Cervical screening standards valid for data collected from 1 April 2020
Updated 12 March 2021
Applies to England
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CSP-S01: coverage under 50 years
Description
The proportion of women in the resident population eligible for cervical screening aged 25 to 49 years at end of period reported who were screened adequately within the previous 3.5 years.
Rationale
Cervical screening supports detection of cell abnormalities that may become cancer and is estimated to save 4,500 lives in England each year. Inclusion of this indicator provides an opportunity to incentivise screening promotion and other local initiatives to increase coverage of cervical screening.
Improvements in coverage would mean more cervical cancer is prevented or detected at earlier, more treatable stages.
Definition
Numerator: number of eligible women with a technically adequate screen within the previous 3.5 years.
Denominator: number of women aged 25 to 49 years resident in the area (determined by postcode of residence) who are eligible for cervical screening at a given point in time, excluding those without a cervix.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 80.0%
Caveats
None
Data collection and reporting
Data source: National Health Application and Infrastructure Services (NHAIS) and or Exeter (Practice Profile)
Responsible for data quality and completeness: cervical screening call and recall service
Responsible for submission: NHS Digital
Reported by: clinical commissioning group (CCG)
Published by: CCG
This standard is also the key performance indicator CS1
Reporting period
Quarterly
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S02: coverage 50 years and above
Description
The proportion of women in the resident population eligible for cervical screening aged 50 to 64 years at end of period reported who were screened adequately within the previous 5.5 years.
Rationale
Cervical screening supports detection of cell abnormalities that may become cancer and is estimated to save 4,500 lives in England each year. Inclusion of this indicator provides an opportunity to incentivise screening promotion and other local initiatives to increase coverage of cervical screening.
Improvements in coverage would mean more cervical cancer is prevented or detected at earlier, more treatable stages.
Definition
Numerator: number of eligible women with a technically adequate screen within the previous 5.5 years.
Denominator: number of women aged 50 to 64 years resident in the area (determined by postcode of residence) who are eligible for cervical screening at a given point in time, excluding those without a cervix.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 80.0%
Caveats
None
Data collection and reporting
Data source: NHAIS and or Exeter (Practice Profile)
Responsible for data quality and completeness: Cervical screening call and recall service
Responsible for submission: NHS Digital
Reported by: CCG
Published by: CCG
This standard is also the key performance indicator CS2
Reporting period
Quarterly
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S03: test: timely receipt of result letter
Description
Proportion of women expected to receive their screening results in writing within 14 days from date of the sample being taken.
Rationale
It is essential that women receive the results of screening in a timely manner to make sure those who require further tests and those who do not are informed at the earliest opportunity.
Definition
Numerator: number of result letters issued with an expected date of delivery within 14 days of the sample being taken in the reporting period.
Denominator: number of women who have had a sample result issued in the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
The expected date of delivery is calculated by the call and recall IT system adding a set number of days to the sending date according to the postage - for example one day for first class, 2 days for business class and 3 days for second class.
Performance thresholds
Acceptable level: greater than or equal to 98.0%
Caveats
None
Data collection and reporting
Data source: VSA: Vital Signs at Tier 1 (vital sign target for the programme and national requirements from the NHS operating framework)
Responsible for data quality and completeness: cervical screening call and recall service
Responsible for submission: NHS Digital
Reported by: CCG
Published by: CCG
Reporting period
Annually
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S04: test: minimise false negative reporting
Description
Assessing accuracy of first cytology examination as determined by rapid review.
Rationale
To minimise false negative cervical screening test reporting.
Definition
Numerator: true positives
Denominator: true positives plus false negatives
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
True positives means abnormals correctly identified before rapid review.
False negatives means abnormals correctly identified at rapid review.
| Initial screening report prior to rapid review | Final report: abnormal high grade or worse | Final report: borderline or low grade | Final report: normal - negative or inadequate |
|---|---|---|---|
| Abnormal | a | b | c |
| Normal | d | e | f |
Sensitivity
Sensitivity for all abnormalities:
-
numerator: a plus b
-
denominator: a plus b plus d plus e
Sensitivity for high grade (moderate and above):
-
numerator: a
-
denominator: a plus d
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Sensitivity for all abnormalities greater than or equal to 90.0%
High grade (moderate and above) greater than or equal to 95.0%
Caveats
Qualification - rapid review includes rapid preview.
For sensitivity calculations, the following are treated as high grade cytological abnormalities:
- ?glandular neoplasia (non-cervical)
- borderline endocervical
- high-grade dyskaryosis (moderate)
- high-grade dyskaryosis (severe)
- high-grade dyskaryosis or ?invasive squamous carcinoma
- ?glandular neoplasia of endocervical type
Data collection and reporting
Data source: cervical screening laboratory
Responsible for data quality and completeness: cervical screening laboratory
Responsible for submission: cervical screening laboratory
Reported by: cervical screening laboratory
Published by: cervical screening laboratory
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S05: test: inadequate samples
Description
The proportion of samples reported as cytology inadequate. An inadequate sample result can be assigned following a test outcome of either HPV unavailable or cytology inadequate.
