Could universal breast cancer screening be coming to Hong Kong? Leader Carrie Lam hints at policy change

In what appears to be a shift of the government’s position on breast cancer screening, Hong Kong leader Carrie Lam Cheng Yuet-ngor has revealed that officials will explore whether a population-wide mammography programme is needed to fight the city’s most common cancer in women.

Lam, Hong Kong’s first woman chief executive, said the government was collecting data to assess the need.

Breast cancer claimed the lives of 702 Hong Kong women in 2016, up from 637 in 2015.

The chief executive touched on the topic on Thursday as the city marked International Women’s Day. She addressed guests at a ceremony to open a new breast health centre in Wong Tai Sin with the Hong Kong Breast Cancer Foundation.

“There is a need for the government and the medical sector to conduct more research and collect more data, in order to explore whether it is appropriate to implement universal breast cancer screening for asymptomatic women or those at average risk,” Lam said.

But she did not elaborate or make any commitment to such a scheme. Her words however did signal a slight shift in the government’s stance on the issue. At present only women with an increased risk of breast cancer are recommended for a mammogram.

Officials have maintained there is insufficient evidence to recommend universal screening. The issue remains a subject of debate in Western countries after some studies found mass screening could lead to unnecessary surgery or treatment, and others found only a slight drop in the mortality rate.

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In Hong Kong only the private sector and non-governmental organisations offer breast cancer screening, which can cost a few thousand dollars.

“Before any conclusion is reached, service providers should explain in detail to women the advantages, risks and limitations [of mammography] to allow women to make the best choice,” Lam said.

The Breast Cancer Foundation has been pushing for a population-wide programme, which it says would allow for early detection and treatment.

Chairman Eliza Fok Ho Yi-wah said in an address at Thursday’s ceremony that Singapore, Taiwan and Japan had implemented breast cancer screening programmes.

She cited studies in Taiwan that found universal screening every two years had achieved a 40 per cent reduction in mortality compared with annual clinical breast examinations. Meanwhile, risk-based mammography screening did not seem to be correlated with a “statistically significant mortality reduction”, she said.

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Fok herself is a recovering breast cancer patient.

The American Cancer Society states in its guidelines that women aged 45 to 54 should undergo a mammogram every year, and women 55 and older every two years.

Lam said the government attached great importance to the prevention and control of cancer. That had been reflected in initiatives rolled out in her policy address last October to strengthen primary health care, she said.

The latest official figures show the number of new breast cancer cases in 2015 was 3,920. The figure accounted for about 26 per cent of all new cancer cases among women. In 1994 the number of new breast cancer cases was just 1,266.

A total of 21,082 women underwent a mammogram at public hospitals in 2015.