Replies to LegCo questions
LCQ21: Protection of women health
Following is a question by the Dr Hon Elizabeth Quat and a written reply by the
Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council
today (November 1):
Question:
The Government indicated in the Policy Address delivered recently that it would
strengthen its support for families to "protect the interests and well-being of
women". However, many members of the public have relayed to me that the
Government's measures for protecting the health of women are inadequate. In this
connection, will the Government inform this Council:
(1) of the top five diseases causing death of females in Hong Kong at present
and, in respect of each of such diseases, (i) the number of newly confirmed
cases, (ii) the number of deaths and (iii) the age distribution of the deceased
persons, in each of the past five years;
(2) given that the Community Care Fund launched a three-year pilot scheme in
October last year to provide free cervical cancer vaccination for teenage girls
from eligible low-income families, of the estimated expenditure of the scheme,
and so far (i) the number of beneficiaries, broken down by age group, (ii) the
expenditure incurred, and (iii) whether the number of beneficiaries has met the
Government's target;
(3) whether it will consider providing free cervical cancer vaccinations for all
women of the relevant age cohort in the territory; if so, of the details and the
timetable; if not, the reasons for that;
(4) of the number of person-times and age distribution of women receiving
cervical smear tests at the Woman Health Centres and Maternal and Child Health
Centres under the Department of Health in each of the past 10 years;
(5) of the public healthcare institutions which currently provide cervical smear
tests for women; the number of units providing such service and the average
charge for each test;
(6) of the respective numbers of (i) newly confirmed cases of and (ii) deaths
caused by cervical cancer and breast cancer for each age group of women in each
of the past 10 years;
(7) whether it has plans to provide free medical consultation and breast cancer
screening services for women with higher risk of breast cancer; if so, of the
details and the timetable; if not, the reasons for that; of the public
healthcare institutions which currently conduct breast cancer screening for such
women;
(8) as some women have relayed that the waiting time for receiving mammography
and breast ultrasound scanning at public hospitals is too long, which may thus
result in delay in their receiving diagnoses and treatments, whether the
authorities will introduce measures to shorten the waiting time; if so, of the
details; if not, the reasons for that;
(9) as a report of the Hong Kong Breast Cancer Foundation indicates that most
breast cancer patients have no family history of breast cancer, whether the
Government will introduce measures to enable those women falling into this
category to receive diagnostic confirmation and treatment in the early onset of
the illness; if so, of the details; if not, the reasons for that; and
(10) whether it has plans to follow the practices of places such as the Mainland
and Taiwan in implementing a breast cancer screening programme for women, and
providing breast cancer screening services for women in need through
public-private partnership or collaboration with non-profit-making women health
centres in the community; if so, of the details; if not, the reasons for that?
Reply:
President,
Our reply to the various parts of the question is as follows:
(1) The top five diseases causing death of females in Hong Kong in 2016 were
malignant neoplasms (cancer), pneumonia, diseases of heart, cerebrovascular
diseases, and nephritis, nephrotic syndrome and nephrosis. A breakdown of the
number of registered female deaths caused by the above diseases from 2012 to
2016 by age group is at Annex 1.
The number of newly confirmed cases of malignant neoplasms (cancer) from 2011 to
2015 is at Annex 2. The Department of Health (DH) does not maintain the number
of newly confirmed cases of other diseases.
(2) The Community Care Fund (CCF) launched the Free Cervical Cancer Vaccination
Pilot Scheme (the Pilot Scheme) in October 2016 to provide free cervical cancer
vaccination service for the following teenage girls from low-income families:
female recipients of age 9 to 18 under the Comprehensive Social Security
Assistance (CSSA); and
female students aged 9 or above on full grant under the School Textbook
Assistance Scheme.
The Family Planning Association of Hong Kong (FPAHK) is the implementing agent
of the Pilot Scheme. The total provision for the three-year Pilot Scheme is
$98.75 million. It is expected to benefit about 31 100 teenage girls.
During the implementation of the Pilot Scheme from October 2016 to the end of
September 2017, the FPAHK provided free cervical cancer vaccination service for
10 144 eligible teenage girls, at an expenditure of $21.31 million. A breakdown
of the number of vaccine recipients by age is at Annex 3.
