Your check-up report says "abnormal" — what next? Two centres, two answers for one person; what the official position is, and how a public referral works

Updated: 2026-08-31

The first thing to sort out on receiving a report marked "abnormal" is that "outside the reference range" and "having a disease" are two different things. A worked calculation in a clinical pharmacology journal shows that if a reference range covers 95% of results in a normal population, then across 20 tests only 36% of normal people will have all 20 within range — though the author states plainly that this rests on two assumptions they themselves say do not hold (Aust Prescr 2009;32:43-6). And the "range" is not a common ruler: a survey of ten Hong Kong laboratories found upper reference-interval limits for aspartate aminotransferase (AST) differing by up to 47% (Hong Kong Med J 2019;25(4):295-304). The Consumer Council recorded three cases in February 2025, one of them a woman who had breast ultrasound at two centres: one report gave 8 nodules with the largest at 5.7 cm, the other 3 nodules with the largest at 3.4 cm. On "adding a tumour marker test": ⚠️ first distinguish screening (looking for early disease at population level, before any symptom or abnormal finding) from diagnostic evaluation (working out what an abnormal finding is, after one has appeared) — WHO states that when screening identifies abnormalities, "further tests to establish a definitive diagnosis should follow". The official recommendations quoted below answer the first question. The Centre for Health Protection's Cancer Expert Working Group summary says this about routine screening of average-risk asymptomatic people: not recommended for liver cancer (including ultrasound or AFP testing, updated 2025), lung, thyroid, ovarian, pancreatic (including CA19.9) and stomach cancer; nasopharyngeal and prostate cancer are put differently — "insufficient evidence", which is not the same as "not recommended". To follow up in the public system: you need a referral letter issued by a locally registered doctor within the past three months, your Hong Kong identity card and your address. This article covers how to read a report and how the process works. It does not judge what your number means, and offers no medical advice — how your report is read is for a doctor to decide.

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#How many kinds of "abnormal" are there? Distinguish these three first

One asterisk on a report can mean three quite different things.

• One: outside the reference range. That is a statistical position, not a diagnosis.
• Two: outside this laboratory's reference range. As below, ranges can differ considerably between laboratories.
• Three: clinically significant. That step is for a doctor who has examined you and knows your history.

Between step one and step three stands a doctor. This article does not take that step for you at any point.

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#Why does testing more items make at least one out-of-range result more likely?

Because a "reference range", by definition, leaves out a proportion of healthy people.

A 2009 Australian Prescriber article on pitfalls in interpreting laboratory results makes the point with a simple calculation. From the English original:

"A multiple biochemical analysis can be performed by one machine and produce 20 results. Assuming these results were all independent of each other (which they are not) and that results from the reference population are normally distributed (which they may not be), only 36% of normal people will have all 20 results in the reference range. There will be 64% with at least one abnormal result"

(In plain terms: one machine runs 20 biochemical tests; on assumptions the author himself rejects, only 36% of normal people stay in range throughout, and 64% show at least one "abnormal" result.)

⚠️ The two parenthetical caveats are the author's own and cannot be set aside. The 36% is not a measured proportion but a worked illustration, making one point: the more items you test, the greater the chance that at least one falls outside range.

The same article prints its Box 1:

"If the reference range covers 95% of results for a normal population, the chance of a healthy individual having a certain number of normal tests is: Two out of two tests 90% (0.95 x 0.95 = 0.90) All 20 of 20 tests 36% (0.95^20)"

It also has a very practical reminder: "When deciding if a result is abnormal, look at related tests." Its example: alkaline phosphatase is one of the "liver function tests", the others being bilirubin, gamma glutamyl transferase, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase; abnormality in the others is what makes a liver problem more likely.

Who most needs to know this: anyone who has had a package with many items and then seen several asterisks — the number of asterisks is not itself a measure of how bad the news is.

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#Who sets the "normal range"? The same test, different laboratories

It is adopted and validated by the laboratory that issued the report — which may have established it itself, adopted a manufacturer's or the literature's interval and validated it, or transferred an existing one.

