LCQ11: Prevention and treatment of cancers
29.3.2023

âFollowing is a question by the Hon Elizabeth Quat and a written reply by the Acting Secretary for Health, Dr Libby Lee, in the Legislative Council today (March 29): Question: According to the data from the Hospital Authority (HA), cancer is the top killer in Hong Kong. Nearly 15 000 people died of cancer in Hong Kong in 2020, accounting for nearly 30 per cent of the total deaths in Hong Kong, with lung cancer being the cancer causing most deaths (accounting for 26.4 per cent of all cancer deaths). However, there are views pointing out that a comprehensive screening system for lung cancer is currently unavailable in Hong Kong, and public education and promotion on cancer prevention are not sufficient either. In this connection, will the Government inform this Council: (1) of the (i) number of new lung cancer cases, (ii) number of lung cancer deaths and (iii) percentage of the number of lung cancer deaths in the total deaths in Hong Kong, over the past three years; (2) as there are views that there are no noticeable symptoms at the early stages of lung cancer and the presence of serious symptoms almost indicates a terminal stage, and there are data showing that the cure rate of lung cancer is far higher at earlier stages than at the terminal stage, whether the Government has plans to introduce a comprehensive screening programme in relation to lung cancer in Hong Kong to help members of the public detect and treat lung cancer earlier; if so, of the details; if not, the reasons for that; (3) as some experts indicated that the accuracy of lung cancer tests can be effectively enhanced through new technologies, such as Next-Generation Sequencing and artificial intelligence image analysis, whether the Government will study the introduction of the relevant technologies into Hong Kong to enhance the relevant test effectiveness; if so, of the details; if not, the reasons for that; (4) as there are views pointing out that the Cancer Case Manager Programme, which was introduced by the HA in 2010-2011 and targeted at patients of breast and colorectal cancers, has been remarkably effective, whether the Government knows if the HA will extend the aforesaid Programme to cover lung cancer patients; if the HA will, of the details; if not, the reasons for that; and (5) as it is learnt that while immunotherapy has become more extensively applied to cancer treatment, the Government only subsidises patients with specific cancers and a certain level of programmed death ligand 1 (PD-L1) to purchase relevant medicines, whether the Government will relax the relevant restrictions, so that the immunotherapy can apply to all cancer patients; if so, of the details; if not, the reasons for that? Reply: President, The Government attaches importance to cancer prevention and control as an important strategy to prevent and control non-communicable diseases. As early as 2001, the Government established the Cancer Coordinating Committee (CCC). Chaired by the Secretary for Health and comprising members who are cancer experts, academics, doctors in public and private sectors as well as public health professionals, the CCC formulates strategies on cancer prevention and control and steers the direction of work covering prevention and screening, surveillance, research and treatment. The Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) established under the CCC regularly reviews local and international evidence and makes recommendations on cancer prevention and screening applicable to the local setting. In addition to the CEWG, the structure of the CCC also comprises the Department of Health (DH), the Hong Kong Cancer Registry (HKCaR), the Hospital Authority (HA) and the Research Office of the Health Bureau which oversee cancer surveillance, treatment and research respectively, and directly report to the CCC. The consolidated reply, in consultation with the DH and the HA, to the question raised by the Hon Elizabeth Quat is as follows: (1) According to the statistics of the HKCaR and the HA, the number of new cases of lung cancer from 2018 to 2020 is appended in the following table: Year New cases of lung cancer (Note 1) 2018 5 252 2019 5 575 2020 5 422 According to the statistics of the DH, the number of registered deaths from lung cancer from 2019 to 2021 and the percentage to all number of registered deaths is set out in the following table: Year Number of deaths from lung cancer (Note 2) Percentage to all number of registered deaths (Note 3, 4) 2019 4 033 8.3 per cent 2020 3 910 7.7 per cent 2021 4 037 7.8 per cent (2) The CEWG established under the CCC chaired by the Secretary for Health regularly reviews the local and international scientific evidence, with a view to making recommendations to the Government on evidence-based measures for cancer prevention and screening for the local population. It is worth noting that the overall benefit of cancer prevention by establishing healthy living, eating and exercise habits, and reducing the risk factors