The struggle in combating cervical cancer in Hong Kong

20170417140000, Victoria Tan
Combating cervical cancer in Hong Kong
By adopting a more comprehensive government-sponsored program, experts estimate the HPV vaccination may prevent up to 90% of cervical cancer cases.
Cervical cancer is one of the first cancers to be able to be eradicated with a vaccine. However, in comparison to the 70% rates in the United States, United Kingdom, Australia and Canada, Hong Kong only achieved a shockingly low 10% rate of the HPV vaccination.

Calling for a wider coverage of cervical cancer vaccination programme for more women


In response to the request for increasing coverage of the HPV vaccine, the Hong Kong government approved a HK$99 million three-year program funded by the Community Care Fund in October 2016. The program provides girls from low-income families with free cervical cancer vaccines, which would otherwise cost HK$3,000 in private clinics. It was projected to cover over 30,000 girls aged between nine to 18 years old.

“We hope the scheme will encourage girls to use proactive actions to safeguard their health,” said Susan Yun-Sun Fan, Executive Director of the Family Planning Association.

Apart from the efforts made by the government, Karen Leung Foundation, Hong Kong’s first non-governmental organisation focusing on raising awareness about cervical cancer, has also called for a wider coverage of HPV vaccines for more women.

The foundation was established in 2012 by Seth Fischer and Waqas Khatri in memory of Karen Leung, Fischer’s employee and Khatri’s wife. It was until Karen’s death at the young age of 34 due to cervical cancer that Fischer realised the cancer is actually preventable, despite the fact that it was ranked as the seventh most common cancer in the city.

To prevent other women from suffering from cervical cancer, the group collaborated with the Chinese University of Hong Kong (CUHK) to sponsor free HPV vaccines to 12 primary schools in low-income districts.

“Our goal is to provide all girls with the choice of vaccination,” said Fischer. “It is a very cost-effective way to save lives.”

All boys and girls should be offered the choice of vaccination


Still, the HPV vaccination has yet to be incorporated into Hong Kong’s regular vaccination schedule. By adopting a more comprehensive government-sponsored program, experts estimate it may prevent up to 90% of cervical cancer cases. In fact, reports published by the World Health Organisation (WHO) have pointed out that over 50 countries already include the HPV vaccination in their respective immunisation programs.

“The vaccine is by far the most effective means to prevent cervical cancer,” said Professor Hextan Yuen-Sheung Ngan, Head of Obstetrics and Gynaecology in the University of Hong Kong (HKU). “The government should put forward a school based model, as the vaccine is most effective when given before girls become sexually active,” she added.

Ngan suggested the vaccination programme should cover boys as well. This is in accordance with the Centers for Disease Control and Prevention (CDC)’s recommendation which states that all males should be given the HPV vaccination in order to protect against cancers of the throat, penis and anus.

Eight strains within the HPV virus group are responsible for 90% of cervical cancer cases


In 2014, human papilloma virus (HPV) has made up 3.3% of newly diagnosed cancer cases in Hong Kong.

Anyone who has ever had sexual intercourse is at risk of contracting HPV. Approximately 90% of women with HPV are asymptomatic and are able to clear the infection on their own. However, some women are infected persistently with high risk strains of HPV, which may progress to developing pre-cancerous lesions and eventually cervical cancer.

There are over 115 viruses in the HPV group. However, only eight of the strains (HPV 16, 18, 31, 33, 35, 45, 52, 58) are responsible for 90% of cervical cancer cases worldwide.

New nine-valent HPV vaccine may prevent more cases of cervical cancer


A new nine-valent HPV vaccine was first licensed for use in December 2014. Compared to the older bivalent and quadrivalent vaccines, the nine-valent vaccine offers protection against nine types of common cancer-causing viruses, including HPV type 31, 33, 45, 52 and 58, which altogether account for 15% of cervical cancer cases.

This nine-valent HPV vaccine is offered in the three-year government vaccination programme. HKU is also launching a campaign this year offering these nine-valent vaccines at a discounted price of HK$2,250 versus the expected price of HK$4000 to HK$4,500 in private clinics. 

Regular screening paramount in reducing cases of cervical cancer


Besides vaccinations and safe sexual practices, regular screening is essential in diagnosing the disease or preventing the disease from advancing to the later stages. Full blown cervical cancer takes an average of ten years to manifest. Throughout the journey when the disease advances to different stages, it progresses through a series of well-defined pre-cancerous lesions that can be detected on a Pap smear.

Although undergoing screening every three years is recommended for all women aged 25 to 64 with a sexual history, only 60% of Hong Kong women receive regular pap smears. MIMS

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Sources:
http://www.scmp.com/news/hong-kong/health-environment/article/2004177/hong-kong-government-urged-introduce-cervical
http://www.scmp.com/news/hong-kong/health-environment/article/1898969/deprived-young-hong-kong-women-receive-subsidised
http://www.scmp.com/news/hong-kong/health-environment/article/1864035/self-testing-urged-cut-rate-cervical-cancer-hong
http://www.scmp.com/news/hong-kong/health-environment/article/1940330/fight-rid-hong-kong-cervical-cancer
http://www.scmp.com/news/hong-kong/health-environment/article/2022051/thousands-set-benefit-hong-kongs-free-hpv
http://www.chp.gov.hk/en/content/9/25/56.html
http://emedicine.medscape.com/article/253513-overview#a3
https://www.cdc.gov/hpv/downloads/9vhpv-guidance.pdf