Rationale
To monitor the proportion of inadequate results to make sure women are being recalled for repeat testing appropriately.
Definition
Numerator: number of women aged 25 to 64 with screening samples taken in GP and NHS community clinics reported as inadequate.
Denominator: number of women aged 25 to 64 with screening samples taken in GP and NHS community clinics.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Samples with inadequate cytology will have previously tested positive for high-risk HPV
Performance thresholds
Acceptable level: 5th to 95th percentile across all laboratories
Caveats
The KC61 form only allows a single category of inadequate to be recorded, so this will include samples with a test outcome of HPV unavailable and cytology inadequate.
Data collection and reporting
Data source: KC61 (central data return)
Responsible for data quality and completeness: cervical screening laboratory
Responsible for submission: cervical screening laboratory
Reported by: cervical screening laboratory
Published by: cervical screening laboratory
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date last last updated: October 2020
CSP-S06: test: cytological positive predictive value (PPV)
Description
The proportion of women referred with high grade abnormalities who have a histological outcome of cervical intraepithelial neoplasia (CIN)2, CIN3, adenocarcinoma in situ, cervical glandular intraepithelial neoplasia (CGIN) or cervical cancer.
Rationale
The positive predictive value (PPV) is a measure of the accuracy of cytological prediction of CIN2, CIN3, adenocarcinoma in situ, CGIN or cervical cancer. A high PPV can indicate accurate prediction although other factors need to be taken into account such as abnormal predictive value (APV).
Definition
Numerator: number of women referred to colposcopy in the previous 12 months with moderate dyskaryosis cytology or worse whose colposcopic outcome is a histological diagnosis of CIN2, CIN3, adenocarcinoma in situ, CGIN or cervical cancer
Denominator: number of women referred to colposcopy in the previous 12 months with moderate dyskaryosis cytology or worse whose colposcopic outcome is nothing abnormal detected (NAD) or a histological diagnosis of normal, HPV, CIN1 or worse.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
CIN 1 or worse is defined as: CIN1, CIN2, CIN3 adenocarcinoma-in-situ, CGIN or cervical cancer.
Performance thresholds
Acceptable level: 5th to 95th percentile derived from the previous year’s KC61 return
Caveats
Cytology is partly subjective and may be overcalled and the PPV can be further influenced by histological diagnosis and colposcopy practice and disease prevalence. The method used to calculate the range will mean that some laboratories will be outside the standard and this would warrant further investigation.
Data collection and reporting
Data source: KC61 (Part C2)
Responsible for data quality and completeness: cervical screening laboratory
Responsible for submission: cervical screening laboratory
Reported by: cervical screening laboratory
Published by: cervical screening laboratory
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S07: test: cytological abnormal predictive value (APV)
Description
Assesses the percentage of samples reported as low grade which lead to a colposcopy referral and where the histological outcome is CIN2, CIN3, adenocarcinoma in situ, CGIN or cervical cancer.
Rationale
The APV is an indirect measure of the accuracy of cytological prediction of CIN2, CIN3, adenocarcinoma in situ, CGIN or cervical cancer. A high APV can indicate inaccurate prediction although other factors need to be taken into account such as PPV.
Definition
Numerator: number of women referred to colposcopy in the previous 12 months with borderline squamous or low grade dyskaryosis cytology whose colposcopic outcome is CIN2, CIN3, adenocarcinoma in situ, CGIN or cervical cancer.
Denominator: the number of women referred to colposcopy in the previous 12 months with borderline squamous or low grade dyskaryosis cytology whose colposcopic outcome is colposcopy NAD or a histological diagnosis of normal, HPV, CIN1 or worse.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
CIN 1 or worse is defined as: CIN1, CIN2, CIN3 adenocarcinoma-in-situ, CGIN or cervical cancer.
Performance thresholds
Acceptable level: 5th to 95th percentile derived from the previous year’s KC61 return.
Caveats
Cytology is partly subjective and may be undercalled. The APV can be further influenced by histological diagnosis and colposcopy practice. The method used to calculate the range will mean that some laboratories will be outside the standard and this would warrant further investigation.
Data collection and reporting
Data source: KC61 (Part C2)
Responsible for data quality and completeness: cervical screening laboratory
Responsible for submission: cervical screening laboratory
Reported by: cervical screening laboratory
Published by: cervical screening laboratory
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S08: test: colposcopy - timely biopsy result letter sent
Description
Proportion of women to receive biopsy results within 4 weeks from date of test.
Rationale
It is essential that women receive the results of biopsy (diagnostic or treatment) in a timely manner to ensure those who require further treatment and those who do not are informed at the earliest opportunity.
Definition
Numerator: number of women receiving biopsy (diagnostic or treatment) results within 4 weeks of the test date.
