Question by Hon KP Chan on Preventive Health Screening for Early Detection of Cancer at the Legislative Council Meeting on February 8th, 2012
While the number of new cancer cases in Hong Kong surged by about 22% in the decade since 2000, the number of radiological imaging scan, which is a crucial tool for diagnosing cancer and assessment of cancer stages, performed in Hong Kong was much lower than those in other places. Studies conducted by the Columbia University of the United States (US) reveal that the breakthrough in cancer imaging technologies resulted in a drop in the number of cancer-related deaths in US by 40% in a period of 10 years. Based on the figures of the Hospital Authority (HA) and the ratio of around nine to one for the number of people using public medical services to those using private medical services, it is projected that in 2010-2011, the average number of Magnetic Resonance Imaging (MRI) scans performed in Hong Kong per 1,000 population was about 18.3, which was two to four times lower than those in most member countries of the Organisation for Economic Co-operation and Development (OECD) in 2009 (e.g. 75.5 in Iceland, 55.2 in France and 43 in Canada). Similarly, the average number of Computed Tomography (CT) scans performed in that year was about 77.5 per 1,000 population, which was much lower than the numbers of 156.2 in Iceland, 138.7 in France and 125.4 in Canada. In this connection, will the Government inform this Council:
(a) given the significant increase in new cancer cases in Hong Kong in recent years, and that compared to the numbers five years ago, the numbers of MRI and CT scans performed in 2010-2011 at the hospitals under HA had already increased by about one-fifth and one-third respectively, why such numbers still lagged far behind those in the aforesaid countries;
(b) given that according to the information of OECD, in 2010, there were 22.6 MRI machines per one million population in Greece and 42.5 CT machines per one million population in Australia, whether it knows the respective numbers of MRI and CT machines per one million population in Hong Kong at present; as it has been reported that last year, Tuen Mun Hospital admitted that some non-urgent patients had to wait for eight years before they could use the MRI scanning service, whether this was caused by insufficient equipment or manpower; and
(c) given that of the aforesaid rate of increase in new cancer cases, the rate of increase in the two age groups of 45 to 64 and 65 or above was 44% and 17% respectively, whether the authorities have put forward any targeted measure to reduce the cancer risks of people in these two age groups; in addition, given that according to the statistics of the American Cancer Society, the rate of increase in the number of new cancer cases in Hong Kong in the five years since 2005 almost doubled the corresponding rate of increase in US, whether the authorities have analysed the numbers and recent trends of cancer cases in Hong Kong and in other places, and compared in depth the environmental, lifestyle and genetic differences so as to identify the causes of the higher rate of increase in Hong Kong as compared to other places, and reduce the incidence of cancers at the macro policy level?
Reply by the Secretary for Food and Health, Dr York Chow:
Acting Madam President,
Cancer is a major public health concern in Hong Kong. In 2009, there were nearly 26,000 newly diagnosed cancer cases. To fight against cancer with the public in an effective manner, the measures adopted by the Government and the Hospital Authority (HA) must be scientifically justified and accord with the actual situation. Before I respond to the question, I would like to clarify on a few points here –
(i) Firstly, the preamble of the question refers to a study from the Columbia University of the United States (US). The information that we have gathered shows that a doctor from the Columbia Business School published a study in 2010, holding the conclusion that between 1996 and 2006, the age-adjusted cancer mortality rates in the US declined by 13.4%, with about 40% of the decline (that is 5.4%) attributable to imaging innovation. The study did not conclude that imaging technologies resulted in a drop in the number of cancer-related deaths by 40%.
(ii) Secondly, the question draws reference to some data provided by the Organisation for Economic Cooperation and Development (OECD). According to the relevant report, the data provided by various countries did not share a common basis. For instance, some excluded private sector services; some only covered organisations eligible for reimbursement under their health protection system; while some excluded the public sector. With regards the data of the US, OECD pointed out that there seemed to be an overuse of computer tomography (CT) and magnetic resonance imaging (MRI) examinations, possibly because of payment incentives that allowed doctors to benefit from exam referrals.
There are also differences between Hong Kong and countries mentioned in the question in terms of social infrastructures and healthcare systems. For example, in Europe and America, the total health expenditure in some countries forms a steep double-digit percentage of gross domestic product, bringing immense pressure to the Government’s finances and healthcare system. On the other hand, the figure for Hong Kong is at 4.8%, yet our health statistics still compare favourably with other developed countries.
Moreover, the demographics, health circumstances, disease incidence and geographical settings of Hong Kong are also different to the countries mentioned in the question. In using medical technology, healthcare personnel of different places may also have received different training, adopted different practices and face different incentives. In this connection, it is not appropriate to use OECD data for direct comparison on the number of CT and MRI scanners or the number of scans performed each year.
