Executive summary
Published 24 October 2019
© Crown copyright 2019
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This publication is available at https://www.gov.uk/government/publications/cervical-screening-invasive-cervical-cancer-audit-2013-to-2016/executive-summary
The NHS Cervical Screening Programme in England provides high-quality cervical screening to a target population of about 14 million people (women and people with a cervix). The cervical screening programme is highly effective in preventing cervical cancer and still more effective in preventing death from the disease. This report focuses on 6,028 cases of cervical cancer diagnosed between April 2013 and March 2016.
Human papillomavirus (HPV) triage
For the first time we evaluate the impact of introducing human papillomavirus (HPV) triage of borderline or low-grade cytology into the screening programme. We find it has led to a timelier diagnosis by improving the time between the abnormal test and diagnosis. It has increased the proportion of people being diagnosed with early stage cervical cancer (stage IA) which has a much better prognosis and requires less aggressive treatment than for late stage cancer. It has also halved the proportion of people without cancer who are asked to return early for repeat testing following a low-grade abnormality from 22% to 10%. This has the benefit of reducing the anxiety people experience with early repeat testing.
Screening history
We also assessed screening histories of people diagnosed with cervical cancer and compared them to those of people without cancer. Among people diagnosed with cancer, the proportion who are up-to-date with screening has decreased over time, and a larger proportion have no screening history. The increase in people with no screening history is only observed among those diagnosed with early stage cancers (stage IA and IB) and is most noticeable in people under the age of 35.
Age at diagnosis
Fifteen percent (15.4%) of all cervical cancers are diagnosed in people aged 65 or over. There has been an increase in the proportion of cancers diagnosed as stage II or worse in this age group from 64% between 2007 and 2008 to 73% between 2014 and 2015. This is because less people with cancer diagnosed when they were aged 65 to 79 (65%) had a screening test between the ages of 50 to 64, when compared with people of the same age without cancer (91%).
These audit results show that the high priority being given to encouraging individuals to attend cervical screening routinely is evidence-based as it reduces the chance of developing cervical cancer.
The audit results show that there has been no increase in the total number of people being diagnosed with cervical cancer aged 25 to 34, following the change in age at which people are first invited from age 20 to age 25 in 2008 to 2009. However, the number of people diagnosed with cervical cancer aged 25 to 26 has tripled because more people in the 25 to 26 year old age group are being diagnosed on or around their first invitation for screening making a diagnosis of early stage (FIGO 1A and 1B) cervical cancer (rather than late stage cancer) more likely. It is still the case that most people (86%) age 25 to 26 have their cancer detected following their first screening test. This suggests that young people are being diagnosed in a timely manner, increasing their likelihood of being able to access fertility preserving treatment and having a cervical cancer-free life thereafter.
Non-detection of potential abnormalities
No screening test is perfect. However the audit results confirm that the quality of cytology in England is high and that situations where a potential abnormality is not detected during routine screening are rare. From the audit findings, we estimate that screening did not pick up a potential cytological abnormality in only 1.7% of people aged 25 to 49 and in 3.4% of women aged 50 to 64.
Incidence
Peak incidence of cervical cancer is observed in the 25 to 29 year old age group (1,054 or 17.5%), followed by cases in people aged 30 to 34 (830 or 13.8%). The most common histological type is squamous carcinoma (67%), followed by adenocarcinoma (20%) and adeno-squamous carcinoma (2.3%).
Staging information
The proportion of cases with missing cancer stage information has more than halved since the first audit report was published in 2011 (from 21% to 9.5% in this report). We estimate that had all the cervical cancers been staged, 36% of cancers would be stage IA, 33% stage IB, 24% stage II or III and 7% stage IV.
Treatment
The most common treatment for cervical cancer is cone biopsy or ‘loop’ excision (30.7%). This reflects the fact that most cancers are diagnosed at an early stage; 92% of stage IA cervical cancers are diagnosed at the earliest possible stage (IA1). Most people with stage IA1 cancer are aged between 25 and 34 (57%), a further third (32%) are aged 35 to 49. Treatment for stage 1A1 cancer is almost always completely successful and fertility can be preserved.