breast Cancer Support Gibraltar is extremely excited that their
primary wish, Gibraltar's own Breast Screening Programme (BSP), is
to be realised and to start any day now with a pilot programme. The
Charity has worked very hard these last three years to ensure that
all measures necessary to provide a BSP have been put in place by
the GHA. It has lobbied the GHA for the delivery of a service which
Gibraltar can be proud of on a par and in many ways better, than the
approved NHS BSP in the UK. As opposed to the UK, which screens
women every three years from the age of 50 to 70, Gibraltar will
screen women from 40-49 yearly, 50-64 every two years and 65-74
every three years.
The Charity feels it is important that the women of Gibraltar are
informed of all the facts surrounding a BSP so they can make an
informed choice when they are invited for screening. Once the BSP
starts to roll out to all women in Gibraltar over the age of 40,
public information leaflets will be made available, providing
details of the logistics of the programme and how it will work.
We have consulted with Breast Cancer Care, (a leading breast cancer
charity in the UK), to ensure that the information we provide is
correct. It is important to stress that breast screening saves lives
and it means that cancers will be detected at an earlier stage,
increasing the rate of successful treatment and survivability. As
with any medical investigations, there is a small risk of false
readings which can cause alarm but can also be addressed by an
in-house radiologist by referring to other diagnostic imaging tools
at his/her disposal. According to a report by Peter Gotzsche et al
in the BMJ 21 February 2009, their statistics show that for every
2,000 women screened regularly over 10 years, one will avoid dying
from breast cancer and 10 women will receive unnecessary treatment.
Breast Cancer Care UK is very careful to point out that despite this
minimal risk with breast screening, it leaves no doubt that
screening is good for women and they advise women to attend routine
screening when invited and we concur with that view.
Gibraltar plans to use a mammography unit for the BSP, as in all
breast screening programmes around the world. After a request from
the then GHA Breast Radiologist Dr Bernathova, and consultation with
Dr Wilson, Head of Radiology at the Royal Marsden Hospital, Breast
Cancer Support Gibraltar successfully convinced the Bonita Trust to
purchase a Digital Mammography Unit with Computer Aided Detection
(CAD). This is a fabulous IT tool built into the unit which
highlights areas of discrepancy in the breast image even before the
radiologist has scrutinised it. After selection and approval by Dr
Bernathova, we are thrilled that the Bonita Trust purchased the
equipment last August, (not all BSP centres in the UK have yet
bought such advanced digital technology).
While researching for the Bonita Trust the advantages of digital
mammography over analogue, we found clear benefits which we would
like to share with you:
· The quality of the digital images are much better and clearer as
the contrast is better
· Women with implants (after breast enhancement surgery) can have a
successful mammogram with this technology as any changes in the
breast tissue will be detected due to the improvement in image
· The compression plates are more comfortable, especially for women
with implants & larger breasts and the patients are ‘under
compression’ for less time
· The image processing is faster as images are sent directly to a
workstation in real time; images can also be sent electronically to
a tele-radiology centre
· There is reassurance for women as they can chat to the
mammographer who will confirm the image is there etc. as the
workstation is in same room
· A lower radiation dose is given as the mammogram is quicker and
· The images can be manipulated by the radiologist at the
workstation who can zoom in to areas of concern; there would be
fewer incidents of repeat mammograms being required to obtain a
magnified view etc.
· More efficient use of radiologist’s time due to speed and accuracy
of digital equipment
· As this technology takes the mammogram image more quickly, it is
ideal for screening large numbers of women, i.e. a breast screening
· This technology is less likely to need an upgrade in the future,
only of its IT
After screening the breast with the mammogram, in a very small
number of cases, areas of discrepancy within the breast image that
are still not clear will require further investigation. For these
diagnostic purposes, ultrasound or an MRI can be used to highlight
an area again. Ultimately only a biopsy and pathological
investigation will determine what the change in the breast is. For
this reason, after a request from GHA radiologist Professor Bodner,
our Charity bought a Vacuum System for the digital mammography unit.
This facilitates obtaining a biopsy by literally 'sucking up' a
tissue sample using the mammographic equipment as a guide to
localise the lesions. This avoids open biopsies (surgery) and
processes more women more quickly, with less stress and anxiety for
Magnetic Resonance Imaging (MRI) is undergoing a clinical trial in
Germany as a possible tool for screening, however this is still at
the trial phase (as are many types of drugs, treatments & imaging
technology) and may not be successfully approved after the necessary
time period required in which to rigorously test the service. After
some research into the matter and consultation with Breast Cancer
Care UK we discovered that MRI is not used anywhere in the world for
breast screening: it requires an inordinate amount of uncomfortable
time for a woman to be in in order to image both breasts
successfully (over two hours of staying absolutely still in a
tunnel-like machine and if you move, start the process all over
again), making it impractical and very time-consuming as a screening
However, as mentioned earlier, MRI is an excellent diagnostic tool
used to support the few unclear ultrasound or mammography images
that cannot be read, and this is standard practice in all modern
health services including Gibraltar. If there ever comes a time
where MRI is approved for breast screening by the National Institute
for Health & Clinical Excellence (NICE) and adopted by the UK's NHS
BSP, Breast Cancer Support Gibraltar will be lobbying the GHA to do
likewise in Gibraltar; until then, we await results on all clinical
trials that affect breast cancer & disease care.
A word on Ductal Carcinoma in Situ (DCIS), which constitutes 20% of
all breast cancers. Thanks to digital mammography technology, more
DCIS is highlighted in women who are screened, which has led to some
of the unnecessary treatment suggested by Gotzsche et al, mentioned
earlier. Jackie Harris, Breast Cancer Care UK's Clinical Nurse
Specialist on Breast Health & Family History, explains that as DCIS
is a non-invasive breast cancer, since screening started over 30
years ago, many women have lived with DCIS without it becoming
invasive or being of detriment to the health of women. However, a
small percentage of DCIS does become invasive if left untreated;
clinicians and experts in this field are investigating DCIS further
in order to understand the disease better to suggest different
treatment protocols to protect those women who would otherwise
receive unnecessary over-treatment for it. The jury is still out
there for DCIS; however Breast Cancer Care UK will keep the public
informed of progress in this area as it gets it.
Breast Cancer Support Gibraltar would like to reassure the public
that they are happy with the planned BSP that will be on offer in
Gibraltar and that the Charity will always demand and expect the
best. We are also happy to answer any queries or concerns the public
may have about this or breast disease in general.
Breast Cancer Support