From the abstract of a 2019 local survey (Hong Kong Med J 2019;25(4):295-304), in the English original:

"the upper RI value of up to 47% for aspartate aminotransferase (absolute difference of 16 U/L)" "inter-laboratory percentage differences of upper RI limits were up to 47%"

(In plain terms: between laboratories the upper reference-interval limits differ by up to 47%; for AST the absolute difference is 16 U/L.)

⚠️ To read that figure accurately: "up to 47%" is the maximum across analytes, and it concerns the upper limit of the reference interval — the ruler printed on the right of the report, not the number the machine measured.

The practical consequence is direct: the same blood sample may be printed as "normal" at laboratory A and carry an asterisk at laboratory B. So — read the range printed on your own report, and do not measure it against the range on another report or one found online.

This site has a separate article on exactly that: “How should laboratory and imaging reports be read? The 'normal range' is a property of the laboratory, not of your body”.

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#One person, two centres, two answers

The Consumer Council recorded three cases in CHOICE issue 580, February 2025. All of the following is the Council's account.

#Case one: both the timing of the test and the reference value questioned

A woman bought an AMH test packaged with a CA125 ovarian cancer marker blood test, at $980. She had asked the centre beforehand whether the test needed to avoid her period, and staff said it did not. She had blood taken during her period; two weeks later she was told her AMH was about a third of the normal level for her age group and that her CA125 marker was far above normal, and she was advised to add more detailed tests.

⚠️ The correction that followed came from her own family doctor, not from the Council's judgement. The Council's account: "she later consulted her family doctor, who told her that CA125 testing should not be done during menstruation, as the value may be raised; and that the AMH reference value cited by Centre A was in fact far above the correct reference value for her age group, so her AMH was at a normal level." In its reply to the Council the centre "gave no explanation or response on staff having said the test need not avoid menstruation, or on the reference value", but agreed to refund.

#Case two: 8 nodules against 3; 5.7 cm against 3.4 cm

A woman bought a gynaecological check under a buy-one-get-one offer, including upper abdominal and breast ultrasound and a set of women's cancer markers, for a combined $7,800. ⚠️ Note: $7,800 is the price of the whole package, not of one breast ultrasound.

The first report: 8 breast nodules, one of them 5.7 cm across, with staff recommending further tests. She had a second scan at another centre: only 3 similar nodules, the largest 3.4 cm across.

⚠️ The centre's explanation must be read alongside: in reply to the Council, Centre B "denied that the report was wrong or that there was any deception", saying that "the difference in the reported values might be due to factors such as her being at a different point in her cycle, for example before or after menstruation, or the direction of pressure of the ultrasound probe". The matter was settled with a refund through mediation.

This article does not judge which report was right. The case makes a more basic point: ultrasound is operator-performed and read in real time, and two results can differ — so one report is not by itself a conclusion.

#Case three: a liver cyst found, a tumour marker added on the spot

A man joined a basic body check plan that included one ultrasound examination at $500, and chose the liver. Staff told him he had two liver cysts, one 2.6 cm across, and recommended a cancer marker test; when he hesitated, staff "said the result would be the same wherever he was tested" and offered a half-price rate for those over 60, at $800. The Council writes: "in a state of great worry and fear, he paid $800 on the spot for a liver cancer test."

⚠️ Again, the explanation about liver cysts came from his own doctor: the Council's account is "he subsequently sought a doctor's opinion, who said that liver cysts generally need only periodic monitoring and very rarely become cancerous." This article does not treat that as a clinical guideline; your situation is for your own doctor to judge.

Who most needs to know this: anyone advised at a check-up centre to "add a test" on the spot — the section below sets out the official position on routine screening of average-risk asymptomatic people. ⚠️ But one distinction has to come first; see the opening of the next section.

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#What is the official position on "adding a tumour marker test"?

⚠️ Before the table below, separate two things: screening and diagnostic evaluation.

• Screening looks for early disease at population level before any symptom or abnormal finding. The US National Cancer Institute states: "Screening tests are not meant to diagnose cancer... Screening tests usually do not diagnose cancer. If a screening test result is abnormal, more tests may be done to check for cancer."
• Diagnostic evaluation happens after an abnormal finding, to establish what that finding is. The World Health Organization states: "When abnormalities are identified during screening, further tests to establish a definitive diagnosis should follow."

