Cervical Screening Programme, England - 2019-20 [NS]

The statistics presented in this publication are derived from information that is routinely collected by PHE for the operation of the cervical screening programme.

Information is collected on the following NHS Digital Korner Collection (KC) returns:

• KC53
  Information from the call and recall system, collected for all 151 Upper Tier Local Authorities (LAs).
• KC61
  Information on screening samples examined by pathology laboratories, collected from all 48 laboratories carrying out cervical screening in 2019-20. 45 laboratories reported activity for 2019-20.  The number of labs reduced to 8 by the end of 2019-20.
• KC65
  Information on referrals to colposcopy, subsequent treatment and outcomes, collected from all 194 clinics providing colposcopy services in 2019-20.

The full KC forms are available via the main publication page.

Women between the ages of 25 and 64 are invited for regular cervical screening under the NHS Cervical Screening Programme (the programme).

The cervical screening programme is intended to detect abnormalities within the cervix that could, if undetected and untreated, develop into cervical cancer.

A first invitation for screening is sent to a woman when she is 24.5 years old.

Subsequent invites are sent every three or five years depending on a woman’s age³.

Women aged 65 or over can still be invited for screening if a recent or previous cervical cytology sample is abnormal. Additionally, women may also be screened if they have not had a cervical screening test since 50 years of age and they request one.

Call
A call invite is an invitation sent to previously unscreened women.

Recall
A recall invite is an invitation for subsequent screens.

A more detailed overview of the programme can be found here.

HPV primary testing as routine began implementation as a pilot in 2013 and full rollout was achieved in December 2019.

HPV is a common virus which, although harmless in most women, is linked to the development of abnormal cervical cells. If left untreated, these abnormal cells can develop into cervical cancer.

In areas using HPV primary testing, screening samples are sent to pathology laboratories for HPV testing first.

Where the HPV virus is detected (a HPV positive result), a cytology screen is then performed.

The results of each test are sent to the call/recall department to send to the woman.  Results are also sent to the woman’s GP or the sample taker (if not the GP). Women should be notified of their test results in writing within 2 weeks of the sample being taken.

Most women receive a normal result and are recalled for another routine test in 3 or 5 years dependent on their age.

Actions following HPV primary testing results are detailed below.

In a small proportion of cases the pathology laboratory is unable to get a valid HPV result or assess the cells on the cytology slide. In such cases, the test is considered an unavailable HPV result or an inadequate cytology result and women are asked to return for a repeat test 3 months later.

HPV testing as triage (sorting) for women with borderline and low-grade dyskaryosis results was rolled out from March 2012.

In areas using HPV testing as triage, screening samples are sent to pathology laboratories for slide preparation and screening by a cytologist/screener.

Where a test result shows borderline change or low-grade dyskaryosis (abnormal cell changes), the sample is then tested for infection with high-risk HPV (Human Papillomavirus)⁴. 

The results of each test are returned to the call/recall department and the woman’s GP or the sample taker (if not the GP). Women should be notified of their test results in writing within 2 weeks.

Most women receive a normal result and are recalled for another routine test in 3 or 5 years dependent on their age.

Actions following HPV testing as triage results are detailed below.

Negative cytology

Woman is returned to routine recall screening without an HPV test.

Borderline change or low-grade dyskaryosis (abnormal cell changes)

An HPV test is carried out.

If the result is HPV negative the woman is returned to routine recall screening.

If the result is HPV positive the woman is referred to colposcopy.

High-grade dyskaryosis (or worse)

Woman is referred to colposcopy immediately without an HPV test being carried out.

In a small proportion of cases the pathology laboratory is unable to assess the cells on the cytology slide to give a result and the test is considered inadequate. In such cases women are asked to return for a repeat test 3 months later.

Women referred for colposcopy⁵ attend a colposcopy clinic where a colposcope (a lighted, low-powered microscope) is used to closely examine the cervix to determine appropriate treatment, if any.

A woman may be referred for a colposcopy following her cervical screening if:

• some of the cells in her screening sample are abnormal
• the nurse or doctor who carried out the screening test thought her cervix didn't look as healthy as it should
• it wasn't possible to give her a clear result after several screening tests
• she has had persistent HPV-positive tests (under HPV primary screening)

A biopsy may be taken from the cervix for diagnosis and/or the cervix may be treated.

Women who do not require immediate treatment may be kept under surveillance by repeat cytology tests, with or without repeat colposcopy, at suitable intervals.

1. PHOF outcome figures may show small variances year-on-year as updates are made to historic figures after the data are published.
2. See http://www.phoutcomes.info/ and https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency for more information.
3. https://cks.nice.org.uk/cervical-screening#!scenario
4. Where HPV primary screening is being piloted, women are first tested for HPV. If the sample is found to be positive, it is then examined by the cytologist for any abnormal cells.
5. https://www.nhs.uk/conditions/colposcopy/