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Hong Kong Med J 2007;13:194-8

Hong Kong women show a ‘disturbingly low utilisation of mammography’ for breast cancer screening, according to a study in the June issue of the Hong Kong Medical Journal.

The study, which examined records of 702 women diagnosed with breast cancer over the past 5 years found that only eight percent of tumours were detected by screening mammography. Most tumours, (80 percent), were detected by the women themselves. Overall, the tumours detected by screening mammography were smaller and at a less advanced stage, making it possible to treat most of them (65 percent) without removal of the whole affected breast.

The study also found that older women were less likely to use mammography breast screening services than younger women, even though the older group are at higher risk of breast cancer and more likely to benefit from mammography.

The authors believe public attitudes to breast screening may be adversely affecting breast cancer outcomes. “We caution that breast cancer survival outcomes in Hong Kong could be negatively impacted by long-term continuation of this evidently conservative public attitude towards screening, and encourage ongoing open and critical assessment”.

Hong Kong Med J 2007;13:216-20

A study of people hospitalised after taking over-the-counter slimming products has found that some diet pills contained drug analogues. Drug analogues are substances similar to some drugs but chemically altered to evade detection. Three people who took slimming products containing n-nitrosofenfluramine, an altered version of the banned drug fenfluramine, were hospitalised with liver damage. One woman died, while another had irreversible liver failure and needed a liver transplant to survive.

Other products were found to contain modified versions of sibutramine. Sibutramine is registered as a prescription-only medicine in Hong Kong but not the modified substances. One woman developed acute psychosis and had to be hospitalised for psychiatric care after taking a slimming product containing this.

In their study, published in the June edition of the Hong Kong Medical Journal, the authors say “We believe that some manufacturers adulterate their slimming products with anti-obesity drug analogues, instead of the original molecules in an attempt to evade interception by regulatory authorities.

The imperceptible use of these analogues is very dangerous because they have not been tested formally for efficacy and safety. In view of the potential harm to the public, more effective and proactive measures are required to guard against the illicit use of pharmaceutical analogues. There is also a need for increased awareness among the public and the medical professionals about this emerging threat.”

Hong Kong Med J 2007;13:231-3

Two cases in which the babies of mothers from Mainland China died because the pregnancy had gone beyond full term and the mother had no medical monitoring are described in the June edition of the Hong Kong Medical Journal.

One baby was delivered dead at 42 weeks 6 days’ of pregnancy while the second, born at 44 weeks’ gestation, was moribund at birth and died 18 days later. In both cases no cause beyond postmaturity was found. Neither induction of labour nor foetal monitoring had been performed despite these gestations going beyond 41 weeks because of a current ‘social obstetrics’ phenomenon—non-local expectant mothers coming to Hong Kong from Mainland China for delivery.