LCQ22: Colorectal Cancer Screening Pilot Programme
Last year, the Department of Health started the phased implementation of the Colorectal Cancer Screening Pilot Programme (Pilot Programme) to subsidise Hong Kong residents born in the years from 1946 to 1955 to undergo faecal occult blood test and colonoscopy examination. However, some members of the public have complained to me that they have been identified as individuals at a high risk of getting colorectal cancer (high-risk individuals) and hence not suitable to enrol in the Pilot Programme, but they cannot afford the cost of colonoscopy examination provided by private medical practitioners. Moreover, the Hospital Authority launched the Colon Assessment Public-Private Partnership Programme (PPP Programme) last year to provide a subsidy for around 8 000 eligible public hospital patients to receive colonoscopy examination provided by private medical practitioners. In this connection, will the Government inform this Council:
(1) whether it knows, at year-end of each of the past five years, the respective average waiting time of patients of public hospitals under various hospital clusters for undergoing colonoscopy examination;
(2) given that high-risk individuals are not suitable to enrol in the Pilot Programme, whether the Government will launch another subsidy programme for colonoscopy examination for this type of people; if so, of the details;
(3) whether it will subsidise those public hospital patients who have not been invited to join the PPP Programme and who are high-risk individuals to undergo colonoscopy examination; if so, of the details; if not, the reasons for that, and what other plans the authorities have to alleviate the financial burden of such patients;
(4) given that there is a trend of people suffering from colorectal cancer at a younger age, whether the Government will examine the inclusion of Hong Kong residents aged 40 to 50 in the Pilot Programme; and
(5) whether, apart from the aforesaid two programmes, the Government has considered implementing other subsidy programmes for the prevention or diagnosis of colorectal cancer; if so, of the details?
In recent years, colorectal cancer has become the most common cancer in Hong Kong. In 2014, there were 4 979 newly registered cases of colorectal cancer, accounting for 16.8 per cent of new cancer cases. Colorectal cancer was the second most common cause of cancer deaths in 2015. A total of 2 073 people died of colorectal cancer in that year, accounting for 14.5 per cent of all cancer deaths.
In response to the increasing healthcare burden arising from colorectal cancer, the Department of Health (DH) launched the three-year Colorectal Cancer Screening Pilot Programme (the Pilot Programme) on September 28, 2016 to gather relevant local experience in colorectal cancer screening and collect relevant data, with a view to drawing conclusions and making evidence-based recommendations, which will form the basis for the deliberation of whether and how colorectal cancer screening service may be provided to the wider population. The Pilot Programme subsidises asymptomatic Hong Kong residents born from 1946 to 1955 to undergo colorectal screening tests in phases to help identify people at increased risk of having the cancer or people who already have the disease, so that they can have early treatment and the therapeutic effectiveness can be enhanced.
My reply to the various parts of the question is as follows:
(1) The Hospital Authority (HA) does not keep statistics on the waiting time for colonoscopy examination in public hospitals in the past five years.
(2) and (3) From the medical perspective, screening means examining people without symptoms in order to identify people who already have the disease or people at increased risk of disease, so that prevention, early detection and treatment can be provided to enhance therapeutic effectiveness. In general, people who consider receiving colorectal cancer screening can be classified into "average risk" and "high risk" groups.
According to the recommendations on colorectal cancer screening made by the Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) of the Government, people with "high risk" refer to individuals who have significant family history, such as those with an immediate relative diagnosed with colorectal cancer at the age of 60 or below; or those who have more than one immediate relatives diagnosed with colorectal cancer irrespective of age at diagnosis; or those who have immediate relatives diagnosed with hereditary bowel diseases. People with "average risk" refer to individuals aged 50 to 75 who do not have significant family history.
The Pilot Programme targets at individuals with "average risk". It adopts the faecal occult blood test (FOBT), which has been used widely in the international arena, as a screening tool to detect tiny amounts of blood in the colon which is invisible to the naked eye. Testing will be repeated every two years. The CEWG recommends that people with "high risk" should not receive the FOBT. Instead, they should undergo invasive investigation (such as sigmoidoscopy or colonoscopy) regularly, depending on their individual condition and age, to have the colon wall inspected directly and accurately. Some people with "high risk" may need to undergo genetic tests to identify any inherited genetic mutation. This approach prevents people at "high risk" from delay in seeking appropriate treatment as a result of bleeding not occurring at the time of the FOBT and thus failing to detect abnormalities.
Anyone who has suspected symptoms should seek early consultation at relevant medical institutions including the HA. People with "high risk" can seek help from private doctors or non-profit-making medical institutions to receive risk assessment, including undergoing genetic tests when necessary, in order to decide an appropriate screening option.
(4) There are multiple risk factors for developing colorectal cancer and the risk increases significantly over the age of 50. After reviewing and considering the latest local and international scientific evidence, the CEWG recommends that individuals aged 50 to 75 to consult their doctors and consider screening for colorectal cancer. This is generally in line with the age groups covered by overseas colorectal cancer screening programmes.
The Pilot Programme aims at assessing the implications of population-based screening on the effectiveness of treatment and the healthcare system. Thus, the target group must be sufficiently representative and the current service capability should not be overloaded. After due consideration, the Government has decided to invite eligible Hong Kong residents aged 61 to 70 to undergo faecal immunochemical test screening in phases over a period of three years.
The Government will use the experience gathered from the Pilot Programme as the basis of further deliberation in order to decide whether and how colorectal cancer screening should be extended to cover more people in future. For those who are not currently covered by the Pilot Programme, we suggest that they should consult their family doctors about the need for colorectal cancer screening. Our suggestion is in line with the recommendations of the CEWG to the general public.
(5) Apart from screening, adoption of healthy lifestyles is also essential for preventing colorectal cancer. Healthy lifestyles include increasing the intake of dietary fibre from vegetables, fruits and whole grains, reducing the consumption of red and processed meat, having regular physical activities, maintaining a healthy body weight and waist circumference, and avoiding tobacco and alcohol. On this front, the DH has all along been actively promoting healthy lifestyles as a major preventive strategy in reducing the burden caused by non-communicable diseases such as cancers to the public and society. Members of the public should also take note of their health conditions and seek early medical consultation if symptoms such as presence of blood in stool, abdominal pain, changes in bowel habit or unexplained weight loss occur.
The Government will review and assess the effectiveness of the three-year Pilot Programme and formulate the future screening strategy with reference to the CEWG's recommendations. Meanwhile, the DH will continue its publicity and educational efforts in this area. The Government has no plan to implement other subsidised programmes for the screening of colorectal cancer at this stage.
Ends/Wednesday, March 29, 2017
Issued at HKT 12:50
Issued at HKT 12:50