Who receives, benefits from and is harmed by cervical and breast cancer screening among Hong Kong Chinese?

Abstract

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. 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. A total of 6.2% of women (>or=18) reported regular pap but no mammography or clinical breast examination (CBE) as per local evidence-based guidelines, whereas among women aged >or=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. 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.