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SCMP Reporter

Medical staff fighting cervical cancer in Hong Kong have managed to push the disease back, with the number of women suffering the disease declining, but more needs to be done, experts say.
This should include a public ban on smoking in the territory - as passive and active smoking are major risk factors.

The most recent figures provided to SCMP.com show the incidence of cervical cancer fell sharply in the past two decades - from 24.8 per 100,000 women in 1983 to 8.9 per 100,000 in 2003.
There were 590 cases and 140 deaths in 1983 but 408 cases with 106 deaths in 2003.
In 2004, 128 women died of the disease in Hong Kong. Figures for last year are not yet available.
Oncologist Anthony Ying Chi-ho, a member of Hong Kong Anti-Cancer Society, told SCMP.com that Hong Kong could do better.

''It is good to know that fewer women are getting this disease but compared with western countries, Hong Kong?s achievements are not good enough,'' explained Dr Ying.

He said that in some western countries, such as Finland and Australia, broad-based screening programmes had cut the incidence of cervical cancer dramatically - in some cases by almost 80 per cent.
 
However, in Hong Kong the drop in the past 20 years had only been about 50 per cent.
In Finland there were only 3.9 cases for every 100,000 women, as opposed to 8.9 in Hong Kong in 2003.
Cervical cancer is an invasive malignant tumour which spreads from the surface of cervix into deeper tissues, then to adjacent organs such as the kidneys, and finally to the liver, lungs and brain.

It usually strikes sexually-active women between 25 and 64.
The early stage of cervical cancer may produce no symptoms. In the advanced stage, patients may experience vaginal bleeding between periods, during or after sex or any time after menopause.
If detected early, the disease is curable and can even be treated without impairing fertility.
Most encouragingly, cervical cancer can be detected at the pre-cancerous stage, and be preventable.
A simple smear test instead of drugs or vaccines has saved many lives - and experts say this is the biggest success in cervical cancer campaigns.
Since their introduction half a century ago in the United States, Pap smears are believed to have reduced the cervical cancer death rate by about 70 per cent, studies show.
A Pap smear test generally takes a matter of minutes. Doctors take cell samples from cervix and place them on a slide. The test highlights abnormal cells and consistently abnormal smears may be a reason for further investigation, even in a complete absence of symptoms.
Dr Joanna So Shuk-kuen, a senior medical officer from the Department of Health, has been promoting a government screening campaign. She stresses that screening is vital.

''The development of cervical cancer is comparatively slow which explained why screening could help,'' Dr So told SCMP.com.
Screening was needed because cervical cancer did not show any symptoms in its pre-cancerous stage. It usually took 10 years for abnormal cells to transform into cancerous tissue, so only regular tests could detect abnormal cells.
''Education to enhance public awareness of regular screening was extremely important,'' she said.
Anthony Ying called for more to be done via mass screening campaigns.
''Although we have made improvements, there is room for further improvements in the coverage of current screening programmes,'' he said.
 The Hong Kong government set up the Cervical Screening Programme on International Women's Day in 2004.
About 190,000 women have so far registered.
 Dr So said the campaign had covered 62 per cent of women in the territory, compared with 43 per cent two years ago.
At the same time, Dr Ying advised women not to be shy or embarrassed about screening. They must not ignore possible symptoms, he stressed.
''Don't keep waiting - and only see a doctor or have a medical check-up until symptoms appeared,'' added Dr Ying.
Chinese conservatism has been blamed for reluctance in taking a regular Pap smear. Some women in the territory are still uncomfortable discussing their bodies.
He also reiterated that abnormalities detected during a Pap smear did not mean the worst. These abnormalities could often regress but they could persist or progress.
Even if they lead to cervical cancer, there are still chances of recovery. In the first stage of the disease, the recovery rate can be as high as 85 per cent. In stage two, three and four, the recovery rates are about 75 per cent, 35 per cent and 20 per cent respectively.
Cervical cancer killed 106 women in 2003, a large number compared with the 408 new cases in that year.
''It could be a message that these women waited until they got severe symptoms,'' said Dr Ying, ''so early detection is very important''.
In examining causes, most scientific studies point to a human papilloma virus (HPV) infection as a prerequisite for developing cervical cancer.
The virus, which is sexually transmitted, has been found in most cervical cancer cases and two forms of the virus are responsible for an estimated 70 per cent of cancer cases.
''Having sex too early or having multiple sex partners increases the chances of being infected with the virus,'' Dr So said.
Dr Ying agreed. He added that smoking was also found to be a high risk factor, ''no matter if it is active or passive smoking''.
''I absolutely support the government's total ban [on smoking in indoor workshops and restaurants],'' he stressed.
He said there was no proof that family history was a major risk factor for cervical cancer, according to current medical studies.
''The case of Anita Mui and her sister doesn't?t necessarily mean family history is a risk factor, maybe they were both exposed to a similar lifestyle,'' Dr Ying said, declining to comment further on the case.
The death of Anita Mui Yim-fong, Hong Kong's popular singer and actress, generated considerable public interest in cervical cancer. Mui, who died at the end of 2003, was only 40.
Her older sister, Ann Mui Oi-fong, also died from the disease in 2000 at the age of 41.
The Mui sisters were born into a low-income family and their father died when they were very young. Anita began singing when she was only five and turned professional at seven.
 
