NHS CERVICAL SCREENING PROGRAMME AND REFERRAL PATTERNS FOR COLPOSCOPY

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NHS CERVICAL SCREENING PROGRAMME AND REFERRAL
PATTERNS FOR COLPOSCOPY

• Dr Sue Calvert

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History of the screening programme

• Introduced in 1964 but not in a structured way
• Call-recall instituted 1988
• Recommended screening women aged 20-64 every 3-5
  years
• Financial incentives to GPs introduced 1990

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Results

• Gradual increase in number of women screened
• 40 1989
• 85 now (83 of women 25-64 years screened once
  in last 5 years)
• 2000-01 (England)
• 4.1 million smears,
• 3.6 million as a result of the screening
  programme

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Results

• 2000-01 (England)
• 9.6 inadequate
• Of adequate smears
• 92.9 negative
• 5.7 borderline / mild
• 0.7 moderate
• 0.7 severe or worse

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Results

• Referrals to colposcopy (2000-01)
• inadequate 10
• borderline 18
• mild 21
• moderate 18
• severe 13
• severe ?invasive lt1
• ?glandular 2
• other 17

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Results

• Referrals to colposcopy April to June 1998
• Following persistent borderline / mild
• 0.2 cancer
• 22 CIN II/III
• Following moderate / severe or worse
• 2.7 cancer
• 72 CIN II/III

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Effect of screening on cervical cancer

• Incidence of cervical cancer was 35 lower in
  1995 than 1990
• Since 1988 accelerated decrease in mortality from
  1 to 7 / year
• Screening has saved 8000 lives in England and
  Wales between 1988 and 1997
• Susieni P., Adams J. BMJ 19993181244-45

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National recommendations for colposcopy

• x3 borderline smears
• x2 mild smears
• Any smear showing
• Moderate
• Severe
• ?Invasive
• Glandular abnormality

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Local variants

• Leeds/Bradford and others
• x2 borderline
• Any smear mild or worse
• Surveys in Bradford (unpublished)
• 11/43 (25) women referred with 2 borderline
  smears had high grade CIN