IN response to the report by Elisabeth Tacey ('Cervical cancer on the increase',South China Morning Post, November 14), there is no doubt that cervical screening cytology has been one of the major successes in medicine, resulting in a marked reduction in incidence and mortality from invasive carcinoma of the cervix in many countries. There is also no question that Hong Kong requires a broader-based population-wide screening programme, and the Hong Kong College of Pathologists strongly supports this issue. However, the type of programme employed must be carefully considered and the use of computerised screening tests does not necessarily provide the full answer. Human input is crucial to ensure that cases which are abnormal are not missed and that 'normal' cases are not falsely labelled as having cancer. Though few details of the study are given, the article cites only 1,415 cases and it should be noted that, for a low frequency abnormality, recognised standards require a much greater number of individuals to be studied to reach a significant conclusion. Unfortunately, the headline to the article does a grave disservice to the overall benefits of cervical screening cytology. Women should be aware that there is a relationship between sexual activities and genital cancer, but to strongly indicate that changing morals are at fault is counter-productive. The result of such emphatic close linking of the two will result in even fewer women deciding to have a Pap smear for fear that even if a minor treatable condition is found, they will be labelled as promiscuous or immoral. Cervical screening has become so successful and highly regarded that the public expects a foolproof system with 100-per-cent reliability. Sadly, no screening programme, using solely human or computer-assisted screening, is 100-per-cent foolproof. The Papnet system mentioned in the article is accepted in the United States only as an adjunct for re-checking of Pap smears already examined by an experienced cytotechnologist working under the supervision of a cytopathologist - the US Government's Food and Drug Administration (FDA) has not approved this system for the initial assessment of smears which is how Papnet is now used in Hong Kong by Papnet (Far East). The various automated systems now available for performing cytology screening need greater evaluation. Until this is available, the public should not be misled by premature conclusions. DR ROBERT JOHN COLLINS Chairman, Professional and General Affairs Committee, Hong Kong College of Pathologists
