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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):


     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?



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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