Denominator: number of women receiving biopsy (diagnostic or treatment) results.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
The result is defined as the final clinical outcome and management plan communicated to the woman following a multi-disciplinary team meeting discussion (where required).
The date of receipt is defined as the date the result letter is posted.
Performance thresholds
Acceptable level: greater than or equal to 90.0% within 4 weeks
Achievable level: 100% within 8 weeks
Caveats
Data from biopsies taken during the first month of each quarter is collected to give time for results to have been issued.
Data collection and reporting
Data source: KC65 (Part D) (central data return)
Responsible for data quality and completeness: NHS trust or cervical screening provider
Responsible for submission: NHS trust or cervical screening provider
Reported by: colposcopy clinic
Published by: colposcopy clinic
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S09: intervention or treatment: colposcopy - 12 month follow-up after treatment
Description
The proportion of treated women with CIN or cancer within 12 months of previous treatment.
Rationale
Maximise successful treatment to ensure that the number of women with residual high grade disease or cancer within 12 months of treatment is as low as possible.
Definition
Numerator: number of women who have biopsy proven CIN or CGIN within 12 months of the first excisional treatment.
Denominator: number of women who have been treated for the first time for CIN or CGIN using an excisional method during the previous 12 months.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
This measure is reported in arrears. For example, the report for 1 April 2018 to 31 March 2019 looks at the outcomes of women treated between 1 April 2017 and 31 March 2018.
Performance thresholds
Acceptable level: less than or equal to 5.0%
Caveats
There are some clinical circumstances which may affect achievement of this standard. Exception reports will be required.
Data collection and reporting
Data source: colposcopy clinic system
Responsible for data quality and completeness: NHS trust or cervical screening provider
Responsible for submission: NHS trust or cervical screening provider
Reported by: colposcopy clinic
Published by: colposcopy clinic
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S10: intervention or treatment: colposcopy - inadequate referral
Description
A woman should be referred for colposcopy after 2 consecutive inadequate cytology or HPV unavailable screening tests and offered an appointment within 6 weeks of referral.
Rationale
To make sure that no abnormality is missed and a definitive screening result is achieved.
Definition
Numerator: number of women referred after 2 consecutive samples with inadequate cytology or HPV unavailable results offered an appointment within 6 weeks
Denominator: number of women referred after 2 consecutive samples with inadequate cytology or HPV unavailable results
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 99.0%
Caveats
None
Data collection and reporting
Data source: colposcopy clinic system
Responsible for data quality and completeness: NHS hospital trusts
Responsible for submission: NHS hospital trusts
Reported by: colposcopy clinic
Published by: colposcopy clinic
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S11: intervention or treatment: colposcopy - 6 week appointment
Description
Proportion of women who are offered a colposcopy within 6 weeks of referral due to a positive HR-HPV test and negative cytology OR borderline squamous changes or low-grade dyskaryosis.
Rationale
To make sure women are seen within 6 weeks of their abnormal result for further assessment to ensure timely management and to reduce anxiety associated with uncertainty.
Definition
Numerator: number of women offered an appointment within 6 weeks following a positive HR-HPV test and negative cytology or borderline squamous or low-grade dyskaryosis.
Denominator: number of women referred for an appointment following a positive HR-HPV test and negative cytology or borderline squamous changes or low-grade dyskaryosis
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 99.0%
Caveats
None
Data collection and reporting
Data source: colposcopy clinic system
Responsible for data quality and completeness: NHS trust or cervical screening provider
Responsible for submission: NHS trust or cervical screening provider
Reported by: colposcopy clinic
Published by: colposcopy clinic
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2020
CSP-S12: intervention or treatment: colposcopy - high grade referral 2-week appointment
Description
Proportion of women who are offered a colposcopy appointment within 2 weeks of referral due to a cytological report of high-grade dyskaryosis (moderate) or worse.
Rationale
To ensure women are seen within 2 weeks of their high grade abnormal result for further assessment to ensure timely management and to reduce anxiety associated with uncertainty.
Definition
Numerator: number of women offered an appointment within 2 weeks following a cytological report of high-grade dyskaryosis (moderate) or worse.
Denominator: number of women referred for an appointment following a cytological report of high-grade dyskaryosis (moderate) or worse
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
High-grade dyskaryosis (moderate) or worse includes:
- borderline endocervical
- high-grade dyskaryosis (moderate)
- high-grade dyskaryosis (severe)
- high-grade dyskaryosis/ ?invasive squamous carcinoma
- ?glandular neoplasia of endocervical type
Performance thresholds
Acceptable level: greater than or equal to 93.0%
Caveats
None
Data collection and reporting
Data source: KC65 (Part A)
Responsible for data quality and completeness: NHS trust or cervical screening provider
Responsible for submission: NHS trust or cervical screening provider
Reported by: colposcopy clinic
Published by: colposcopy clinic
Reporting period
Annual
Review dates
Date standard introduced: September 2018
Date standard last updated: October 2018