that cause or induce cancer is far greater than comprehensive screening for individual low-probability cancers. For lung cancer, the CEWG considers there is insufficient evidence to recommend screening in asymptomatic persons at average risk. Cigarette smoking is the single biggest risk factor for developing lung cancer. As the most important primary prevention strategy, the DH all along encourages the general public to adopt healthy lifestyle, including no smoking, and provides free smoking cessation services to help smokers quit smoking. The CEWG will keep reviewing the latest scientific evidence and update its recommendation as appropriate. (3) In light of the development of genetic and genomic services, the HA has begun to introduce next-generation sequencing (NGS) tests a few years ago, and has gradually applied to the diagnosis of various diseases. For example, NGS tests will be used for enhancing non-small cell lung cancer diagnostic service in 2023/24. The HA has established a governance structure and a set of guiding principles for the adoption of Artificial Intelligence (AI) for clinical use, and is progressively rolling out these AI initiatives, including a chest X-ray AI tool which has been put in place in all General Out-patient Clinics patients to prioritise and reduce the reporting time for unusual cases. Besides, the AI Chest X-ray also screens and detects mass and nodules for Accident and Emergency Departments, Specialist Out-patient Clinics and some hospitalised patients in order to reduce the chance of missing lesions. (4) The HA provides a patient-centred coordinated care service for the cancer patients through the Cancer Case Manager (CCM) programme since 2010/11 with a view to enhancing the service quality. The first phase of the programme targets patients with breast cancer and colorectal cancer. Under the programme, CCMs navigate the patients along the patient journey and facilitate the co-ordination of the diagnostic process and treatment. From 2014/15, the programme has covered all seven clusters under the HA, and has extended to other cancer types from 2020/21, providing services to patients with blood cancer, gynecological cancer, musculoskeletal tumor and urological cancer. In the future, the HA will continue to improve cancer treatment services, and actively consider expanding the scope of services to more cancer types (including lung cancer), so as to improve the service accessibility for cancer treatment, and help relieve the stress and anxiety of patients and caregivers resulting from complicated treatment procedures. (5) As the major provider of publicly-funded public healthcare services, the HA attaches great importance to providing optimal care for all patients (including cancer patients) while ensuring patients an equitable access to cost-effective drugs of proven safety and efficacy under the highly subsidised public healthcare system. On drug management, the HA has an established mechanism for regular evaluation of new drugs and review of its Drug Formulary (HADF) and coverage of the safety net, including formulation of clinical criteria for drugs to be included in the HADF and the safety net. The process follows the principles of evidence-based practice, rational use of public resources, targeted subsidy, opportunity cost consideration and facilitation of patients' choice, taking into account the safety, efficacy and cost-effectiveness of drugs and other relevant considerations, including international recommendations and practices as well as views of professionals and patient groups. In accordance with the above principles and mechanisms, five immunotherapy drugs for cancer treatment are currently included in the subsidy coverage of the Community Care Fund Medical Assistance Programmes (First Phase Programme), including Nivolumab, Pembrolizumab, Durvalumab, Atezolizumab and Ipilimumab. Among them, the first four drugs are for the treatment of lung cancer. Eligible patients with clinical needs can apply for drug subsidy to use the related drugs. Evaluation of drugs is an ongoing process driven by evolving medical evidence, the latest clinical developments and market dynamics. The HA will continue to keep abreast of the latest development of clinical and scientific evidence of different cancer drugs and immunotherapy, listen to the views and suggestions of patient groups, and review the HADF and coverage of the safety net under the principle of rational use of limited public resources while providing adequate medical care to the largest number of patients in need. Note 1: The number of new cases of lung cancer in 2021 and 2022 are not yet available. Note 2: The number of deaths from lung cancer and the percentage to all number of registered deaths in 2022 is not yet available. Note 3: According to the number of registered deaths in Hong Kong released in "Number of Deaths by Leading Causes of Death, 2001 &ndash; 2021" by the Centre for Health Protection of the DH. Note 4: Numbers are accurate to the nearest 1 decimal place.