Hong Kong cancer therapy

20,000 elderly Hongkongers risk missing follow-up colorectal cancer screenings when scheme ends

Medical experts say more lives can be saved with early detection, but an overhaul of the system is needed

PUBLISHED : Friday, 02 February, 2018, 7:02am
UPDATED : Friday, 02 February, 2018, 7:01am

More than 20,000 elderly people in Hong Kong will miss follow-up screenings for colorectal cancer, the most common form of the killer disease in the city, if the programme is shut down in two years amid a lack of extra government funding.

Medical experts urged health officials earlier this week to inject money and expand the screening. The three-year pilot scheme, which started in 2016 for those aged 60 and above, ends in 2019.

The calls came as colorectal cancer has become more prevalent worldwide and in Hong Kong, where 5,036 new cases were recorded in 2015, accounting for about 16.6 per cent of all new cancer cases.

About 2,089 Hongkongers died from the disease in 2016, making up about one in every seven cancer deaths.

“It’s about changing the whole health care system,” Professor Martin Wong Chi-sang, director of the CUHK Jockey Club Bowel Cancer Education Centre, said.

“Although the government may have to foot a larger bill at the beginning, the monitoring system built through the programme will help save many lives ... with regular screening and early diagnosis,” said Wong, who is also a task force member of the pilot programme.

The government rolled out the first phase of the scheme in 2016, followed by the second and third phases in 2017. Free faecal occult blood tests – a non-invasive examination of stool samples – were provided in batches to about 820,000 Hongkongers aged between 61 and 70.

By January 28 this year, about 62,000 eligible individuals had been screened, among which 13.1 per cent tested positive and were referred for largely subsidised colonoscopies.

Among the 5,894 participants who tested positive and received a colonoscopy, some 67.7 per cent had an adenoma – a usually benign tumour – detected and removed, while 386 people were diagnosed with colorectal cancer.

Nearly 300 colorectal cancer cases identified in Hong Kong screening programme

About 55 per cent of patients were still in the early stages of the disease and stood a better chance of recovery.

Some 54,498 people who tested negative were recommended to have a second screening every one to two years. But not all of them would receive a free follow-up faecal test, as the subsidised scheme would have expired.

“We have been constantly reviewing the effectiveness of the programme and will discuss whether it should be extended or turned into a permanent project,” Patrick Chong Shing-kan, senior medical and health officer from the Department of Health, said.

One follow-up session – set to begin in September – will cover the first batch of participants who had been tested between September 2016 and February 2017.

With an end date of 28 September, 2019, Chong admitted that it remained unclear if those who joined the scheme later would get their second tests in time.

Wong said the programme was worth being extended and he believed most of the costs would come from colonoscopies – which did not apply to all screening recipients – instead of the faecal tests.

“Just think about how many we can save with regular check-ups and early detection,” Wong said.

“If the programme closes as planned in 2019, some people may be less incentivised to seek rescreening.”

A faecal test costs around HK$100 to HK$300 per person, while a colonoscopy costs HK$8,000 to HK$9,000.

Currently, 157 doctors have enrolled in the pilot programme to conduct colonoscopies, fewer than a quarter of the 651 primary care doctors enlisted to conduct faecal tests.