(3) In Hong Kong, cervical cancer is one of the most common cancers among women,
which is primarily caused by persistent infection with high-risk human papilloma
virus (HPV) through sexual contact. According to the latest recommendations
issued in 2016 by the Scientific Committee on Vaccine Preventable Diseases
(SCVPD) and the Scientific Committee on AIDS and Sexually Transmitted Infections
(SCAS) under the Centre for Health Protection (CHP) of the Department of Health
(DH), HPV vaccine (also known as cervical cancer vaccine) is effective and safe
for individual protection against cervical infection and cancer arising from
specific types of viruses.
The SCVPD and SCAS considered that the public health strategy for HPV
vaccination should be formulated on the basis of clinical evidence available
internationally, epidemiological understanding and the projected population
benefits derived from local studies. In this connection, the Government is
conducting a study on the cost-benefit analysis (CBA) of organised
population-based vaccination. An analysis report is expected to be ready in the
first half of 2018. The SCVPD and SCAS will carefully review its recommendations
in light of the CBA results with a view to coming up with recommendations on the
long-term strategies for preventing cervical cancer. The SCVPD and SCAS will
publish their recommendations in due course.
(4) and (5) Launched by the DH on March 8, 2004 in collaboration with the
healthcare sector, the Cervical Screening Programme (CSP) is a territory-wide
programme to encourage women aged 25 to 64 who ever had sex to have regular
cervical cancer screening. Its objective is to increase the coverage of cervical
cancer screening so as to reduce the incidence and mortality rates of cervical
cancer in Hong Kong. The CSP has also established the Cervical Screening
Information System (CSIS) for storing all the data related to the CSP and
sending reminders to participants.
The DH, non-governmental organisations and private healthcare facilities are the
major service providers of the CSP. A total of 31 Maternal and Child Health
Centres (MCHCs) under the Family Health Service of the DH provide cervical
cancer screening service to eligible women, aged 25 to 64 who ever had sex, at a
charge of $100 per attendance. Recipients of CSSA, Level 0 Voucher Holders of
the Pilot Scheme on Residential Care Service Voucher for the Elderly or holders
of medical waiver certificates are exempted from payment. The three Woman Health
Centres (WHCs) and 10 MCHCs under DH which are providing women health services
to women aged 64 or below would also provide cervical screening service.
A breakdown of the number of attendances for cervical screening services at the
MCHCs and the number of enrolment for women health services in the past 10 years
is at Annex 4.
Apart from the Family Health Service of the DH, cervical cancer screening
services are also provided by Social Hygiene Clinics and the Elderly Health
Services of the DH to women according to their need.
As regards non-governmental organisations (e.g. the FPAHK and the United
Christian Nethersole Community Health Service) and private healthcare
organisations, they also provide cervical cancer screening services where
charges are determined by individual healthcare service providers as well as
whether additional services are required.
The Government announced in January 2017 that the Community Care Fund had been
invited to launch a three-year pilot scheme to subsidise eligible low-income
women to receive cervical cancer screening and preventive education. The pilot
scheme aims to reach out to low-income women to encourage them to receive
cervical cancer screening and enhance their awareness of cervical cancer, so as
to reduce the risk of them contracting cervical cancer. The pilot scheme is
expected to be launched in December 2017 and details will be announced in due
course.
(6) Information on the number of newly confirmed cases and registered deaths
caused by breast cancer and cervical cancer respectively for females from 2006
to 2015 by age group is at Annex 5.
(7), (9) and (10) The Government attaches great importance to the prevention and
control of cancer, including female cancers. As early as 2001, the Government
has established the Cancer Coordinating Committee (CCC) which is chaired by the
Secretary for Food and Health and comprised members who are cancer experts,
academics, doctors in public and private sectors as well as public health
professionals. The CCC formulates comprehensive strategies and makes
recommendations for the prevention and control of cancer. The Cancer Expert
Working Group on Cancer Prevention and Screening (CEWG) under the CCC is
responsible for regularly reviewing the evidence on cancer prevention and
screening, and formulating evidence-based recommendations and measures which are
suitable for local conditions. In 2016, the CEWG reviewed the latest scientific
evidence of the screening of and revised recommendations for seven major cancers
(including breast cancer) in Hong Kong. Details are set out in the website of
the CHP at www.chp.gov.hk/en/content/9/25/31932.html.
