Press Releases

FPAHK launches new co-testing with HPV DNA test to more effectively screen for pre-cancerous cervical abnormalities and reduce cervical cancer risk

The Family Planning Association of Hong Kong (FPAHK) launches a brand new service, co-testing: Human Papillomavirus (HPV) DNA test + Computer Imaging Assisted Liquid-based Cervical Cytology, in April this year to provide women aged 30 or above an alternative cervical screening method with higher sensitivity for earlier detection of precancerous lesions relative to the conventional method of cervical cytology alone.                                                                                                               

“As a pioneer in cervical cancer prevention, FPAHK has been dedicating to promoting public education and providing health services on the prevention of cervical cancer for more than 50 years. In view of the latest clinical research evidence and medical expert guidelines, FPAHK this month begins to offer co-testing, which includes an HPV DNA test capable of detecting the carcinogenic high-risk HPV (hr-HPV) types,” said Dr Mona Lam, FPAHK’s Executive Director. Women aged 30 or above may opt for either co-testing at a charge of only HK$750 or cervical cytology (computer imaging assisted liquid-based cytology or LBC) alone at HK$310 *. 

With evidence from randomized controlled trials (RCT) conducted in their populations, many western countries have published national guidelines incorporating HPV testing in their cervical screening programmes. Locally, the Hong Kong College of Obstetricians and Gynaecologists (HKCOG) recommended in its Guidelines for Cervical Cancer Prevention and Screening (p.5-6) published in 2016 to incorporate co-testing in the cervical screening strategy. A study of the University of Hong Kong published in 2020 had findings consistent with overseas RCT results and demonstrated that co-testing led to earlier detection of clinically significant pre-invasive lesions (https://hub.hku.hk/handle/10722/281714). In July 2021, the World Health Organization (WHO) updated the WHO Guideline for Screening and Treatment of Cervical Pre-cancer Lesions for Cervical Cancer Prevention (WHO Press release: New recommendations for screening and treatment to prevent cervical cancer) to shift the global strategy to adopt HPV DNA testing as a first-choice screening method with the screen, triage and treat approach as one of the recommended algorithms. 

The Cancer Expert Working Group on Cancer Prevention and Screening, Centre for Health Protection (CHP) revised its Recommendations on Prevention and Screening for Cervical Cancer in June 2021 to incorporate primary hr-HPV testing or co-testing for average-risk women aged 30-64 who ever had sexual experience, owing to its potential higher sensitivity, earlier and increased detection of precancerous lesions to allow early treatment, potential better reduction in incidence of cervical cancer, longer screening intervals and feasibility of self-sampling, as an alternative to cytology testing. Re-screening of HPV-negative cases is recommended every five years. For women aged 25-29 who ever had sexual experience, cytology every 3 years after 2 consecutive normal annual screenings continues to be recommended. 

“The advantage of co-testing is the dual assurances it provides to women,” said Dr Grace Wong, FPAHK’s Senior Doctor, “due to its higher sensitivity in assessing cervical cancer risk by detecting abnormal cervical cells and hr-HPV infection simultaneously. Clients can space out their screening interval to 5 years if they get dual negative results. Moreover, only one single sample is required for both tests, adopting the same sampling process for cytology.” 

“The HPV DNA test offered by FPAHK is performed by the University Pathology Laboratory, The University of Hong Kong. The test is clinically validated and approved by the United States Food and Drug Administration for cervical cancer screening. It detects 14 hr-HPV types including the highest-risk HPV-16 and HPV-18 genotypes. More than 95% of cervical cancer cases are caused by hr-HPV infection through persistent infection (WHO：HPV and cervical cancer),” Dr Lam said. 

According to HKCOG management protocols, HPV-positive and cytology-negative women would be referred for colposcopy if genotyping indicates HPV-16 or HPV-18 or otherwise advised to have repeated co-testing after a recommended period. For HPV-negative and cytology-positive cases, repeated co-testing after a recommended period or referral for colposcopy depending on the severity of cervical cytology abnormalities would be arranged. Those with dual positive results would be directly referred for colposcopy. 

“Primary screening with HPV testing alone without triage is associated with increased false-positive results and colposcopy rates. With co-testing, clients tested positive for HPV would be triaged by cytology result and immediate decisions regarding colposcopy can be made. It minimizes unnecessary anxiety and pain associated with over-diagnosis and over-treatment in cases of false-positive results as transient HPV infections are particularly common among young women,” Dr Wong said. 

Cervical cancer was the seventh commonest female cancer in Hong Kong in 2020 and it was the eighth leading cause of cancer deaths among women. In 2022, 5.77% of 31,954 Pap tests performed on well women at FPAHK were found to be abnormal. Dr Wong said with age-standardized incidence rate of 7.6 cervical cancer cases per 100,000 women in 2020 (Hong Kong Cancer Registry, Hospital Authority Oct 2022) and only 52.1% reported ever had cervical screening (Report of Population Health Survey 2020/22, Non-Communicable Disease Branch Centre, CHP, Department of Health), Hong Kong was still behind the WHO goal of an incidence rate below 4 per 100,000 women to achieve elimination of cervical cancer, which rests on the corresponding targets by 2030: 90% of girls fully vaccinated with HPV vaccine by age 15, 70% of women screened using a high-performance test by age 35 and again by age 45, and 90% of women identified with cervical diseases be appropriately managed. She reminded women of the importance of regular screening to prevent cervical cancer and being aware of symptoms such as abnormal vaginal bleeding given that screening couldn’t be 100 percent accurate. 

For details on FPAHK’s cervical screening service, please refer to the printed service pamphlet or FPAHK’s website: www.famplan.org.hk. For public enquiries, please call the FPA Clinic Services Hotline at 2572-2222.

* FPAHK adopts a triage system under which clients are classified into different service categories. “Pap Test” and “Pap Test & HPV test (Co-test)” are single service item applicable to the following services with varied arrangements: 

• “Birth Control Service” – a nurse assessment fee is chargeable per visit: $30 (entitled persons) / $60 (non-entitled persons)
• “Women’s Health Service“, “Menopause Service”, “Pre-marital Check-up Service” and “Pre-pregnancy Check-up Service” – “Pap Test” or “Pap Test & HPV test (Co-test)” is included in these service packages, service fees of which are listed on the FPAHK website