Last updated on October 7, 2021.
What is cervical cancer | HPV and cervical cancer | Statistics | Signs and symptoms | Stages | Prevention | Screening options | Screening programme | Where to screen | Costs | Treatments | Insurance coverage
Cancer remains the number one killer in Hong Kong, accounting for 30.5% of all registered deaths in 2019. As Hong Kong’s population ages significantly, the number of cancer cases is projected to rise by 30 to 40% by 2030.
Although cervical cancer is almost completely preventable and treatable, it kills over 300,000 women each year around the world, with 1 woman diagnosed every minute. 90% of these women live in poor countries, where vaccines and screening are not commonly provided.
Various campaigns have been done to raise awareness about cervical cancer and its link with HPV but more is never enough. Here is your complete guide to cervical cancer in Hong Kong, reviewed by Dr. Patricia Poon, specialist in Clinical Oncology in Hong Kong.
What is Cervical Cancer?
Cervical cancer is a type of gynecological cancer. There are five main types of gynecological cancers and the four others: ovarian cancer, endometrial/urine (womb) cancer, vulvar and vaginal cancer, and trophoblastic disease.
Cervical cancer forms in the cervix (the organ connecting the vagina and uterus) due to uncontrolled growth of abnormal cells. The cervix is covered by a thin layer of tissue composed of ectocervix (squamous cells).
While there are several types of cervical cancers, it is most generally caused by an infection called HPV (Human Papillomavirus). Actually, cervical cancer is by far the most common HPV-related disease.
SCC (Squamous Cell Carcinoma) is the most common type of cervical cancer, accounting for approximately 85% of all cases.
Rarer types of cervical cancers include small cell carcinoma, melanoma, adenocarcinoma, adenosarcoma, adenosquamous, and lymphoma. These are not related to HPV, and are also not as preventable as Squamous Cell Carcinoma.
HPV and Cervical Cancer
Human papillomavirus (HPV) is a very common group of viruses, present all over the world. While there are more than 100 types of HPV, only about 14 are cancer-causing. They are called high risk.
As the most common viral infection of the reproductive tract, HPV will infect most sexually active women and men at some point in their lives.
While most HPV do not cause any health issue, a small proportion of infections from certain HPV can persist and progress to cervical cancer. Two HPV types (16 and 18) cause around 70% of cervical cancers and pre-cancerous cervical lesions.
It is important to note that it takes about 15 to 20 years for cervical cancer to develop in women with normal immune systems, but only 5 to 10 years in women with weakened immune systems, like those with untreated HIV infection.
Cervical Cancer Statistics in Hong Kong
Cervical cancer is the 8th most common cancer among females in Hong Kong. It is also the 8th major cause of female deaths in Hong Kong. In 2019, it caused 2.6% of women’s deaths in Hong Kong. The crude death rate for this cancer was 4.0% per 100,000 female population. The age-standardized death rate due to cervical cancer was recorded to be 1.4% per 100,000 standard population.
To learn more about cervical cancer figures in Hong Kong, click here.
Signs and Symptoms
Most women do not have any visible symptoms or signs of precancer. Symptoms don’t become visible until cancer grows into nearby tissue or becomes invasive. However, some common symptoms are:
- Light bleeding or blood spots between or following periods
- Excessive vaginal discharge
- Bleeding after menopause
- Bleeding after douching, intercourse or a pelvic examination
- Unexplained, back pain and/or regular pelvic pain
- Heavy menstrual bleeding
- Pain during sexual intercourse
Cervical cancer occurs with abnormal changes in the cervical tissue. The risk of these changes is linked to HPV infection (Human Papillomavirus). It is important to repeat that HPV is very common and that most women with HPV never develop cervical cancer, and that while there are many types of HPV, only certain types can cause cervical cancer.
In addition, early sexual intercourse, sexual relations with multiple partners, and taking birth control pills (contraceptives) increase the risk of cervical cancer as they lead to greater exposure to high-risk HPV.
Girls who begin sexual activity before age 16 or within a year of starting their menstrual periods are at high risk of developing cervical cancer.
Stages of Cervical Cancer
The stage describes how serious the disease is and where it has spread. This is the most essential factor in determining how to treat it and how successful treatment might be. In general, the stages range from stage 0 to stage 4.
Stage 0: This stage involves abnormal cells which can be found on the surface of the cervix.
Stage 1: At stage 1 cervical cancer, the abnormal cells grow from the surface into the cervix tissues and maybe into the uterus and nearby lymph nodes.
Stage 2: In this stage, cancer spreads beyond the uterus and cervix, but doesn’t invade the lower part of the vagina or the pelvic walls.
State 3: Cancer spreads into the lower part of the vagina or the pelvic walls. This further leads to ureter blockage. It may or may not affect lymph nodes.
Stage 4: This is the last stage of cervical cancer in which cancer spreads to the rectum, bladder, and distant organs such as bones, liver, lymph nodes, and lungs.
If detected early, the chances of surviving cervical cancer are above 90%. However, as with other cancers, the survival rate decreases significantly if the cancer is discovered late and treatment starts late too. This is why early screening is essential.
For adequate prevention, you need to have regular screenings. It is also recommended to:
- Avoid sexual intercourse with an individual who has many partners.
- Avoid sexual intercourse with people who are infected with genital warts or any other infection.
