October is the month dedicated to Breast Cancer Awareness around the world. Pink ribbons, banners and posters pop up in many shops and corners in the city. The Hong Kong Breast Cancer Foundation holds its annual Pink Walk and Pink Together event, to raise awareness of breast cancer among the public and encourage people to adopt a healthier life style, including doing more exercise, eat healthily, avoid smoking and alcohol, and learn to relieve stress.

Breast cancer awareness has two parts. One, is to note any change in the breasts, such as lumps, skin changes, sudden enlargement or asymmetry. Second, is to undergo regular mammography screening.

Breast cancer is an important health hazard to Hong Kong women. It has persistently been the most common cancer affecting Hong Kong women for 28 years since 1994. According to the latest figures from the Hong Kong Cancer Registry in 2019, 1 in 14 women will develop invasive breast cancer in their lifetime. Every day, 13 people are newly diagnosed and 2 die of breast cancer.  

Early detection saves lives. Breast cancer screening can detect early breast cancers which may not be palpable, and thereby reduce mortality. Mammography screening is available in at least 34 countries in the world, including UK, Canada, Australia, New Zealand, USA, many European and South American countries. In Asia, Singapore, South Korea, Japan and Taiwan have government-funded breast cancer screenings. In mainland China, dual cancer screening for women, namely cervical and breast cancer, is advocated and supported by the Government, especially in the rural areas. 

Successful breast cancer screening can detect 5-10 cases of breast cancer for every 1,000 persons. The Hong Kong Breast Cancer Foundation has provided breast cancer screening services to 85,000 women since 2011 at their Breast Health Centers. Out of 1,000 asymptomatic women, 7 were found to have breast cancer, the detection rate is similar to international figures. 

In Taiwan, results from their breast screening program are very encouraging. For the 1.5 million women who received regular mammography screening in the past two decades, breast cancer staging II and above was reduced by 30%, and the death rate was reduced by 40%.

In the past years, the Hong Kong Breast Cancer Foundation has submitted policy address proposal to the Chief Executive, advocating a three-phase approach to breast cancer screening: first, to implement regular screening for high-risk women; second, to provide free screening for low-income women; and thirdly, based on data from the first and second phase, to work towards universal breast cancer screening.

Today, Hong Kong has taken an important step in breast screening. The Department of Health has launched a Breast Cancer Screening Pilot Scheme in September 2021, offering two yearly mammography screening to average risk women. The program adopts a risk-based approach. Women between the ages of 44 and 69, are considered high risk if they have any of the following risk factors, namely a first degree relative having breast cancer, obesity, lack of physical activity, first menstrual period at the age 11 or earlier, never had a baby, had their first child after age 30, or had a history of benign breast disease. They can also use the breast cancer risk assessment tool developed by the University of Hong Kong to calculate their own individualized breast cancer risk. If they are in the 25% highest risk category, they will be eligible for government subsidized breast screening, with access to government-funded mammography examinations at the three Women's Health Centres, run by the Department of Health.

In Hong Kong, more than 1.5 million women are aged between 44 and 69. According to statistics from the Department of Health, more than half of the adults do not exercise enough. Considering physical inactivity alone as a risk factor for breast cancer, at least 750,000 women will be eligible for risk based screening. Adding other risk factors to reach the highest 25% risk category, at least 187,500 women should be offered two yearly breast screening. The Government needs to encourage participation of NGOs and private medical institutions through public-private partnership, to provide adequate screening services to the public.

In this October Breast Cancer Awareness Month, I urge you to turn knowledge into action, examine your breast health and start regular breast screening. And, support our Pink Together 2022 campaign. This year, we encourage women to do more exercise and to donate for the worthy cause of mitigating the breast cancer threat in Hong Kong.