Journal of Public Health Advance Access originally published online on January 21, 2008
Journal of Public Health 2008 30(1):110-111; doi:10.1093/pubmed/fdm087
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved
Correspondence |
Breast cancer screening practice of Chinese elderly worth re-evaluation of health promotion policy
J.S.Y. Chor
J.C.S. Leung
D.C.C. Chan
P.C. Leung
Jockey Club Centre for Osteoporosis Care and Control,
School of Public Health,
The Chinese University of Hong Kong,
Hong Kong
S. Griffiths
School of Public Health,
The Chinese University of Hong Kong,
Hong Kong
E-mail: josette{at}hkma.org
The incidence of breast cancer increased in many Asian countries.1–3 According to the Hong Kong cancer registry 2003, breast cancer was the commonest cancer and the third leading cause of cancer deaths in women.4 The age-standardized incidence rate increased from 35.7 per 1 00 000 standard population in 1983 to 45.4 per 1 00 000 standard population in 2003. The potential years of life lost at age 75 is 7035 estimated in 2004.1 Thus, it poses an increasingly important burden in both health and finance.
Currently, there are over 20 countries with organized population screening program for breast cancer including Asian countries such as Singapore and Japan. The number is increasing because of the demonstration of the efficacy of these programs in reduction of breast cancer mortality.5 The widely accepted screening method world-wide is mammography which was estimated to have a 15% relative reduction in breast cancer mortality in Cochrane review.6
In Hong Kong, breast cancer screening by mammography is only done by opportunistic screening in voluntary, self-financed and self-referral basis. We have conducted this study to investigate the prevalence of mammography in population based sample of elderly women and the associating factors of the screening practice.
Structured interview was done with 1704 elderly women aged 65 or above recruited from the community in Ms Os study of Hong Kong. Socio-demographic data and family history of breast cancer was recorded. Multivariate analysis was done to evaluate the associating factors.
Result showed that only 13.5% of them had ever had a mammogram before. Even in the subgroup of women with first degree relatives having breast cancer, only 25.93% women had had mammograms, not statistically significant from the general population.
Higher education level is associated with higher percentage of screening. Among those who had primary education, only 10.33% had mammogram while among those who had secondary education or above, 28.78% had mammogram. The adjusted odds ratio (adj.OR) is 2.37 (1.71, 3.27) at 95% confidence interval. Advancing age is an unfavorable factor with adj.OR = 0.53 (0.35, 0.79) in age group 75 or above when compared with age group 65–69. Widowed women were also less likely to have attended for screening with adj.OR = 0.67 (0.47, 0.96).
We have pointed out that the women in Hong Kong are underscreened especially in high risk population with positive family history. This is surprisingly low in a well-developed city. In a study investigating Chinese women in the Philadelphia area, over 70% have ever done mammogram.7 This suggests that the low screening rates are not just due to cultural differences but more to the screening policies. Women with lower education level, widowed status, advancing age and positive family history warrant more in-depth study on the barriers for the screening. For example, there is no formal counseling service offered to first degree relatives of breast cancer patients. Facing the increase in incidence rate of breast cancer, Government should evaluate its policy on screening to combat this public health problem and increasing demand from the citizens.
 |
References |
|---|
 TOP References |
|---|
- Breast cancer. (2006) Available at http://www.chp.gov.hk.
- Wang SC. The Singapore National Breast Screening Programme: principles and implementation. Ann Acad Med Singapore (2003) 32(4):466–76.[Web of Science][Medline]
- Suzuki T, Toi M, Saji S, et al. Early breast cancer. Int J Clin Oncol (2006) 11(2):108–19.[CrossRef][Medline]
- Authority H. Hong Kong Cancer Statistics 2003. In. Hong Kong Cancer Registry. (2006).
- Shapiro S, Coleman EA, Broeders M, et al. Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. Int J Epidemiol (1998) 27(5):735–42. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening.
[Abstract/Free Full Text] - Kosters JP, Gotzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev (2003) (2):CD003373.
- Su X, Ma GX, Seals B, et al. Breast cancer early detection among Chinese women in the Philadelphia area. J Womens Health (Larchmt) (2006) 15(5):507–19.[CrossRef][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||