Cervical cancer screening: public health implications for Hong Kong

Abstract

This thesis examines issues related to cervical cancer epidemiology and prevention through screening, with the aim of informing policy regarding setting up an organised cervical screening programme in Hong Kong.
There are five studies described here. The first, a case control study, indicated that screening is effective in preventing invasive cervical cancer among Chinese women. In addition, the main risk factors identified in other studies, were confirmed as risk factors in this population.
Secondly, a cross-sectional study examined the pattern of cervical screening in Hong Kong. The screening system at that time achieved poor coverage, was inefficient, inequitable and potentially harmful.
Thirdly, a cross-sectional study of practitioners showed the diversity in provision of services and the lack of consensus among practitioners in the management of abnormal smears.
Fourthly, the use of an industrial quality management technique in monitoring quality, using inadequate smear rates as an indicator is assessed. It demonstrated that this is an efficient and useful method that can be applied to monitoring a screening programme.
The last study was a randomised controlled trial showing that when women are given balanced information on cervical screening, with information on both the harms and benefits, relatively fewer chose to attend.
The implications of these studies in relation to setting up a screening programme are discussed.