Aim:  To evaluate the outcome of a cervical cancer screening program in a population of elderly women (age ≥65 years) in Hong Kong. Methods:  A retrospective audit was undertaken on the results of the cervical smear examinations performed on 9950 clients attending the Elderly Health Centers. A wooden Ayre's spatula was used to perform the Papanicolaou (Pap) smear in all the subjects. In patients with specific indications a cytobrush was also used. The outcome was measured in terms of the number of unsatisfactory smears, and the possible causes were analyzed. Results:  The unsatisfactory rate of the Pap smear examination was 7.8%, and this was inversely related to less than 3 months obstetrics and gynecology training of the family doctor in each center, but was not related to the years of clinical experience of the practitioner. Conclusions:  The quality of the Pap smear could be improved by providing more hands‐on training for the doctors, preferably in obstetrics and gynecology, and possibly by using a better instrument for sample taking (e.g. combination spatula and brush).