1. Introduction and programme policy
Updated 5 January 2023
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1. Introduction
1.1 Aim of the NHS Cervical Screening Programme
The aim of the NHS Cervical Screening Programme (NHS CSP) is to reduce the incidence of and mortality from cervical cancer through a systematic, quality-assured population-based screening programme for people aged 24.5 to 64 who have a cervix.
Since its introduction, the screening programme has helped halve the number of cervical cancer cases, and research published in 2004 and 2016 estimates it saves thousands of lives per year in England. In 2018 to 2019 approximately 3.4 million individuals were screened in England.
The programme is continuously monitored to ensure adherence to the consolidated programme standards and other quality indicators.
The Clinical Professional Group for Colposcopy (colposcopy CPG) developed this guidance based on evidence where available or recommended best practice. The colposcopy CPG was established to provide professional clinical advice to the NHS Cervical Screening Programme (NHS CSP). Its members are leading professionals in colposcopy.
1.2 Primary HPV screening
Primary human papillomavirus (HPV) screening has been demonstrated within randomised controlled trials reported in 2009, 2014 and 2019 to be more sensitive than cytology to detect pre-invasive disease of the cervix. Improved sensitivity leads to a reduction in incidence of both adenocarcinomas and squamous carcinomas of the cervix compared to cytology screening alone. The improved sensitivity of high risk HPV (hrHPV) testing and its high negative predictive value also enables longer screening intervals for individuals with normal test results and is the optimum primary screening test for vaccinated individuals. The lower specificity of hrHPV testing requires a reflex triage test to ensure colposcopy clinics are not over burdened with unnecessary referrals and individuals are not inconvenienced.
A national programme of primary HPV screening with triage by cytology results now operates following the evidence from the English primary implementation pilot report. The pathways can be found in the cervical screening pathway requirements guidance.
1.3 Cytology reporting
Further information regarding laboratory reporting and cytology terminology is available.
1.4 Future developments in cervical screening intervals following the implementation of primary HPV screening
The UK National Screening Committee (NSC) has recommended the extension of the screening intervals from 3 to 5 years for individuals aged 24.5 to 49 who test hrHPV negative as part of their routine screen test.
Once primary HPV screening has been fully implemented and embedded in the programme clinical pathways, IT developments will be progressed to enable this change. This guidance will be updated again once the extended screening intervals are implemented.
2. Screening programme policy
2.1 Routine screening intervals
The NHS CSP sends the first invitation for cervical screening when an individual reaches 24.5 years of age. Individuals are then recalled every 3 years until they turn 50, when the recall interval changes to every 5 years. This is based on evidence from an audit of screening histories in the UK. The intervals can be found in the programme call and recall guidance.
2.2 Individuals referred to colposcopy with an hrHPV positive and cytology negative result, either as a screening sample or as a test of cure sample following treatment for cervical intra-epithelial neoplasia (CIN)
Individuals with an adequate colposcopic examination who are negative on colposcopic opinion or biopsy are discharged to recall. The date for the next recall should be 3 years after their referral screening result. The colposcopy clinic is responsible for notifying the call and recall service with the due date for the next screen.
2.3 Age at starting screening
Individuals are invited for their first screening test at the age of 24.5 years. Individuals under this age who have symptoms, are concerned about their sexual health, or are worried about their risk of developing cervical cancer, should contact their GP or their local genito-urinary medicine (GUM) clinic.
Management algorithms are available for the management of individuals under 25 who have symptoms of cervical cancer.
2.4 Age at finishing screening
Routine screening ends when an individual attends for screening on or after the age of 60 and meets the criteria for automatic ceasing. This is because their next routine test would be due after their 65th birthday. Guidance is available on ceasing and deferring individuals from cervical screening.
Following the move to primary HPV screening, the UK NSC recommends implementation of 2 surveillance tests at 12-month intervals for individuals who are and remain hrHPV positive and cytology negative. People aged 65 and over who have had a previous abnormality, including those with an hrHPV positive result in the absence of abnormal cytology, remain in recall until they have completed follow-up tests. They will not be ceased automatically due to age while they remain eligible for non-routine screening.
2.5 Unscheduled screening
Unscheduled cervical screening does not form part of the cervical screening programme. Provided an individual has undergone screening within the recommended interval (depending on their age), they should not be re-screened.
Individuals with cervical symptoms, including persistent vaginal discharge that cannot be otherwise explained (for example an infection), should be referred in a timely manner for investigation.
2.6 Services offering NHS cervical screening
Cervical screening is mainly accessed via primary care. However it can also be accessed via locally commissioned contraceptive and sexual health services, extended access services, genito-urinary medicine clinics or, in limited circumstances, in colposcopy or gynaecology.
2.7 Screening tests taken outside the NHS screening programme
Non-NHS tests include those taken privately, overseas, by charities or by workplace health services. This may include tests reported by NHS laboratories which are providing reporting services under a private contract. Any test which was not taken or processed as part of a contract for NHS cervical screening services is considered a non-NHS test. Individuals having non-NHS tests remain eligible for NHS cervical screening at the recommended intervals.
2.8 Withdrawal from screening
Ceasing from colposcopy
Colposcopists are now able to cease individuals due to:
- prior radiotherapy to the pelvis
- absence of cervix
Voluntary withdrawal
Individuals may voluntarily withdraw from the cervical screening programme. Further details are in the programme ceasing guidance. Information for people wishing to opt out of NHS screening programmes is available on GOV.UK.
2.9 Summary of standards
Between the ages of 24.5 to 49, individuals are offered cervical screening every 3 years.
Between the ages of 50 and 64, individuals are offered cervical screening every 5 years.