While prophylactic vaccination is likely to provide important future health gains, cervical cancer screening will need to be continued for the whole generation of women that is already infected with the HPV types included in vaccines. Potential reductions in cervical cancer screening due to misconceptions about HPV vaccine protection or any relaxation of cervical cancer screening could result in an increase in cervical cancer rather than the anticipated reductions. Many alterations in cervical cancer screening are anticipated and needed in the near term and over the long-term, population-based U.S. surveillance is critical to assessing the safety and effectiveness of these changes as well as to address continuing failures In the cervical screening, diagnosis and treatment process. Sustained population-based surveillance enables the assessment of system and practice failures and successes prior to and coincident with a variety of anticipated overlapping changes in cervical cancer prevention programs (e.g. vaccination, lengthened screening Intervals and new HPV tests and applications). In anticipation of the critical need for population-based, woman-based surveillance of U.S. cervical cancer screening, the New Mexico Notifiable Diseases and Conditions (NMAC 7.4.3.12) incorporated mandatory state-wide reporting of all cervical screening (Pap and HPV) and all diagnostic and treatment procedures (cervical, vulvar and vaginal pathology), whether positive or negative or abnormal or normal, respectively. Our innovative surveillance transcends organizations and systems of care enabling the NM-HOPES-PRC Research Project 2 to conduct a comprehensive population-based elaboration of cervical cancer screening processes and its deficiencies (failures) with the goal of enabling future interventions that improve cervical cancer prevention. Data from our cervical cancer screening surveillance unit, the New Mexico HPV Pap Registry (NMHPVPR) will also be linked to the New Mexico Tumor Registry (NMTR) to describe screening, diagnosis and treatment histories of women diagnosed with incident invasive cerviical cancer. The NMTR is a founding member of the U.S. National Cancer Institute's Sun/eillance, Epidemiology, and End Results (SEER) Program. Through partnerships with the University of New Mexico (UNM) Geospatial and Population Studies (GPS) program and the University of Southern California's (USC) GIS Research Lab, we will identify and evaluate the impact of geographic barriers on failures in screening and prevention practices and invasive cervical cancer outcomes. New Mexico offers a rich opportunity in which this surveillance is conducted among diverse multi-cultural populations suffering a variety of health disparities including those attributable to high levels of poverty and rural living.