Breast cancer is the most common cancer affecting women in Hong Kong, accounting for nearly 30% of all new female cancer diagnoses annually. While overall incidence rates remain lower than in many Western nations, cases in Hong Kong have risen steadily. Fortunately, early detection significantly improves treatment outcomes and survival rates.
The Risk-Based Approach to Screening
Unlike countries that offer universal population-wide mammograms, Hong Kong’s Department of Health follows a risk-based screening strategy recommended by the Cancer Expert Working Group on Cancer Prevention and Screening (CEWG). Recommendations depend on individual risk profiles:
1. High-Risk Women
Women in high-risk categories are advised to undergo annual mammography screening, starting at a younger age (or 10 years earlier than the age of diagnosis of their youngest affected relative, but no earlier than age 30).
Criteria: Confirmed carriers of BRCA1/2 gene mutations, strong family history of breast/ovarian cancer, or a history of chest radiation therapy between ages 10 and 30.
Additional Tests: Confirmed BRCA1/2 carriers or those with past chest radiation should consider supplemental annual Magnetic Resonance Imaging (MRI) screening alongside mammograms.
2. Moderate-Risk Women
Women with a moderate risk profile should consult a doctor to weigh the benefits and potential harms of regular screening.
Criteria: Having one first-degree female relative diagnosed with breast cancer at age 50 or younger, or two first-degree relatives diagnosed after age 50.
Recommendation: Mammography screening every two years after medical consultation.
3. General Population / Average Risk
Women aged 44 to 69 with specific combinations of personalized risk factors (such as early menarche, late first childbirth, physical inactivity, or high body mass index) that increase their overall risk are encouraged to undergo mammography screening every two years after consulting a primary care provider.
Key Screening Guidelines Summary
Government Initiatives & Local Resources
Breast Cancer Screening Pilot Programme: Launched by the Hong Kong SAR Government, this program utilizes the locally validated Breast Cancer Risk Assessment Tool to help eligible women (aged 44 to 69) evaluate their personalized risk level and receive subsidized mammography screening via District Health Centres (DHCs) and Women Wellness Satellites.
Hong Kong Breast Cancer Foundation (HKBCF): Operates Breast Health Centres providing mammography, ultrasound, clinical examinations, and financial assistance programs for low-income women.
Department of Health Woman Health Centres: Offer clinical breast examinations, health advice, and referrals for diagnostic imaging as appropriate.
What Every Woman Should Do
Be Breast Aware: Regularly pay attention to the normal look and feel of your breasts. Look out for changes such as new lumps, skin dimpling, nipple discharge or retraction, or unusual swelling under the armpit.
Assess Your Risk: Use online assessment tools, such as the government's Breast Cancer Risk Assessment Tool via local DHCs, or consult a family doctor to understand your risk profile.
Adopt Healthy Lifestyle Habits: Regular physical exercise, maintaining a healthy body weight after menopause, and limiting alcohol intake help lower the long-term risk of developing breast cancer.
香港乳癌篩查
乳癌是本港女性最常見的癌症，佔每年新診斷女性癌症個案近 30%。雖然總體發病率仍低於許多西方國家，但香港的個案一直穩步上升。幸而，及早發現能顯著改善治療效果及提高生存率。
按風險為本的篩查策略
與提供全民乳房X光造影篩查的國家不同，香港衞生署採納了癌症預防及篩查專家工作組（CEWG）的建議，實施按風險為本的篩查策略。具體建議取決於個人的風險程度：
1. 高風險女性
高風險類別的女性建議每年進行 乳房X光造影篩查，並應從較年輕的年齡開始（或比其最年輕確診患病親屬的確診年齡早 10 年，但不應早於 30 歲）。
條件：經確認為 BRCA1/2 基因突變攜帶者、有強烈的乳癌或卵巢癌家族病史，或在 10 至 30 歲期間曾接受胸部放射治療。
附加檢查：經確認為 BRCA1/2 攜帶者或曾接受胸部放射治療者，應考慮在乳房X光造影以外，每年加做 磁力共振掃瞄（MRI） 作補充篩查。
2. 中度風險女性
中度風險的女性應諮詢醫生，以權衡定期篩查的益處與潛在風險。
條件：有一位直系女性親屬在 50 歲或以下確診患上乳癌，或有兩位直系親屬在 50 歲以上確診。
建議：經醫生諮詢後，每 兩年 進行一次乳房X光造影篩查。
3. 一般人口／一般風險
年齡介乎 44 至 69 歲 的女性，若具備增加整體風險的特定組合個人風險因素（如初潮過早、高齡初產、缺乏體能活動或體重指數偏高），鼓勵在諮詢基層醫療醫生後，每 兩年 進行一次乳房X光造影篩查。
關鍵篩查指引摘要
(註：原草稿表格中一般風險的年齡範圍列為 40–69 歲。香港衞生署專家工作組之官方建議，針對一般風險評估的指定年齡範圍應為 44 至 69 歲。)
政府措施與本地資源
乳癌篩查先導計劃：由香港特區政府推出，利用本地驗證的 乳癌風險評估工具，協助合資格女性（44 至 69 歲）評估個人風險程度，並透過地區康健中心（DHC）及婦女健康中心／服務點獲得資助的乳房X光造影篩查。
香港乳癌基金會（HKBCF）：營運乳健中心，提供乳房X光造影、超聲波檢查、臨床檢查以及為低收入女性提供財務資助計劃。
衞生署婦女健康中心：提供臨床乳房檢查、健康諮詢及適當的診斷性影像檢查轉介服務。
每位女性應盡的本份
關心乳房健康：定期留意自己乳房的正常外觀和觸感。注意是否有任何異常變化，例如新腫塊、皮膚凹陷、乳頭溢液或內陷、或腋下出現不尋常的腫脹。
評估個人風險：使用線上評估工具（如經由本地地區康健中心提供的政府乳癌風險評估工具），或諮詢家庭醫生以了解自己的風險狀況。
養成健康生活習慣：定期進行體能活動、在停經後保持健康的體重，以及限制飲酒，均有助降低罹患乳癌的長期風險。
| Risk Profile | Key Criteria | Recommended Screening |
|---|---|---|
| High Risk | BRCA1/2 mutation, family history of early breast/ovarian cancer, or past chest radiation | Annual Mammogram (plus annual MRI for BRCA carriers or radiation history) |
| Moderate Risk | 1 first-degree relative with breast cancer diagnosed 50 yrs, or 2 diagnosed > 50 yrs | Mammogram every 2 years |
| Average / General Risk | Women aged 40–69 with personalized risk factors | Mammogram every 2 years after doctor consultation |
| 風險類別 | 關鍵條件 | 建議篩查項目 |
|---|---|---|
| 高風險 | BRCA1/2 基因突變、早期乳癌／卵巢癌家族史，或曾接受胸部放射治療 | 每年進行乳房X光造影（BRCA 攜帶者或有放射治療史者另加每年 MRI） |
| 中度風險 | 1 位直系親屬於 50 歲確診，或 2 位親屬於 > 50 歲確診乳癌 | 每 2 年進行一次乳房X光造影 |
| 一般風險 | 具備個人風險因素的 44–69 歲 女性 | 經醫生諮詢後 每 2 年進行一次乳房X光造影 |