Replies to LegCo questions
LCQ14: Breast cancer and cervical cancer
Following is a question by the Dr Hon Elizabeth Quat and a written reply
by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative
Council today (May 8):
Question:
Statistics of the World Health Organization show that, in 2010, 54.8 women
in every 100 000 women in Hong Kong had breast cancer. Compared with the
world average ratio (39 women had breast cancer in every 100 000), Hong
Kong is a place with an above average incidence rate. According to the
statistics of the Hospital Authority (HA), breast cancer tops the list of
the "Top Ten Cancers" for women in Hong Kong. In 2010, the life-time risk
of Hong Kong women having breast cancer was one in 19. Also, eight women
were diagnosed with breast cancer and at least one died of breast cancer
every day on average. The Hong Kong Breast Cancer Foundation has pointed
out that information of the International Cancer Screening Network shows
that population-based breast cancer screening can reduce the mortality
rates of various countries/regions by 20% to 38% and, at present, more
than 34 countries and regions around the world (including Mainland China
and Taiwan) have implemented population-based breast cancer screening. As
Hong Kong has not implemented such screening, less than 5% of the 1.5
million women aged 40 to 69 have undergone the screening. On the other
hand, statistics of HA indicate that, in 2010, the life-time risk of women
having cervical cancer was one in 145, and one in every 445 women died of
cervical cancer. In this connection, will the Government inform this
Council:
(a) of the respective numbers of newly confirmed cases and deaths of
breast cancer and cervical cancer in Hong Kong in each of the past five
years;
(b) of the respective total expenditure on prevention and treatment for
breast cancer and cervical cancer by public healthcare institutions in
each of the past five years, and set out in a table the details of the
amounts of expenditure on health education, medical examination and
assessment, specialist treatment, operations and in-patient services, and
follow-up rehabilitation, etc.; the total and a breakdown of the projected
expenditure in each of the next five years;
(c) whether public healthcare institutions have provided subsidised breast
cancer screening for women with family history of the cancer; if so, of
the number of women screened, the expenditure incurred, and the breast
cancer detection rate in each of the past five years; of the number of
women to be screened and the projected expenditure in each of the next
five years;
(d) whether it knows the number of women screened for breast cancer on
their own expenses in private healthcare institutions, the fees involved
and the breast cancer detection rate in each of the past five years;
(e) whether it has assessed the expenditure to be incurred each year for
implementing a free breast cancer screening programme for women aged 40 to
69; if it has, of the details; if not, the reasons for that;
(f) of the number of women of the relevant age cohort who received
screening for cervical cancer provided by public healthcare institutions,
the expenditure incurred, and the cervical cancer detection rate in each
of the past five years; the number of women to be screened and the
projected expenditure in each of the next five years;
(g) whether it knows the number of women who received cervical cancer
screening and cervical cancer vaccinations on their own expenses in
private healthcare institutions and the fees involved in each of the past
five years;
(h) whether it has assessed the respective expenditure to be incurred each
year for implementing a free cervical cancer screening programme and a
free cervical cancer vaccination programme for all women; if it has, of
the details; if not, the reasons for that; and
(i) of the respective numbers of women who received screenings for breast
cancer and cervical cancer provided by each of the Woman Health Centres (WHCs)
and Maternal and Child Health Centres (MCHCs) under the Department of
Health in each of the past five years; whether there were differences in
the numbers of women screened among various WHCs and MCHCs; if so, of the
reasons for that; of the respective estimated numbers of women using such
services in each of the next five years; whether there are measures to
enable more women to know about such services; if so, of the details; if
not, the reasons for that?
Reply:
President,
Cancer is a major public health issue in Hong Kong. Its prevention,
control and screening policies must be grounded on fact, scientific
evidence and public interest. In examining whether to introduce a
population-based screening programme or vaccination programme for a
specific disease, the Government needs to carefully consider a number of
factors, such as the prevalence of the disease in Hong Kong, the accuracy
and the safety of the tests for the local population, as well as the
effectiveness in reducing incidence and mortality rates of the disease.
