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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 (October 15):
Question:
Breast cancer is the most common cancer among females in Hong Kong, and ranks the third among cancers causing deaths of females in Hong Kong. In the Prevention and Screening for Breast Cancer published in April 2014, the Cancer Expert Working Group on Cancer Prevention and Screening (Working Group) of the Department of Health pointed out that breast cancer screening was proven to be beneficial for women with a higher risk of developing breast cancer. The Working Group therefore recommended that such women "should seek advice from doctors about whether they should receive breast cancer screening". On the other hand, as revealed by the Hong Kong Breast Cancer Registry Report No. 5 published in 2013 by the Hong Kong Breast Cancer Foundation (the Foundation), among more than 9 800 breast cancer patients covered by the Report, only 14.5 per cent had a family history of breast cancer. The Foundation also pointed out that breast cancer screening for women currently implemented on the Mainland and in Taiwan and many Western countries had helped to reduce the mortality rates of breast cancer patients. In this connection, will the Government inform this Council:
(1) whether it has compiled statistics on the current population of those women in Hong Kong belonging to groups with a higher risk of developing breast cancer;
(2) whether it will, in response to the recommendation by the Working Group, provide the needed medical consultation and breast cancer screening services for women with a higher risk of developing breast cancer; if it will, of the details and the timetable; if not, the reasons for that; of the public health-care institutions in Hong Kong currently offering breast cancer screening services to such women;
(3) given that the Report of the Foundation indicated that most breast cancer patients had no family history of breast cancer, of the measures put in place by the Government to help this category of women to detect breast cancer and receive treatments as early as possible;
(4) given that some women have relayed that the waiting time for mammography and breast ultrasound scanning at public hospitals is too long, which might result in delay in their receiving diagnoses and treatments, whether the Government has measures in place to shorten the waiting time; if it does, of the details; if not, the reasons for that; and
(5) whether the Government will consider following the practices of the Mainland, Taiwan and other countries 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?
Reply:
President,
Cancer is a major public health issue. As early as in 2001, the Government established the Cancer Coordinating Committee (CCC), which is chaired by the Secretary for Food and Health and comprises members including cancer experts, academics, doctors in public and private sectors, as well as public health professionals, for effective prevention and control of cancer. The Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) was set up under the CCC to regularly review and discuss the latest scientific evidence, local and worldwide, with a view to providing recommendations on suitable cancer prevention and screening measures for the local population.
In examining whether to introduce a population-based screening programme for a specific disease, the Government needs to carefully consider a number of factors, including the seriousness and prevalence of the disease locally, accuracy and safety of the screening tests for the local population, as well as effectiveness in reducing disease incidence and mortality. The Government also needs to give due consideration to the actual circumstances, such as the feasibility, equity, cost-effectiveness of the screening programme and public acceptance.
As we have pointed out a number of times, population-based breast cancer screening by mammography is a subject of controversy. In the West where the incidence rate of breast cancer is relatively high, some countries have started to implement population-based mammography screening programmes since the 1980s. However, studies have found that there was only a slight drop or even no reduction in the mortality rate of breast cancer after the implementation of the screening programmes. Some studies also revealed that screening programmes have caused harm such as over-diagnosis and over-treatment. As a result, several Western countries are considering adjusting their breast cancer screening policies. Separately, while some Chinese or Asian communities (e.g. Singapore and Taiwan) have implemented population-based breast cancer screening programmes, there is no comprehensive data published that could 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.
Internationally, the latest 2013 systemic review of Cochrane Collaboration has shown that mammography screening likely reduces breast cancer mortality but it also leads to over-diagnosis and over-treatment. The review has concluded that it is unclear whether mammography screening does more good than harm. In December 2013, the Swiss Medical Board of the Switzerland published a report which has recommended the country to suspend the mammography screening programme. On the other hand, a report released by Canada based on a large randomised controlled trial of more than 90 000 women in Canada has found that mammography does not reduce breast cancer mortality in women, but leads to unnecessary surgery or treatment, which has therefore suggested reassessing the value of mammography screening. Hong Kong should take reference from these latest evidences.
Basing on the above considerations and having thoroughly reviewed scientific information, the CEWG considers that there is insufficient evidence to recommend for or against population-based mammography screening in Hong Kong, given that it is not clear whether screening does more good than harm to asymptomatic women. However, CEWG considers that individual women at increased risk of breast cancer women should seek medical assessment and advice about whether they should receive breast cancer screening. CEWG will continue to keep in view the latest developments on this subject. Meanwhile, 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.
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, eating less meat and more vegetables, and maintaining a healthy body weight. In this connection, the Department of Health (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 five parts of the questions is as follows:
(1) The Hong Kong Cancer Registry (the Registry) does not possess comprehensive statistics about women in Hong Kong belonging to the groups with a higher risk of developing breast cancer. At present, the Registry has collected data relating to new ductal carcinoma in-situ (DCIS) cases to facilitate the detection of the trend of pre-malignant abnormalities. According to the statistics of the Registry, there were 472 and 484 new DCIS cases in 2010 and 2011 respectively.
(2) and (5) Given the lack of public health evidence supported by scientific soundness at present, the Government has no plan to introduce programmes or provide service through public-private partnership for population-based mammography screening. Women at high risk of developing breast cancer should seek assessment and advice from a doctor in order to make an informed choice on whether they should receive mammography screening. At the same time, health-care professionals have a duty to thoroughly explain and analyse the benefits and harms associated with mammography screening to women so as to facilitate them to make informed decisions for personal health. The DH operates three Woman Health Centres and 10 Maternal and Child Health Centres which provide Woman Health Service (WHS) to women aged 64 or below. The WHS includes clinical breast examination. Women at high risk of breast cancer may decide to receive mammography screening after medical assessment. If abnormalities are found, they will be referred to specialists for follow-up management.
Currently, there are a number of non-governmental organisations and private institutions providing mammography screening services. By making reference to CEWG's recommendations and focusing the services on women at higher risk of developing breast cancer, there could be more optimal use of health-care resources.
(3) The Government will continue to promote health and disease prevention to the community, and provide targeted services on health promotion and disease prevention according to the health needs and risks of different gender and population groups. A number of service units under the DH have been providing women with information on women's health as well as relevant community resources through different channels in an effort to facilitate women to make choices that are conducive to their health and to seek appropriate health-care services where necessary. For prevention of breast cancer, DH will continue to promote the practice of healthy lifestyles, encourage breastfeeding and promote breast awareness among women, so that medical attention could be sought early if any abnormalities of the breast are identified through regular review and comparing changes of the breast.
To increase the public's awareness and understanding of breast cancer prevention and screening, a bilingual booklet "Prevention and Screening for Breast Cancer - Information for women and their families" jointly developed by CEWG and DH, published in May 2013, is available on the website of the Centre for Health Protection (www.chp.gov.hk) for public information.
(4) The hospitals under the aegis of the Hospital Authority (HA) arrange mammography and breast ultrasound imaging services in accordance with the assessment of doctors. Those patients who are confirmed or suspected of having developed breast cancer and belong to the groups with a higher risk of developing breast cancer will be accorded priority for receiving such services. In 2013, around 95 per cent of the patients who were accorded priority for such services completed the examination within two months. The HA will review its operation and services as appropriate to further improve its medical services provided to the public.
Ends/Wednesday, October 15, 2014
Issued at HKT 16:01
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