Cervical Screening Programme (CSP)

1. Cervical Screening Programme(CSP) November 2006

2. Cervical Cancer in Hong Kong • Incidence rate • The 4th most common cancer among females in Hong Kong in 2003 • 408 new cases, accounting for 4.3% of all new cancer cases in females • Age-specific incidence rate: 8.9/100,000 • Median age at diagnosis: 50 years

3. Cervical Cancer in Hong Kong • Mortality rate • 8th most common cause of cancer deaths among females in 2004 • 128 deaths • Account for 2.8% of all cancer deaths in females

4. Age - standardized incidence rates Age - standardized mortality rates 14.2 Singapore (1993 - 1997) 4.2 US - Black (1996 - 2000) 9.7 Hong K Hong Kong (2000) ong (2000) 4.1 Singapore (1998) Ireland (1998) 9.5 3.5 Ireland (1998) Germany (1998) 9.4 3.2 Norway (1997) 9.4 US(SEER) - Black (1996 - 2000) 2.8 4 European Union (1998) Norway (2000) 9.3 2.7 New Zealand (1999 ) New Zealand (1999) 9.2 2.6 Hong Kong (2000) Hong Kong (2000) 8.1 Europea n Union (1998) Germany (1999) 2.6 7.5 England (1999) England and Wales (2001) 2.3 7.0 Sweden (2000) US - White (1996 - 2000) 2.0 Canada (1999) 6.7 Sweden (2000) 1.9 6.5 Canada (1997) 1.9 The Netherlands (1998) 6.4 The Netherlands (1999) 1.8 US(SEER) - White (1996 - 2000) Australia (1999) 1.6 Australia (1999) 6.3 Finland (1999) 1.3 Finland (1999) 3.8 0 1 2 3 4 5 0 4 8 12 16 Rates (per 100,000 standard population) Rates (per 100,000 standard population) International Comparison of Age-standardized Incidence and Mortality Rates of Cervical Cancer

5. Local Situation Before the Launching of CSP • Lack of an organized screening programme • Cervical smear taking coverage rate among women was about 44% • Screening was not based on women’s risks or needs • Many women had little knowledge or had misconceptions on cervical screening • Lack of well recognized quality management guidelines and standards • No central registry to store the cervical smear results • Public and private sector service providers operated separately without collaboration

6. The Development of CSP • In 2001 Policy Address, the Government pledged to launch a Cervical Screening Programme (CSP) for women • The Cervical Screening Task Force (CSTF) was established in December 2001 to oversee the planning, implementation and evaluation of CSP

7. The Development of CSP 3 Working Groups formed Public health experts Professional groups Recruitment & Education Members of CSTF Service providers From public & private sectors Universities Quality Management NGOs Women groups Information System

8. The Development of CSP The goals of CSTF • To formulate a sound, evidence-based screening policy for maximize the benefits of the programme • To develop effective recruitment and public education strategies • To build an information system, the Cervical Screening Information System (CSIS) • To establish quality assurance standards and guidelines • To facilitate public-private collaboration

9. The Development of CSP • Department of Health (DH) conducted questionnaire surveys on private practitioners and laboratories: • To collect information on cervical screening practices and difficulties faced • To collect their opinions on cervical screening programme • DH also visited various private laboratories and clinics • To understand their modes of operation and information systems

10. The Development of CSP • DH conducted focus group study on women: • of different ages and background • to study their beliefs, behaviour and attitudes regarding cervical screening • to investigate the facilitators and barriers for women to receive cervical smear examination

11. The Development of CSP • In July 2003, the Health Panel of the Legislative Council supported the CSP. • CSP was launched on 8 March 2004 by DH in collaboration with other health care providers

12. Dr. Lam Ping-yan, Director of Health delivering the opening speech at the launching ceremony

13. The officiating party composed the CSP logo and declared the launching of the CSP. The officiating party (from left to right): Dr. Susan Fan, Mrs. Peggy Lam, Dr. Lam Ping-yan, Dr. Robert Law, Mrs. Leung Lau Yau-fan

