Cervical Screening Programme - Centre For Health Protection

CervicalScreeningProgramme

Cervical ScreeningProgrammeRegular ScreeningEarly DetectionTimely TreatmentPrevention of Cervical Cancer

Contents1Cervical Cancer4Cervical Cancer Screening1015Cervical Screening ProgrammeSome Healthcare Providersor Organisations that ProvideCervical Cancer ScreeningService

Cervical CancerCervical cancer is one of the common cancersamong females in Hong Kong. Almost all cervicalcancers are caused by persistent infection withone of the cancer-causing (or high-risk) humanpapillomavirus (HPV) types. HPV infection is usuallyfound in persons who have ever been sexuallyactive. Most people with HPV infection do not haveany symptoms and will clear the infection on theirown. Some females with persistent high-risk HPVinfection in the cervix will develop pre-cancerouscell changes. While the majority of these changeswill regress to normal, some may progress to cancerover years.The following figure illustrates the natural course ofthe development of normal cervical cells to lchangesregressioninvasionCervicalcancer

Risk factors for the progression from HPV infectionto cervical cancer include:1234567multiple sexual partners or sexual partnerwith multiple sexual partnerssexual intercourse at earlier ageco-infection with sexually-transmitteddiseasessmokingweakened immunity, e.g. infected withHuman Immunodeficiency Virus (HIV)long term use of oral contraceptive pillsfor more than 5 years (the risk returns tonormal after 10 years of stopping use)increasing parity (number of babies born)or younger age at first pregnancyDespite the above risk factors, regular cervicalcancer screening and timely treatment of thedetected pre-cancerous changes can preventcervical cancer.However, the most commonly neglected risk factoris failure to get a regular cervical cancer screen.2

Prevention of cervical cancerRegular cervical cancer screening is proven to bean effective way of preventing cervical cancer.Cervical cancer can also be prevented by reducingthe HPV infection and the progression frompersistent HPV infection to cervical cancer. Hereare some preventive measures:Practise safer sex (e.g. use condoms andavoid having multiple sexual partners) toreduce the chance of HPV infection andto protect against sexuallytransmitted diseases Get HPV vaccinationbefore initiation ofsexual activity Do not smokePVH3

Cervical Cancer ScreeningWhat is cervical smear?Cervical smear (also named Pap smear) is asimple and quick screening test that only takes afew minutes. The doctor or nurse will put a specialinstrument called a speculum into the vagina andwipe some cells from the cervix with a spatula or abrush. The cells will then be sent to the laboratoryfor am showing how a cervical smear is taken4

Who needs cervical cancer screening?nnnn5Cervical cancer screening is for healthy womenwho have no symptom.In general, women aged 25 to 64 years whoever had sex, irrespective of marital status, arerecommended to receive regular cervical cancerscreening.Screening may be discontinued in women aged65 years or above if three previous consecutivesmears within 10 years are normal.Women aged 65 years or above who everhad sex and have never had cervical cancerscreening should be screened, even if they nolonger have periods, haven’t had sex for manyyears or had sterilisation.

nnnnWomen aged 21 to 24 years who ever had sexand risk factors for cervical cancer (e.g. havingmultiple sexual partners, smoking, weakenedimmunity) should consult their doctors for theneed for cervical cancer screening.Women who have received HPV vaccination stillneed regular cervical cancer screening becauseHPV vaccination does not protect against theHPV types not included in the vaccine, noragainst existing HPV infections.Women who have never had sex do not needcervical cancer screening.Women who have hysterectomy with removalof cervix for benign diseases and without priorhistory of cervical changes can discontinuescreening.If in doubt, please consult the doctor.6

When should I have cervical cancer screening?nnnn7All women who ever had sex should have regularcervical cancer screening by smear starting fromthe age of 25.If your first cervical smear result is normal, youshould have the second smear 1 year later.If your second smear result is also normal, youshould repeat smears every 3 years.If you have any symptom (such as abnormalvaginal bleeding), you should see a doctorpromptly, even if your last smear result wasnormal.

What do the cervical smear results mean?nnAround 90% of the cervical smear resultsare“negative”(normal), meaning that noabnormal cell is found on your cervix. But youstill need regular screening.A “positive” or “abnormal” result usually meansthere are some changes in the cells of yourcervix. It does not necessarily mean that youalready have cancer. Most of these changesare due to HPV infection. A small number ofwomen may have pre-cancerous cells whichcall for treatment to prevent them from turningcancerous. Your doctor will advise you on thenecessary follow-up and investigations.Please note that cervical smear is a screening test.If the result shows cell changes, further examination(e.g. colposcopy) will be required to identify theextent and severity of abnormal cells and helpguide subsequent management.8

Limitations of cervical smearAlthough screening by regular cervical smears is aneffective way to prevent cervical cancer, no test isperfect.nnA “false negative” result means a cervical smeartest is reported as negative (normal) in thepresence of abnormal lesion in the cervix. Itmay be due to sampling, transfer or laboratoryproblem. Therefore, even if your previous smearresult is normal, you still need to have regularsmears to detect and treat early pre-cancerouscell changes.A “false positive” result means a cervical smeartest is incorrectly reported as abnormal whenno abnormality can be found in subsequentinvestigations.Although the smear test is not 100% accurate, it isstill an accessible, affordable and effective meansto reduce cervical cancer risk.9

Cervical Screening ProgrammeThe Cervical Screening Programme (CSP) is aterritory-wide screening programme launchedby the Department of Health on 8 March 2004in collaboration with the healthcare sector toencourage women to have regular cervical cancerscreening. Its objective is to increase the coverageof cervical cancer screening so as to reduce theincidence and mortality rate of cervical cancer inHong Kong.10