She and Ann performed Chinese operas and pop songs in restaurants and nightclubs. Anita won the first New Talent Singing Contest in 1982 at the age of 19. Over the next two decade she became one of Hong Kong's leading singers and actresses.

But according to news reports, Anita drove herself too hard and smoked heavily. Her lifestyle inevitably took a toll on her health.

Her death created a sense of alarm among some Hong Kong women about cervical cancer.
According to a South China Morning Post report in 2004, the initial rush by women for Pap smears after Mui?s death had overwhelmed clinics.
Consequently, more educational ads for Pap smears from the government-run Cervical Screening Programme appeared in public.
In Hong Kong cervical cancer is the fourth-commonest cancer in females and the average age of diagnosed patients is 50.
According to the Hong Kong Cancer Registry, there were 408 new cases, 8.9 in every 100,000 women in 2003, accounting for 4.3 per cent of all new cancer cases in females.
Meanwhile, it was the eighth most common cause of female cancer deaths in 2004. There were 128 deaths, 36 deaths in every one million women, accounting for 2.8 per cent of all cancer deaths in females.
With 288,000 deaths each year, cervical cancer is the second-commonest cause of cancer deaths in women around the world - after breast cancer.
About 510, 000 cases are reported each year with nearly 80 per cent in developing countries, where women have no access to enough education and regular screening.
In the mainland, the incidence of cervical diseases appears to be more prevalent, according to new statistics.
And women are getting the disease younger because they have sex much earlier than previous generations. Some have embraced a lifestyle which has placed them at greater risk of getting the disease.

The China Daily has reported that there are more than 100,000 new cases found in the mainland annually ?with more than 70 per cent of them among poor women in rural areas.
It also reported that Chinese experts were implementing a five-year-plan from 2003 to next year to develop three biochemical tests to identify women at risk. The plan will receive funding from the Bill & Melinda Gates Foundation. The tests are designed for use in less developed regions of the mainland.
Xinhua reported in March that China was expected to use the first vaccine to prevent cervical cancer in 2007 - as long as it can have approval from US Food and Drug Administration.
Two drug makers - Merck & Co and GlaxoSmithKline (GSK) - are competing for approval from the US Food and Drug Administration for HPV vaccines.
Merck's vaccine targets four types of HPV strains, which cause cervical cancer and visible genital warts. GSK?s vaccine targets only the cancer-causing strains of the virus. Early results have indicated both are extremely effective.
However, the one-shot vaccine will be most effective before women become sexually active. This could pose a dilemma for health authorities: how does one decide in modern China when a girl is sexually active.
In the west, debate has arisen about how vaccination should be implemented if a vaccine is approved.
Some doctors advocate vaccination of teenage girls at puberty due to the high risk of cervical cancer. But some conservatives oppose mandatory early vaccination, citing fears that it could be seen as condoning sexual activity before marriage.
Meanwhile, Dr So said the Hong Kong government would monitor the development of vaccination. It will also focus on improving coverage of regular screening, especially factors, such as effectiveness and cost.
Dr Ying supports this approach. ''Vaccination cannot completely replace Pap smears in the fight with cervical cancer.''P> 
Screening through smears played a crucial role in prevention, he said.

National Cancer Institute



Pap smears cut cervical cancer rates