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Women and cervical cancer Hong Kong has a population of 6.8 million. Life expectancy for women at birth was estimated to be 84.3 years in 2003. During the period 1988-1992, Hong Kong's ASR for cervical cancer was ~17; this is lower than that of the Thai, Korean, Filipino, and Singaporean-Chinese populations, but higher than in Japan (Figure 3) [59]. History of cervical screening Until 2004, there was no centrally organised, systematic cervical screening programme (CSP) in Hong Kong. Screening was generally opportunistic or included as part of a general checkup. Screening practices varied between different healthcare providers and there was little collaboration between public and private sector healthcare. Approximately 45% of women, primarily those who were educated and health-conscious, were being screened. This somewhat random coverage was not equitable or efficient, and was unlikely to be cost-effective. Despite this, the ASR for cervical cancer declined steadily between 1983 and 2000, the most significant fall being among women 50-65 years of age. About 50% of cases are diagnosed at stage 1. A centralised cervical screening programme for Hong Kong First approved in 2001, the Hong Kong CSP was launched in March 2004. The goal is to reduce the incidence of, and mortality from, cervical cancer by facilitating regular screening for all patients at risk. Stated objectives are to (i) raise public awareness, (ii) improve population coverage, (iii) promote more equitable and efficient screening, (iv) build quality assurance into the services through professional education and clear guidelines, (v) support private sector activity. Following statistical modelling, the target population was set to include all women 25-64 years of age who have had sex. After two clear annual checks, screening will be scheduled every 3 years, and discontinued at 65 years if the previous Pap smears are normal. Using triennial screens, it was estimated that if coverage raised to 80% of the population, there would be ~75% decrease in the number of cases of cervical cancer. It is hoped that the CSP will increase coverage from 43% to 60% within 3 years, and to 80-85% in the long term. During the period March 2004-June 2005, almost 150 000 women were enrolled in the CSP. Based on age quintiles, enrolment has been highest among women 40-44 years of age. There are large variations between districts. The communication network The CSP incorporates a centralised information system with a website (available at http://www.csis.gov.hk) accommodating the input of data online. The central registry will include screening results, follow-up investigations, and demographic data, and will generate reminder letters to women due for screening. Practitioners will be emailed details of patients recalled, and alerted to abnormal smears. The system will also provide data for ongoing evaluation and monitoring. Public education regarding cervical cancer has not been a priority in Hong Kong; therefore, communication and promotion are priorities. Attention was drawn to the disease when Anita Mui, a popular singer and movie star, died from cervical cancer in December 2003. She was 40 years of age. Her death coincided with the launch of the CSP and may have aided receptivity. Quality assurance All registered doctors and trained nurses may collect cervical smears. Accreditation for participation is coordinated by the Society for Colposcopy and Cervical Pathology. Health professionals whose smears do not meet CSP minimum standards will be invited to attend refresher training. Healthcare professionals who supply smears to the CSP are provided with a training kit, which covers technical skills and communication approaches. A survey of women will be undertaken to gauge levels of satisfaction with the CSP and the Pap smear.… [ABSTRACT FROM AUTHOR]