⚠️ So the question the table below answers is "should routine screening be offered to average-risk asymptomatic people", not "what should I do now that my report has an abnormal finding". An asymptomatic, average-risk person who has an abnormal finding is already on the diagnostic path — and how that path runs is for a doctor to decide on your particular finding, not for this screening-recommendation table.

The Centre for Health Protection's Cancer Expert Working Group on Cancer Prevention and Screening publishes a summary setting out, cancer by cancer, its recommendation for "average-risk asymptomatic people". The wording differs between them — and that matters.

⚠️ "Not recommended" and "insufficient evidence" are not the same sentence. The first is a position; the second is "not enough evidence to reach a judgement". Nasopharyngeal and prostate cancer fall in the second group — and on prostate cancer the summary adds: "an asymptomatic man considering prostate cancer screening should discuss its potential benefits and harms with a clinician so as to make an informed choice; digital rectal examination should not be used as the sole screening method."

Equally important: all of the above concerns "average risk" only. The summary says something different for high-risk individuals — on liver cancer, for example: "people with chronic hepatitis B or C, or cirrhosis from any cause, are at higher risk of hepatocellular carcinoma; such high-risk individuals should seek a doctor's advice about ultrasound and AFP testing every 6 months."

The summary's own closing line: "important note: discuss the benefits and risks with your healthcare provider before undergoing cancer screening."

Who most needs to know this: anyone with a small abnormality on a report who is being advised to add a tumour marker on the spot — the official position for average-risk people is above, but whether you are "average risk" is for a doctor to assess.

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#How do you actually get a second opinion, or follow up in the public system?

A new specialist outpatient case needs a referral letter, and the letter has a time limit.

From the Hospital Authority's “Specialist Outpatient Service” page:

"a person who is unwell should first see a family medicine clinic or a private/family doctor; if further follow-up, consultation, treatment or investigation at a Hospital Authority specialist outpatient clinic is needed, the clinic's healthcare staff will make the referral. The patient must bring the following to a specialist outpatient clinic to make a new-case appointment: Hong Kong identity card (or valid identity document); a doctor's referral letter issued by a locally registered doctor within the past three months; address information."

⚠️ Three months is the life of the referral letter, not the waiting time. A letter issued more than three months ago must be obtained again.

What use is your check-up report? The same page states: "patients should bring identification to their appointment, and any test reports and X-ray films." So reports and images obtained privately are for you to bring.

What happens next? From the Hospital Authority's “Triage System in Specialist Outpatient Clinics” page:

"new referral cases are first screened by a nurse, then reviewed by a specialist doctor who examines the referral letter and test reports and, according to the clinical condition, assigns the patient to one of three triage categories: urgent (priority 1); semi-urgent (priority 2); and stable (routine). For patients classified urgent and semi-urgent, staff will endeavour to arrange consultation within two weeks and eight weeks respectively."

⚠️ "Will endeavour to arrange" is the source's own wording, not a promise. And "stable (routine)" has no corresponding target time.

What if the condition worsens while waiting? From the same page: "if a patient's condition deteriorates while waiting, they may contact the specialist outpatient clinic concerned to ask for an earlier appointment; if the condition is urgent, they may also attend an Accident and Emergency Department." The service page also states that a patient who develops an emergency while waiting should attend the nearest A&E immediately.

Can you book by phone app? Yes, but not for every specialty. The Hospital Authority's service page states that since December 2019, new-case appointment requests may be submitted through "Book Appointment (New Specialist Outpatient Appointment)" in HA Go for the following specialties: anaesthesiology (pain clinic), cardiothoracic surgery, clinical oncology, ENT, ophthalmology, gynaecology, medicine, neurosurgery, obstetrics, orthopaedics and traumatology, paediatrics, and surgery (12 specialties counted on that page on 31 August 2026). ⚠️ The same passage states that whichever method is used, a new-case appointment requires the identity card, the referral letter issued within three months, and address information.

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#Ask about these

Before taking the report to a doctor, or before agreeing to add a test at a check-up centre:

1. Is this "abnormal" outside the reference range, or clinically significant? They are different things.
2. Which laboratory set this range? Upper reference-interval limits can differ considerably between laboratories (up to 47%, for AST).
3. Was the timing of this test right? In the Council's first case, performing CA125 during menstruation was the point in dispute.
4. Am I "average risk"? All of the Expert Working Group's "not recommended" statements concern average-risk asymptomatic people only.
5. Will adding this test change what happens next? If it will not, ask why it is being added.
6. If I want a second opinion, what do I bring? The Hospital Authority writes "any test reports and X-ray films"; for the public system you also need a referral letter issued by a locally registered doctor within three months, and your address information.