Cervical Screening Information SystemCSP has established the “Cervical ScreeningInformation System” (CSIS) for storing datarelated to the CSP, including participants’ personalinformation, smear results and next recommendedtest date.Once you have registered with the CSP, you canlogin to the CSIS to view your cervical smear recordand will receive a reminder when the next smear isdue.Moreover, you can authorise your healthcareprovider to view your past smear records in order toprovide continuous care.The Department of Health strictly complies with thePersonal Data (Privacy) Ordinance in handling andkeeping personal data confidential.11

Methods of registration1Registration through healthcare providerswho have registered with the CSP.2Direct registrationa. Online applicationComplete the onlineregistration form at theCSIS website (www.csis.gov.hk) andthen send a photocopy of the HongKong Identity Card to CSP Office bypost.b. Postal applicationDownload a registration form on the CSPwebsite (www.cervicalscreening.gov.hk).Send the completed form with aphotocopy of the Hong Kong IdentityCard to the CSP Office by post.12

Registrants to note1After successful registration and openingof a personal account, a personalauthorisation code will be created for youto authorise your healthcare provider toaccess your smear record in the CSIS.2If you have registered theCSP through healthcareproviders, your smearresults would be sent directlyto the CSP Office. If you have registered theCSP by yourself, you need to send a copyof your smear report to the CSP Office bypost or email for updating your record inthe CSIS.3As individual healthcare providers whoprovide cervical cancer screening servicemay have different appointmentprocedures and service charges,please contact them directly toenquire about service arrangements.13

4Recipients of Comprehensive SocialSecurity Assistance (CSSA), holders ofwaivers of medical charges under themedical fee waiving mechanism of publichospitals and clinics, or Level 0 Voucherunder the Pilot Scheme on ResidentialCare Service Voucher for the Elderlyare waived from payment for cervicalscreening services at the public sector (e.g.Maternal and Child Health Centres of theDepartment of Health).14

Some Healthcare Providersor Organisations thatProvide Cervical CancerScreening ServicePlease visit the CSP websitewww.cervicalscreening.gov.hkFamily Doctors or GynaecologistsMaternal and Child Health Centres ofDepartment of Health(Provide cervical cancer screening for women aged 25 to64 years)Appointment Hotline: 3166 6631Enquiry Hotline: 2112 9900Website: www.fhs.gov.hk15

Hong KongMaternal andChild Health CentreAnne Black Maternal& Child Health CentreAp Lei Chau Maternal& Child Health CentreChai Wan Maternal& Child Health CentreSai Wan Ho Maternal& Child Health CentreSai Ying Pun Maternal& Child Health CentreTang Chi NgongMaternal & ChildHealth CentreAddress2/F, Anne Black Health Centre,140 Tsat Tsz Mui Road,North Point2/F, Ap Lei Chau Clinic,161 Ap Lei Chau Main Street,Ap Lei ChauLevel 2, Government Office,Block 6, New Jade Garden,233 Chai Wan Road, Chai Wan2/F, Sai Wan Ho Health Centre,28 Tai Hong Street, Sai Wan Ho4/F, Sai Ying Pun Jockey ClubPolyclinic, 134 Queen’s RoadWest, Sai Ying Pun4/F, Tang Chi Ngong SpecialistClinic, 284 Queen’s Road East,Wan Chai16

KowloonMaternal andAddressChild Health CentreEast Kowloon Maternal 1/F, East Kowloon Polyclinic,& Child Health Centre 160 Hammer Hill Road,Diamond HillKowloon City Maternal 4/F, Kowloon City Health Centre,& Child Health Centre Kowloon City Government Offices,42 Bailey Street, Hung HomKwun Tong MaternalLG/F, Kwun Tong Community& Child Health Centre Health Centre Building,60 Hip Wo Street, Kwun TongLam Tin Maternal1/F, Lam Tin Polyclinic,& Child Health Centre 99 Kai Tin Road, Lam TinRobert Black Maternal 1/F, Robert Black Health Centre,& Child Health Centre 600 Prince Edward Road East,San Po KongWang Tau HomG/F, Wang Tau Hom Jockey ClubMaternal & ChildClinic, 200 Junction Road East,Health CentreWang Tau HomWest Kowloon Maternal 2/F, West Kowloon Health Centre,& Child Health Centre Cheung Sha Wan GovernmentOffices, 303 Cheung Sha WanRoad, Sham Shui PoWu York Yu Maternal1/F, Wu York Yu Health Centre,& Child Health Centre 55 Sheung Fung Street,Wong Tai SinYaumatei Maternal1/F, 10 Yan Cheung Road,& Child Health Centre Yaumatei17

New Territories East and IslandsMaternal andChild Health CentreFanling Maternal &Child Health CentreLek Yuen Maternal& Child Health CentreMa On Shan Maternal& Child Health CentreTseung Kwan O PoNing Road Maternal& Child Health CentreWong Siu ChingMaternal & ChildHealth CentreCheung Chau Maternal& Child Health CentreTung Chung Maternal& Child Health CentreMui Wo Maternal& Child Health CentreAddress5/F, Fanling Health Centre,2 Pik Fung Road, Fanling2/F, Lek Yuen Health Centre,9 Lek Yuen Street, Shatin1/F, Ma On Shan Health Centre,609 Sai Sha Road, Ma On Shan1/F, Tseung Kwan O Po NingRoad Health Centre, 28 Po NingRoad, Tseung Kwan O1/F, Wong Siu Ching Clinic,1 Po Wu Lane, Tai PoG/F, St. John Hospital,Cheung Chau Hospital Road,Cheung ChauG/F, Tung Chung Health Centre,6 Fu Tung Street, Tung Chung,Lantau Island1/F, Mui Wo Clinic,2 Ngan Kwong Wan Road,Mui Wo, Lantau Island18