- Delay first sexual intercourse for an extended period.
- Restrict the number of sex partners.
- Quit smoking.
In an important step, the Hong Kong government announced in 2018 that it will introduce free HPV vaccination to school girls starting from the 2019/20 school year.
Cervical screening test is a simple process to check cervix health. Regular cervical screening is important to detect any issue.
The aim of the Cervical Screening Program in Hong Kong is to help people detect and prevent cervical cancer early through regular cervical screening test.
Some of the most common tests are:
1) HPV Test: HPV test is done on a sample of cells released from the cervix of a woman to check for virus, not cells changes. It can be done alone or combined with a Pap test.
2) Pap Test: Also known as Pap smear, it is a general test done by medical experts to detect early changes in cervix cells which can lead to cervical cancer. It may or may not be combined with an HPV test.
Hong Kong’s Cervical Screening Programme
The Cervical Screening Programme is a government-funded scheme, launched to help all women get cervical screening & preventive education. The objective of this policy is to raise public awareness of cervical cancer screening and prevention. This policy applies especially to women aged between 25 to 64 years.
To know more about Hong Kong’s Cervical Screening Programme, click here.
Note that the Hong Kong Family Planning Association’s Cervical Disease Clinic offers colposcopic examination for women diagnosed to have abnormal cells in Pap smear screenings. You can find more details here.
Where to Get Cervical Screening in Hong Kong?
There are 56 hospitals in Hong Kong out of which 44 are public hospitals and the remaining 13 are private hospitals. Here is a list of public and private primary care physicians providing consultation across Hong Kong under the Cervical Cancer Screening Programme.
In Hong Kong, several non-profit organizations support the fight against cancer and help raise awareness about cervical cancer. They include Hong Kong Cancer Fund, which is the city’s largest cancer support organisation and the Karen Leung Foundation which leads the way on the important topic of gynecological cancers in Hong Kong.
What is the Cost of Cervical Screening in Hong Kong?
- For eligible people with a HKID card: $100 per attendance
- For non-eligible people without a HKID card: $205 per attendance
For more information on cervical cancer screening and treatment costs, feel free to call the Hospital Authority at (852) 2300 6555.
What are the treatments for Cervical Cancer?
The stage of cancer is an essential factor in deciding the suitable treatment. Other factors that help to determine the right treatment include the cancer type, location of cancer within the cervix, age, and the overall health of the patient. Treatment options include*:
- Lymph node removal
- Hysterectomy & bilateral salpingo-oophorectomy
- Pelvic exenteration
- Radiation therapy
- Combination therapy
*Consult with your doctor to discuss the most suitable treatment.
Is Cervical Cancer Treatment Covered by Insurance?
According to Alea cervical cancer surgery is usually reimbursed under hospital/surgical benefits whereas chemotherapy/radiation therapies are usually reimbursed under cancer cover. Generally, high-end medical plans will reimburse cancer treatments in full without any sub-limit whereas local plans will have sub-limits.
What are the warning signs of cervical cancer?
Signs of cervical cancer tend to be invisible and cannot be easily detected until a later stage, nevertheless, common symptoms may come in forms of: light bleeding between periods, excessive vaginal discharge, post-menopause bleeding, bleeding or pain after intercourse and unexplained back or pelvic pain.
What is the most common treatment for cervical cancer?
Treatment methods vary regarding the stage, type, location of the cancer, as well as age and body conditions of the patient. Surgery, trachelectomy, chemotherapy and radiation therapy are some common treatment options for cervical cancer.
What are the stages of cervical cancer ?
“Stage 0: Abnormal cells forming on the cervix;
Stage 1: The abnormal cells grow into the cervix tissues and into the uterus and the surrounding lymph nodes;
Stage 2: Cancer cells spread further before invading the lower vagina or the pelvic walls;
Stage 3: Cancer spreads into the lower part of the vagina or the pelvic walls and cause blockage in the ureter;
Stage 4: Cancer spreads to the rectum, bladder and other organs.”
What is Pap smear test and how is it done?
Pap smear is commonly adopted to screen for cervical cancer. It is done by a doctor to identify early changes in cervix cells in order to check for cervical cancer.
What are the risk factors for Cervical Cancer ?
Cervical cancer is mostly caused by an HPV infection. That said, women who is aged over 30, have multiple ssexual partners, a smoking habit, had more than 3 pregnancies or a long-term use of birth control pills are believed to be more susceptible to cervical cancer.
This article was reviewed by Dr. Patricia Poon on June 11, 2019. Dr. Patricia Poon is a specialist in Clinical Oncology who practices in Hong Kong. She graduated from the University of Adelaide, South Australia in 1995. She subsequently received her Oncology training at the Queen Elizabeth Hospital in Hong Kong and became a fellow of the Royal College of Radiologists in 2002. Dr. Poon earned the Fellowship of Hong Kong College Radiologists and Fellowship of the Hong Kong Academy of Medicine (Radiology) in 2005. She also obtained a Master degree in Palliative Medicine at the Cardiff University, U.K. in 2010. Besides training at the Queen Elizabeth Hospital in Hong Kong, she was Consultant Oncologist at the Hong Kong Baptist Hospital until 2014. She is currently working as a private Clinical Oncologist in Hong Kong.