OBJECTIVES. To review and summarise current controversies in cervical screening in Hong Kong and discuss the potential impact of prophylactic human papillomavirus vaccination.

DATA SOURCES. Literature search of Medline to December 2006, the Hong Kong Cancer Registry, and Centre of Disease Control. Study selection Key words search terms were: 'human papillomavirus' 'vaccine' 'cervical cancer' 'screening programme' and 'Hong Kong'

DATA EXTRACTION. Original articles, review papers, books, and the worldwide web.

DATA SYNTHESIS. Cervical cancer is one of the most common cancers in Hong Kong, and can be prevented if detected at its pre-cancerous stage. Despite the huge disease burden this imposes on our society and robust advocacy by the academic sector, an appropriate screening programme is still not in place. Existence of a vaccine that could potentially reduce the costs of universal screening should prompt our government to re-consider subsidising such a programme. While a combined screening-vaccination programme may be more cost-effective than screening alone, the vaccine is still costly, and the government must consider all the pros and cons.

CONCLUSION. The new human papillomavirus vaccine, combined with an organised screening programme, is probably a more cost-effective way of preventing morbidity and mortality due to cervical cancer than the current programme in Hong Kong. More research and cost-effectiveness analyses are needed to decide on the ideal ages for primary vaccination and the requirement for booster shots.

Key words: Cervical intraepithelial neoplasia; Mass screening; Papillomavirus vaccines; Uterine cervical neoplasms; Vaccination

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