The Government also needs to give due consideration to the actual
circumstances, such as the feasibility and cost-effectiveness of the
screening programme and public acceptance.
The Government has established the Cancer Coordinating Committee, which I
chair, to formulate comprehensive strategies and make recommendations for
effective prevention and control of cancer. The Cancer Expert Working
Group on Cancer Prevention and Screening (CEWG) was set up under the
Committee to provide recommendations on preventive measures and screening
of cancers.
At present, cervical cancer screening is the only population-based cancer
screening in Hong Kong which bears sufficient evidence on its
effectiveness. Taking into account the recommendations of CEWG, the
Department of Health (DH) has been running a territory-wide Cervical
Screening Programme in collaboration with public and private healthcare
providers since March 2004, to encourage women aged 25 to 64 who have ever
had sexual experience to have regular cervical smears to prevent cervical
cancer. The Cervical Screening Programme also includes public education
and the establishment of the Cervical Screening Information System which
stores smear records and reminds women to have regular cervical smears.
The human papillomavirus (HPV) vaccine offers protection against cervical
cancer, but cannot effectively protect against infections of some types of
high risk HPV which are not included in the vaccine. It also cannot clear
the virus in those who are already infected. For this reason, women who
have received the vaccination must continue to have regular cervical
smears. According to the latest recommendations issued by the Scientific
Committee on Vaccine Preventable Diseases and the Scientific Committee on
AIDS and Sexually Transmitted Infections under the Centre for Health
Protection of DH, Hong Kong should consider the local context and the
development of scientific evidence, as well as conduct health economic
evaluation of any vaccination programme. The Scientific Committees also
recommended that we should strengthen the implementation of the Cervical
Screening Programme in Hong Kong, raise public awareness and enhance the
public's understanding of the HPV vaccine through health education and
publicity. The Scientific Committees will continue to keep in view the
latest developments on this subject.
Population-based breast cancer screening by mammography is a subject of
controversy. In some Western countries where the incidence rate of breast
cancer is relatively high, population-based mammography screening
programmes have been implemented since the 1980s. However, studies have
found that screening programmes were only followed by a slight drop or
even no reduction in the mortality rate of breast cancer. Some studies
also revealed that screening programmes have caused harm such as
over-diagnosis. As a result, some Western countries are beginning to
adjust their breast cancer screening policies. Separately, while some
Chinese or Asian communities have implemented population-based breast
cancer screening programmes, there is no published data that reflects the
effectiveness or cost-effectiveness of the programmes. There are also no
studies indicating that the programmes can effectively reduce the
mortality rate of breast cancer. Internationally, an independent study
report in 2011 concluded that it was unclear whether mammography screening
does more good than harm. Hong Kong should take reference from these
experiences. CEWG considers that individual women at increased risk of
breast cancer (e.g. those with a family or personal history of the
disease) should seek medical advice about whether they should receive
breast cancer screening, but considers it unclear as to whether
population-based mammography screening does more good than harm to
asymptomatic women. The Government will continue to promote healthy
lifestyles as the main prevention strategy, encourage breastfeeding and
promote breast awareness among women, so that medical attention could be
sought early if any abnormalities of the breast are identified. CEWG will
continue to keep in view the latest developments on this subject.
As a matter of fact, the risk factors associated with many cancers are
closely related to lifestyles. CEWG has pointed out that cancers,
including breast cancer, can be effectively prevented through the adoption
of healthy lifestyles, such as avoiding smoking and alcohol consumption,
having regular exercise, and eating less meat and more vegetables. In this
connection, DH actively promotes healthy diets, encourages regular
exercise, implements effective tobacco control measures and educates the
public on alcohol-related harm, in order to prevent cancer.
Against the above background, my reply to the nine parts of the questions
is as follows:
(a) The Hong Kong Cancer Registry of the Hospital Authority (HA) collects
cancer data of the overall population in Hong Kong. The incidence and
mortality of breast and cervical cancer in the female population are at
Annex A.