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#Frequently asked questions

• Several items on my report are out of range — does that mean something is wrong? Not necessarily. A worked illustration in a clinical pharmacology journal shows that if a reference range covers 95% of results in a normal population, only 36% of normal people will have all 20 of 20 tests within range (Aust Prescr 2009;32:43-6); the author states that the calculation assumes the results are independent of one another ("which they are not") and normally distributed ("which they may not be"). What it means in practice is for a doctor to judge on your situation.
• Why do two laboratories have different "normal ranges"? Because the reference interval is adopted and validated by the laboratory that issued the report — it may be established by that laboratory, adopted from a manufacturer or the literature and validated, or transferred from an existing interval. A local survey found inter-laboratory percentage differences in upper reference-interval limits of up to 47% (for AST, an absolute difference of 16 U/L; Hong Kong Med J 2019;25(4):295-304).
• Two centres did a breast ultrasound and the results differed greatly — which is right? This article makes no judgement. In the case the Consumer Council recorded in February 2025, one report gave 8 nodules (largest 5.7 cm) and the other 3 (largest 3.4 cm); the centre complained against denied any error and said the difference might relate to factors such as the point in the cycle or the direction of pressure of the ultrasound probe.
• A liver cyst was found — should a tumour marker be done straight away? The Centre for Health Protection's Cancer Expert Working Group summary (liver cancer, updated 2025) states that average-risk asymptomatic people are "not recommended to undergo routine liver cancer screening (including ultrasound or AFP testing)"; people with chronic hepatitis B or C or cirrhosis are at high risk, and for them the summary recommends seeking a doctor's advice on ultrasound and AFP testing every 6 months. Which group you belong to is for a doctor to assess.
• Can tumour markers be used for screening? On pancreatic cancer, the summary (updated 2022) states plainly that screening is "not recommended for average-risk asymptomatic people (including testing with the serum biomarker CA19.9)". Other cancers are worded differently; see the table above.
• Are prostate and nasopharyngeal cancer both "not recommended" for screening? Not in the same words. On nasopharyngeal cancer (2025) the summary says there is currently insufficient evidence to recommend EBV antibody serology or EBV DNA testing for population screening; on prostate cancer (2026) it says there is insufficient scientific evidence for or against population screening of asymptomatic men, and recommends that anyone considering screening discuss the benefits and harms with a clinician and make an informed choice.
• Something was found privately and I want to move to the public system — what do I bring? Hong Kong identity card (or valid identity document), a doctor's referral letter issued by a locally registered doctor within the past three months, and address information; bring any test reports and X-ray films to the appointment as well.
• What if the condition worsens while waiting? The Hospital Authority's triage page states that you may contact the specialist outpatient clinic concerned to ask for an earlier appointment; if the condition is urgent you may also attend an Accident and Emergency Department.

Also in this series:

• Why the ruler on the right of the report differs: “How should laboratory and imaging reports be read? The 'normal range' is a property of the laboratory, not of your body”
• Which items have official intervals: “How often should you have a body check? Which items have an official interval, and why packages do not 2026”
• The official risk tool for breast screening: “What score means you need a mammogram? A full breakdown of the government risk tool's five bands, three risk groups and the charges on four routes 2026”

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#What this article does not claim

