Journal of Public Health Advance Access originally published online on May 14, 2008
Journal of Public Health 2008 30(3):282-292; doi:10.1093/pubmed/fdn034
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Who receives, benefits from and is harmed by cervical and breast cancer screening among Hong Kong Chinese?
Gabriel M. Leung, Professor in Translational Public Health1
Pauline P. S. Woo, Post-doctoral Fellow1,*
Benjamin J. Cowling, Research Assistant1
Caroline S. H. Tsang, Senior Medical and Health Officer2
Annie N. Y. Cheung, Professor in Gynaecological Pathology3
Hextan Y. S. Ngan, Professor in Obstetrics and Gynaecology4
Kevin Galbraith, Lecturer in Medical Education1
Tai-Hing Lam, Sir Robert Kotewall Professorship in Public Health and Chair Professor1
1 School of Public Health, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
2 Department of Health, Government of the Hong Kong Special Administrative Region, Hong Kong, China
3 Department of Pathology, University of Hong Kong, University Pathology Building, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
4 Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
Address correspondence to Pauline P. S. Woo, E-mail: pwoo{at}hkusua.hku.hk/pwoo{at}graduate.hku.hk
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Abstract |
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Background To estimate the proportion of and characterize women who had received cervical and breast screening and to quantify the associated preventable burden of disease and potential iatrogenic harm.
Methods A total of 3484 Hong Kong Chinese women were interviewed in person. Screening prevalence and associated predictors, disability-adjusted life-years (DALYs), the numbers of false-positive tests and the resultant confirmatory procedures and related complications were estimated.
Results A total of 6.2% of women (
18) reported regular pap but no mammography or clinical breast examination (CBE) as per local evidence-based guidelines, whereas among women aged 40 years, 5.2% reported regular screening by all three modalities and 55.3% had never been screened for either cancer. Women who underwent regular health checkups were consistently the most likely to have been screened, as were younger, married and socially advantaged respondents. Triennial pap screening would save 708 DALYs annually, or 528 more DALYs compared with the status quo. However, this would generate 28 600 repeat smears and 390 colposcopies from false-positive screens. Opportunistic mammographic screening averted 100 DALYs currently, but could have potentially reduced a further 546 with biennial screening. Mass screening mammography (CBE) would lead to 33 700 (20 200) false-positives per year requiring 29 900 (8300) repeat mammograms or ultrasonograms, 6800 (3000) biopsies and 620 (270) biopsy-related complications.
Conclusions Screening uptake patterns are suboptimal. By making explicit the possible risks and benefits based on this template, policy makers in developing Asia with a similar female cancer burden may be able to use the information to make evidence-based decisions that are consistent with local circumstances, values and preferences.
Keywords: breast cancer, cervical cancer, DALYs, iatrogenesis, screening