Health and wellness

Cancer is the biggest medical fear for Hongkongers – but many are also confused by it

  • About 75 per cent of Hongkongers fear developing cancer, according to a new survey
  • But only one third of those take preventive measures, such as undergoing screenings
PUBLISHED : Wednesday, 24 October, 2018, 6:47pm
UPDATED : Wednesday, 24 October, 2018, 7:08pm

What is the leading medical concern for people in Hong Kong? The majority of residents most fear developing cancer, according to a survey by Medix Medical Monitor Research, based in the United Kingdom. The research polled 500 Hongkongers aged 30 to 59, and found 75 per cent of respondents fear a cancer crisis one day.

Yet, only about a third have done something about it, such as undergoing screenings to catch a cancer-related disease early. For example, among women respondents, only 36 per cent had undergone a Pap smear or breast examination.

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According to the Department of Health, breast cancer is the most common form of cancer among Hong Kong women and the disease remains the third leading cause of cancer deaths in women, with many experts urging women aged 40 or above to get yearly screenings.

Sigal Atzmon, president of Medix Medical Services of which the survey company is part, says it’s alarming how many women have not undergone screenings. On why many don’t, Atzmon says, “it may be a psychological thing where they think, ‘If I deal with it, I am getting close to [death]’.” She adds that fear is not enough of a mobilising force to make people take preventive measures.

With men, only 39 per cent had undergone liver function tests.

“There is a clear need to re-address how everyone from government to insurers and doctors help educate people on the importance of taking a preventive and early-diagnosis approach,” she says.

Cancer remains the No. 1 killer in the city, accounting for more than 30 per cent of deaths in 2016. The fight against cancer is an incredibly complex ordeal. The journey may involve experts from multiple medical fields, and the newly diagnosed are in a race against time to fight the disease while grappling with stress and anxieties – including treatment costs. All this affects the decision-making process.

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In a complicated medical landscape such as Hong Kong, with private and public health care options, as well as a lack of awareness about cancer in general among the public, many people are confused about the best path to take, the survey suggests.

Its findings show a lack knowledge of the crucial steps involved in the cancer treatment journey. Only 13 per cent of respondents said they would consider getting a biopsy to determine the cancer type before treatment. Also only 13 per cent cited understanding the stage of the disease as an important step before undergoing treatment.

These two results were most “disappointing” and “painful” for Atzmon. “Medix offers case management services and we had patients that died because they went to a surgeon who offered surgery [to remove the mass], but did not go through the right process of doing a biopsy and staging of the disease and getting advice from an oncologist.”

These steps have a big impact on quality of care provided, medical and survival rates plus treatment costs, if carried out on time, she says.

A tumour biopsy helps determine whether a mass is benign or malignant.

Staging of the disease determines whether the condition is localised or has metastasised – spread to other parts of the body. Treatment varies upon the stage of the disease.

Atzmon claims that in Hong Kong’s public hospitals, the common practice is to undergo a biopsy to determine an appropriate course of treatments. “One of the major differences between the public versus private system is that in the public system you have tumour boards, where [almost] every case is presented to the board. [It’s] a common practice around the world, and the board includes experts such as oncologists, radiotherapists, pathologists and surgeons [who meet] to discuss cases,” she says. Atzmon says the private sector needs to make this multidisciplinary approach more common.

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Dr Raymond Liang Hin-suen, head of medicine at the Hong Kong Sanatorium & Hospital and director of comprehensive oncology, was not surprised many survey respondents did not know the importance of biopsy and staging.

“They have never been educated on the management of cancer – [you have to keep in mind that the survey] was not asking doctors, medical students, nurses, or cancer patients, but [generally] healthy individuals, so they have no medical knowledge,” he explains.

But he agrees these steps are the cornerstones of cancer treatment. Cancer treatment is complicated with many different types and conditions, so he is cautious about generalising the must-have steps in the process.

A biopsy certainly is very important and we should do it whenever possible, but there are cases where patients are very fragile and the operation is too risky for the patient.
Dr Raymond Liang Hin-suen

“A biopsy certainly is very important and we should do it whenever possible, but there are cases where patients are very fragile and the operation is too risky for them,” Dr Liang says, adding that such circumstances are exceptional.

His larger concern is for patients seeking a biopsy in public hospitals where wait times can be lengthy – particularly for those with a rapidly growing tumour.

He applauds the multidisciplinary approach in general, but says it depends on individual institutions rather than whether they are private or public. Not every case in a public hospital will go through this process, either, Dr Liang notes, as “they have too many cases and not enough resources”.

At private hospitals, the more doctors engaged in the process, the more it costs, and sometimes insurance providers do not cover all elements involved, he says.

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Some cases are more straightforward than others, Dr Liang notes. At his hospital, a multidisciplinary team discuss cases in regular meetings, “but we cannot do it every day. We do this to discuss complicated cases,” he says.

Another survey highlight is that almost half (49 per cent) of participants believe Traditional Chinese Medicine (TCM) complements conventional cancer treatment.

Alternative treatments may interfere with conventional therapies such as chemotherapy, says professor David Zeltser, global medical director at the Medix Group.

He says the liver clears toxins in the body and plays a vital role in efficiency of conventional treatments like chemotherapy. Some TCM products help clear toxins faster while others hamper the liver’s efficient functioning during chemotherapy. He cites Asian ginseng as an example. It is often incorporated in TCM remedies to boost patients’ immune systems, but, in fact, it reduces the effectiveness of many proven chemotherapy drugs, Zeltser says.

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“Physicians should be more proactive in obtaining a complete medication history, including herbal medicine use, when advising on a suitable courses of treatment,” he says.

The company urges patients engaging in both Western and alternative medicine to make it known to their health providers. “It’s a sensitive topic – many doctors, particularly Western ones in Hong Kong, are not open to listening, and say ‘don’t do TCM’ – but that’s the wrong approach,” says Atzmon, adding that there needs to be more open communication between patients and their doctor or oncologist.