14. Screening Policy – Target Population • Women aged from 25 to 64 years • If 2 annual cervical smear results are normal take smear every 3 years thereafter • Women aged 65 years or above • If previous 3 consecutive smear results are normal no need for further smears • Women aged below 25 years • For those who have high risk profile for cervical cancer may be screened according to professional judgement

15. Screening Policy – Screening Interval • In most circumstances, screening frequency should be annually for initial 2 years, and if the results are both normal, then 3-yearly thereafter • Women with risk factors for cervical cancer may need to be screened more frequently

16. CSP Flow Diagram DH conducts publicity programmes to raise public awareness Women select and pay service providers to have cervical smears The central registry sends reminder letters to women due for next screening and provides information to service providers for follow-up Women and service providers cooperate with DH in providing information to the central registry

17. Recruitment and Education Strategies Publicity activities to the general public: • Sending invitation letters to households • Organizing publicity activities: advertisements on TV, radio, major transportation networks, newspapers and magazines; roving exhibitions and health talks • Distribution of education and publicity materials, e.g. booklets, VCDs, tapes and posters, etc. • Established a 24-hour education hotline and CSP hotline • Established the CSP website

28. Recruitment and Education Strategies Publicity activities to service providers and laboratories: • Organized briefing sessions • Issued invitation letters to service providers • Placed advertisements in medical journals • Distribution of materials during medical seminars and talks • Collaborated with professional groups • Organized sharing sessions for laboratory workers

30. Cervical Screening Information System (CSIS) • The central registry of the CSP • Register personal information • Maintain information on screening history and results • Track utilization of cervical screening service and follow-up events • Identify women due for screening and send them reminders • Facilitate record linkage across service providers • Generate statistics on coverage rates and quality assurance standards • Aid research and evaluation

31. Quality Management • Quality management guidelines have been drawn up for all stages of the cervical screening pathway: • Proper smear taking procedures • Proper cytological diagnosis by the laboratory • Cervical smear reports • Management of abnormal smear results • Appropriate follow-up and treatment of abnormal conditions

32. Quality Management • CSP specifically produced the Cervical Screening Manual, the contents of which include proper smear taking procedures and handling of the specimens, and also the management guidelines of abnormal smears issued by the Hong Kong College of Obstetricians and Gynaecologists • Provide training for health professionals who work in the Maternal & Child Health Centres

33. Collaboration of the Public and Private Sectors • CSTF members come from both public and private sectors • Free distribution of professional training kits to private service providers • CSIS collect and store smear records to facilitate patient care by private doctors • Work with universities and professional groups to organize refresher courses

35. Benefits of CSP to Women • Women will receive reminder letters when their next test date is due • Women can view their own cervical smear results in CSIS • With women’s consent, registered service providers can retrieve their cervical smear records, so as to provide more appropriate follow-up

36. Benefits of CSP to Service Providers • Can retrieve smear records of registered women through the internet, so as to provide more appropriate follow-up • Will receive a list of women whose smear is due or overdue in order to facilitate arrangement for appointment • Will receive CSP education and publicity materials free of charge • The clinic information of the service providers will be uploaded onto the CSP website and printed in reminder letters, to facilitate women in making appointment for examination

37. 以 地 區 列 出 以 名 稱 列 出 搜 尋 服 務 提 供 者 - 地 圖

38. 搜 尋 服 務 提 供 者 - 條 件 區 域 : 地 區 : 機 構 : 名 稱 : 電 話 : 地 址 :

39. Statistics As of September 2006, the registration figures of CSP are: • More than 220 000 women have registered • Registered service providers: about 600 • Registered laboratories: 13

40. Statistics • According to DH’s telephone survey in October 2005, about 61.6% women have ever had cervical smear

41. The success of CSP relies on the collaboration of every service provider and organization

42. The End