• It does not use the Expert Working Group's screening recommendations to answer whether a test should be done after an abnormal finding. That summary deals with routine screening of average-risk asymptomatic people; diagnostic follow-up after an abnormal finding is for a doctor to decide on the individual case.
• It does not claim that a second opinion requires the original report. The Hospital Authority's wording is "any test reports and X-ray films, please bring them along".
• It judges no report right or wrong, and takes no side in any case. For the cases the Consumer Council recorded, the replies of the parties complained against are quoted alongside.
• It cites no charge figures from CHOICE issue 559. That issue's fee table did not display when opened on 30 August 2026; only the scope of the survey that did display is cited (12 private hospitals or their affiliated medical centres, 14 private healthcare institutions, 33 basic body check plans in total, collected February to March 2023). Price ranges and item counts circulating informally are not used.
• It does not cite the Consumer Council's 2016 statement on tumour markers. That page would not open on 30 August 2026. For the official position on tumour markers, the article uses instead the Centre for Health Protection Expert Working Group's current summary, which is newer and first-hand.
• It cites no complaint counts. The "171 cases" and "58 cases in 2024" reported informally have no first-hand source and are not used.
• It cites no proportion of new cases triaged as stable. The Hospital Authority's triage page prints only the three categories and two target times, with no proportion.
• It does not say whether other specialties on the list can be booked by app. The Hospital Authority's service page lists only the specialties for which new-case requests may be submitted through Book Appointment; it makes no statement about the rest, and this article draws no inference.
• It cites no charge or time limit for obtaining medical reports or copies of images. The two relevant Hospital Authority pages displayed "this page does not exist" on 30 August 2026. Only the Hospital Authority's instruction to bring reports and X-ray films to the appointment is cited.
• It offers no medical advice, diagnosis or treatment recommendation. Every clinical threshold is quoted, with its source, update year and the population it applies to (average risk / higher risk). How your report is read, whether to follow up, and what follow-up to have, are for a doctor to decide.
• Aust Prescr 2009 and Hong Kong Med J 2019 are both English-language sources. This English version quotes them from their English originals.

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Provenance: compiled from statutory body case records, official screening recommendations and public referral procedures; every figure is marked with its source, the population it applies to, and the date or update year the document itself prints.

Quotations from Chinese-language official documents and press materials appear in our own English translation; the original wording governs.

#資料來源 (Sources)

• Consumer Council, CHOICE issue 580, “Unprofessional body check services: a false alarm and a financial loss”, February 2025: https://www.consumer.org.hk/tc/article/580-body-check-complaints (retrieved 2026-08-30)
• Consumer Council, CHOICE issue 559, basic body check plans, May 2023: https://www.consumer.org.hk/tc/article/559-body-check-plans (retrieved 2026-08-30)
• Phillips P. Pitfalls in interpreting laboratory results. Aust Prescr 2009;32:43-6: https://australianprescriber.tg.org.au/articles/pitfalls-in-interpreting-laboratory-results.html (retrieved 2026-08-30)
• Chan TCH, Mak CM, Chen SPL, et al. Survey on common reference intervals for general chemistry analytes in Hong Kong. Hong Kong Med J 2019;25(4):295-304: https://www.hkmj.org/abstracts/v25n4/295.htm (retrieved 2026-08-30)
• Department of Health, Centre for Health Protection, Summary of Cancer Expert Working Group's recommendations on cancer screening (last page prints "Department of Health, Centre for Health Protection, 2026"; update years for each cancer are shown in the document): https://www.chp.gov.hk/files/pdf/12_summary_tables_on_extracted_cewg_recommendations_all_11_cancer_sites_chi.pdf; Expert Working Group page: https://www.cancer.gov.hk/tc/about_us/cancer_expert_working_group_on_cancer_prevention_and_screening.html (retrieved 2026-08-30)
• Hospital Authority, “Specialist Outpatient Service” page (page carries no date of its own): https://www.ha.org.hk/visitor/ha_serviceguide_details.asp?Content_ID=10053&IndexPage=200067&Lang=CHIB5&Ver=HTML (retrieved 2026-08-30)
• Hospital Authority, “Triage System in Specialist Outpatient Clinics” (page carries no date of its own): https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=214169&Lang=CHIB5&Dimension=100&Ver=HTML (retrieved 2026-08-30)
• National Cancer Institute (US), Cancer Screening Overview (PDQ®)–Patient Version (page prints Updated: October 20, 2023): https://www.cancer.gov/about-cancer/screening/patient-screening-overview-pdq (retrieved 2026-08-31)
• World Health Organization, Cancer fact sheet (page carries no date of its own): https://www.who.int/news-room/fact-sheets/detail/cancer (retrieved 2026-08-31)

Compiled by the editorial team from official recommendations, statutory body case records and academic literature; all clinical content is attributed to its source. This is health information, not medical advice.