(b) The expenditure for prevention and treatment of respective cancers
cannot be broken down as required by the question. DH's spending on public
health education is not classified by types of cancer. In providing
treatment and care services for cancer patients, HA adopts a
multidisciplinary approach across a number of clinical specialties.
Doctors will arrange different forms of examination, pharmaceutical
treatment and other adjuvant treatments in light of the patients' needs,
their clinical conditions and the complexity of their diseases. Moreover,
cancer patients often require integrated medical services, including
general out-patient clinic and specialist out-patient clinic services,
acute care, extended care and hospice care, etc. Some cancer patients also
need treatments for other diseases such as diabetes and hypertension.
(c) There are three Woman Health Centres (WHCs) and ten Maternal and Child
Health Centres (MCHCs) under DH providing Woman Health Service to women
aged 64 or below. The service includes clinical breast examination for all
participants. Women at increased risk of breast cancer will receive
mammography screening after medical assessment. If abnormalities are
found, they will be referred to specialists for follow-up management.
Enrolment figures for the Woman Health Service under DH, the number of
women receiving mammography screening and the number of cases referred to
specialists due to breast problems are at Annex B. DH does not keep data
on the breakdown in expenditure on mammography screening or breast cancer
detection rate.
(d) DH does not collect data on mammography screening performed in private
institutions.
(e) Given the lack of public health evidence at present, the Government
has no plan to introduce a free population-based mammography screening
programme, hence it has not assessed the annual expenditure for the
implementation of such programme. We will continue to keep in view of the
research findings by the medical sector.
(f) The attendance of cervical screening service at MCHCs under DH and
cases referred to specialists are at Annex C. The expenditure of the
Cervical Screening Programme is at Annex D. These figures are expected to
remain stable over the next five years.
(g) DH monitors the coverage of cervical screening among Hong Kong women
through the Behavioural Risk Factor Surveillance System. According to the
Behavioural Risk Factor Survey conducted in April 2012, 69.2% of women
from the age group of 25-64 have ever received cervical smears. DH does
not collect data on the fees for this service provided in private
institutions.
DH also does not collect data on the number of people receiving cervical
cancer vaccines in private institutions or the fees involved.
(h) Under the territory-wide Cervical Screening Programme implemented by
the Government, women who wish to receive cervical smears can select their
preferred service providers. As far as DH is concerned, all 31 MCHCs
provide cervical screening services. Fees will be waived for Comprehensive
Social Security Allowance recipients. Moreover, a variety of woman health
services are also made available by local non-government organisations
(NGOs), including non-profit-making cervical screening services at a lower
price. These established arrangements have been effective and hence the
Government has not assessed the expenditure required for a free cervical
screening programme.
Separately, as there is no health economic evaluation supporting a
population-based HPV vaccination programme in Hong Kong, the Government
has no plan to implement a population-based HPV vaccination programme, and
hence it has not assessed the annual expenditure required for such a
programme. We will continue to closely keep in view of the development of
scientific evidence.
(i) As stated in part (c), the Woman Health Service of DH provides
clinical breast examination to all participating women. The numbers of
women who have enrolled for the Service, received mammography screening
and cases referred to specialists due to breast problems are at Annex B.
Compared with MCHCs, there are more women using the Woman Health Service
at WHCs. This is because WHCs provide the Woman Health Service on a full
time basis, while MCHCs also provide other services including antenatal
and postnatal care, family planning, cervical screening and child health
services.
Cervical screening services are provided by DH at MCHCs. The attendance
for the service is at Annex C.
At present, a number of NGOs, private hospitals and doctors already
provide a wide array of health programmes for women, including breast
examinations and cervical screening services. DH has also been providing
women with accurate information on women's health as well as relevant
community resources through different channels in an effort to empower
women to make choices that are conducive to their health and seek
appropriate health care services where necessary. DH will also make
reference to the primary care development strategy in planning the long
term development of various healthcare services. The Government will
continue to collaborate with other service providers, including private
doctors and NGOs, so as to enhance the primary care services.
Ends/Wednesday, May 8, 2013
Issued at HKT 17:10
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LCQ14 Annex