Press release - immediate release
December 12, 2021

The uptake of cancer screening, especially colonoscopy and Pap smear, remains up to 44% below pre-COVID-19 levels despite pandemic stabilized

HKACS calls for regular screening under the new normal of COVID-19

 

The COVID-19 pandemic has severely interfered with Hongkongers' habits of getting screened for cancer. A survey by the Hong Kong Anti-Cancer Society (HKACS) found that the cancer screening uptake in Hong Kong fell by 31-70% in 2020. More notably, the uptake rate has yet to pick up significantly despite the pandemic in Hong Kong is largely under control in 2021. It is concerning that the decline remains as much as 26-44%. Studies have shown that delays in cancer screening could lead to a rise in avoidable cancer deaths. HKACS suggested that the public should undergo regular cancer screening under the new normal of COVID-19.

 

Cancer screening: a cost-effective health care

Cancer is the leading cause of death in Hong Kong. According to the Cancer Registry of Hospital Authority1, there were more than 35,000 new cancer cases and nearly 15,000 cancer deaths in 2019, representing more than 30% of all deaths in Hong Kong. In fact, one in four people in Hong Kong will develop cancer at some point in their lives2. Cancer screening can help detect cancer early, improve treatment effectiveness and reduce the risk of cancer incidence and mortality. For example, studies have shown that colorectal cancer screening can reduce mortality by 68% while cervical cancer screening can reduce the incidence of by 65%3.

 

Inaction on screening despite having a correct understanding: cancer screening rates remain 44% lower due to fear of catching COVID-19 amid a stabilized pandemic

To understand Hongkongers' cancer screening habits before and during the pandemic, HKACS conducted a survey centering on the topic and polled 1,002 people from October 31 to November 15, 2021. Dr. LIU King Yin, Rico, Chairman of the Cancer Education Subcommittee of HKACS, revealed the following findings and insights:

 

Highlight

Survey findings

Insights

Concerns about delayed cancer diagnosis caused by deferred screenings 

  • The respondents believed that the pandemic would last another 2.5 years on average before it could play out
  • 72% of the respondents agreed that deferred screenings might result in delayed cancer diagnosis
  • The public has a correct understanding of the facts.
  • A British study estimated that prolonged delays in screening related to the pandemic might result in a substantial increase in deaths due to cancer 5 years after diagnosis: 16% for colorectal cancer: 9% for breast cancer: 6% for esophageal cancer; and 5% for lung cancer

Drastic decline in cancer screenings in 2020

Persistent decline despite the pandemic stabilized

 

  • During the pandemic in 2020, the cancer screening rates of the respondents decreased by 31-70% compared to before the pandemic while their uptake rates of general physical examinations decreased by only 23-25%
  • After the pandemic is largely under control (as of mid-November 2021), the cancer screening rates of the respondents remained 26-44% lower than pre-pandemic levels. The elderly group experienced an even larger drop of 37-50%  
  • Cancer prevention should not be neglected while fighting against COVID-19
  • Aging is a major risk factor for cancer. The elderly should get screened for cancer on a regular Basis glucose tests)

 

General physical examinations

 

 

 

The proportion of respondents who underwent regular check-ups/ screenings

 

 

 

before COVID-19

in 2020 and percent change relative to pre-COVID-19

in 2021 and percent change relative to pre-COVID-19

 

 

General check-ups (blood/ cholesterol/ lipid/ glucose tests)

55%

(n=547)

 

41%

(n=410)

(-25%)

 

48%

(n=482)

(-12%)

 

 

 

Eye examinations

31%

(n=312)

24%

(n=240)

(- 23%)

25%

(n=255)

(- 18%)

 

 

Cancer screenings

 

 

Breast screening (female) 

37%

(n=273)

 

25%

(n=184)

(-33%)

27%

(n=198)

(-28%)

 

 

Pap smear (female)

32%

(n=235)

 

16%

(n=121)

(-49%)

19%

(n=142)

(-40%)

 

 

Colonoscopy (50 years old or above)

21%

(n=124)

 

6%

(n=37)

(-70%)

12%

(n=70)

(- 44%)

 

 

Faecal occult blood test (50 years old or above)

14%

(n=87)

 

10%

(n=60)

(跌31%)

11%

(n=64)

(跌26%)

 

Fear of contracting COVID-19. Procrastination and the tendency to get screened only when symptoms appear 

  • Among the respondents who underwent less frequent screening during pandemic peaks

-55% worried that visiting clinics/hospitals, where large crowds are usually present, would increase the risk of contracting COVID-19

-20% were advised by their family to avoid hospitals/clinics

-36% adopted a procrastination mindset: 34% believed it made sense to get screened after the symptoms have appeared

  • It may be too late to get tested after the symptoms have appeared. Regular screening can help detect cancers at an early stage
  • The public, hospitals and clinics should take adequate health protection measures to minimize the risk of contracting the virus. People need not worry too much about that 

*As of mid of November 2021

 

Undergoing regular cancer screening under the new normal is important

Dr. Liu said, "Cancer screening uptake by Hongkongers has greatly declined due to the pandemic. They are still delaying their screening tests with various excuses even though the epidemic situation has been brought under control. It is concerning that the cancer screening rates have not yet rebounded significantly. In the long run, this may lead to more advanced-stage cancer diagnoses, which will create negative impact on both the treatment outcomes and the healthcare system, especially for the elderly who are at higher risk of developing cancer."

In the face of the new normal, HKACS calls on the public to resume cancer screening whenever feasible, e.g. the easing of the pandemic situation so as to reduce the risk of cancer incidence and mortality.

In addition, it is suggested that the cancer screening tests in elderly people should be conducted in a regular manner as the median age at diagnosis was 68 and 62 years for males and females respectively'. The government could consider resuming suspended/ scaled down cancer screening services and sending screening invitations to high-risk individuals through the screening-related publicity materials along with the JoyYou Card.

                                                

1 Cancer Registry, Hospital Authority.
https://www3.ha.org.hk/cancereg/pdf/overview/Overview%20of%20HK%20Cancer%20Stat%202019 tc.pdf

2 Cancer Prevention, Detection & Screening. HKACS. https://www.hkacs.org.hk/ufiles/CancerScreening 1.pdf

3 To Screen or Not to Screen for Cancer. Non-Communicable Diseases Watch. April 2015. https://www.colonscreen.gov.hk/sites/default/files/news/files/NCD watch Apr2015_eng.pdf

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