(iii) Thirdly, the question assumes a 9:1 ratio for the use of radiological imaging facilities and services between the public and private sectors. This estimation is only valid for in-patient services in the public and private healthcare sectors. There is a substantial number of out-patients in Hong Kong who receive CT or MRI scan services in the private sector.
My reply to the three parts of the question is as follows:
(a) As mentioned above, the number of MRI and CT scans performed in public hospitals cannot be compared with the figures provided by OECD. As far as public hospitals are concerned, doctors will arrange for CT or MRI scans based on patients’ clinical needs. All new cancer cases will be included in the priority category if such services are needed for assessment of cancer stages.
(b) According to the Irradiating Apparatus Licensing Service of the Department of Health (DH), as at February 1, 2012, there are 83 units of licensed medical CT systems across the territory. As MRI scanners are not irradiating apparatuses and not subject to statutory licensing control, we do not have statistics on the number of scanners in Hong Kong. As regards HA, it will have 28 CT scanners and 14 MRI scanners in 2011/12. HA plans to procure an additional CT scanner in Princess Margaret Hospital and an additional MRI scanner in Caritas Medical Centre in 2012/13. Hospitals will also continue to implement flexible measures to improve radiological diagnostic services, such as employment and retention of staff, recruitment of radiographers from overseas or provision of additional service sessions.
(c) Generally speaking, ageing is a risk factor for common cancers. With a growing and ageing population in Hong Kong, the actual number of new cancer cases will continue to rise. On the other hand, it should be noted that the age composition and other demographic characteristics of places can vary. Between 2000 and 2009, Hong Kong’s population in the “45 to 64” and “65 or above” age groups grew at almost double the rate of the US. For this reason, a direct comparison in the number of new cancer cases or the rate of increase between two places cannot reflect the risk of cancers or the actual impact of the disease.
In statistics or epidemiology, we refer to the age-standardised incidence and mortality rates calculated using the same standard population, in order to make a meaningful assessment of the figures. Hong Kong has seen declining trends in both age-standardised incidence and mortality risk of cancers.
In 2001, the Government established a high-level multi-disciplinary Cancer Coordinating Committee, overseeing and advising on prevention and control of cancer in Hong Kong. The Committee is chaired by me and comprises of cancer experts from the public and private sectors.
The Cancer Expert Working Group on Cancer Prevention and Screening under the Committee reviews the scientific evidence and provides recommendations on preventive measures and screening of major cancers. For example, according to scientific evidence, we have implemented a cross-territorial cervical screening programme with a view to achieving early diagnosis of cervical cancer. We have also implemented Hepatitis B vaccination for prevention of liver cancer.
In addition, the Hong Kong Cancer Registry of HA serves as a well-established surveillance system. It captures and analyses statistical cancer data of the population, and provides predictions on major cancers facilitating healthcare service planning. On the other hand, DH regularly captures risk-related behavioural risk factors of the Hong Kong adult population through the Behavioural Risk Factor Surveillance System. It collects information such as smoking habits, vegetable consumption, physical activities, use of alcohol, cervical screening practices. This provides evidence that helps us evaluate our health promotion and cancer prevention programmes.
According to World Health Organisation’s estimation, 40% of the cancer deaths could be avoided by leading a healthy lifestyle, such as not smoking, pursuing a healthy diet and regular physical exercise. Although the percentage of cigarette smokers in Hong Kong has dropped from 23% in early 1980s to 11% at present, there is no room for complacency. We will continue our efforts in tobacco control. DH will continue to launch health education initiatives to promote healthy lifestyles.
The Government also places emphasis on effective treatment in order to stop the progression of disease after its occurrence. HA has been committed to radiological treatment services which provide timely and adequate treatment for suitable patients. On the other hand, while HA has been expanding the coverage of the Drug Formulary in recent years, more cancer treatment drugs have been included on a gradual basis and are provided to patients at standard fees and charges. The Government has also provided additional resources to HA to meet increasing drug expenditures. From August 1, 2011, eligible patients can apply to the medical assistance projects under the Community Care Fund, for financial assistance in using cancer drugs that are not yet included in the Safety Net supported by the Samaritan Fund.
HA has also launched a pilot scheme at a number of its clusters for case management of cancer patients. Under the scheme, a consolidated cancer treatment plan is jointly devised by a team of multi-disciplinary professionals. Preliminary evidence suggests that patients are generally content with the cancer case management services.
Under the joint efforts of the Government, the healthcare sector and the community, Hong Kong’s cancer incidence, mortality and survival rates are comparable to developed countries and regions.