Population-based breast cancer screening by mammography is a subject of
controversy. While experience in western countries shows that the implementation
of population-based breast cancer screening by mammography has helped detect
breast cancer in its early stages and reduce its mortality rate, some studies
such as the systemic review of Cochrane Collaboration in 2013 and a study report
released by the Swiss Medical Board of the Switzerland have revealed that breast
cancer screening by mammography can cause problems and harm such as
over-diagnosis and over-treatment. Hence, the advantages of such screening may
be outweighed by its disadvantages. A report released by Canada in 2014 based on
a large randomised controlled trial of more than 90 000 women in Canada has also
found that mammography does not reduce breast cancer mortality in women, but has
led to unnecessary surgery or treatment. It has therefore suggested reassessing
the need of mammography screening. While some Chinese or Asian communities have
implemented population-based breast cancer screening programmes, there is no
comprehensive data published that can reflect 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.
Besides, some local studies have indicated that population-based breast cancer
screening by mammography may lead to more women receiving unnecessary medical
examination and treatment.
From the above scientific evidence, the CEWG concluded that there is
insufficient scientific evidence to recommend for or against population-based
mammography screening for general female population in Hong Kong. It is noted
that all screening tests have their limitations and cannot be 100 per cent
accurate. Women who are considering to take breast cancer screening should seek
advice from doctors based on their individual conditions and needs, and that
they should obtain detailed information about the limitations, potential
benefits and risks of taking the screening test before making a decision.
Women who are considered to be at increased risk of breast cancer (e.g. being a
carrier of certain gene mutations such as BRCA1/2, having a family history of
breast cancer or ovarian cancer, and having received radiation therapy to the
chest before the age of 30) should consult doctors on their assessment and
advice before deciding whether breast cancer screening is necessary.
Studies showed that raising women's awareness of the symptoms of breast cancer
would facilitate early diagnosis and increase chances of cure. For this reason,
all women, no matter whether they are at average risk or higher risk of
developing breast cancer, should be aware of breast health. They should be
cautious of the normal appearance, feel and cyclical changes of their breasts,
so that they can detect any irregular changes in their breasts as early as
possible and seek doctors' advice immediately.
From the public health perspective, the Government must cautiously assess a
series of critical factors when considering whether to introduce a
population-based screening programme for a specific disease. These factors
include to ensure that prevalence of the disease in Hong Kong, accuracy and
safety of screening tests, effectiveness in reducing incidence and mortality
rates, feasibility of implementation, the resources, manpower and facility
capacity of healthcare system, and public acceptance. The overriding concern is
screening does more good than harm to the general population. Given the lack of
public health evidence as supported by scientific soundness at present, the
Government does not have plans to introduce programmes or provide service
through public-private partnership for population-based mammography screening.
Women at higher risk of developing breast cancer can seek assessment and advice
from a doctor in order to make an informed choice on whether they should receive
mammography screening. The Women Health Service under the Family Health Service
of the DH currently follows the advice of the CEWG to promote healthy lifestyles
as the main prevention strategy and breast awareness among women, so that
medical attention can be sought as early as possible if any abnormalities of the
breasts are identified. Women at higher risk of breast cancer may decide to
receive mammography screening after medical assessment.
The three WHCs (on a full-time basis) and the 10 MCHCs which provide women's
health check-ups (on a sessional basis) are listed below:
Name of Clinic | |
WHCs | Chai Wan WHC Lam Tin WHC Tuen Mun WHC |
MCHCs | Ap Lei Chau MCHC Sai Ying Pun MCHC Wang Tau Hom MCHC West Kowloon MCHC Fanling MCHC Lek Yuen MCHC Ma On Shan MCHC Tseung Kwan O Po Ning Road MCHC Tsing Yi MCHC South Kwai Chung MCHC |
Moreover, the DH also actively promotes the importance of healthy lifestyles maintaining healthy body weight, regular exercise and breastfeeding for the prevention of breast cancer.
(8) Mammography and breast ultrasound imaging services will be arranged by public hospitals for patients based on doctors' assessments on the patients' conditions. Those patients who are confirmed or suspected of having breast cancer, or assessed to be at high risk, will be accorded priority for receiving such services. The Hospital Authority will review its services from time to time in order to provide appropriate services for its patients.
Ends/Wednesday, November 1, 2017
Issued at HKT 19:10
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Annexes of LCQ 21