Guidance

Cervical standards data report: 1 April 2019 to 31 March 2020

Published 9 April 2021

Applies to England

In this report we use ‘screening year 2019 to 2020’ to refer to 1 April 2019 to 31 March 2020. See more information about terminology used in this report.

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This is the second data report on the national cervical screening programme standards.

The 2019 to 2020 screening year included a huge milestone for the NHS cervical screening programme (CSP) with the move to primary screening using human papilloma virus (HPV) testing. This is one of the biggest changes since the introduction of the CSP in 1988.

This report focuses on performance in England from April 2019 to March 2020 but also includes trend data from previous years where this is available.

These standards contribute to assessing the quality of the CSP across England. Publishing the data ensures stakeholders and the public have access to reliable and timely information on the quality and performance of the screening programme.

The standards focus on some of the important targets commissioners and providers have to meet and maintain to make sure local screening services are high quality, safe and effective.

The report provides data on coverage, timeliness of receiving results, laboratory and colposcopy clinical standards.

Where the data show that standards are not met or there are data collection issues, providers and commissioners should ensure appropriate action is taken to address the issue. PHE’s screening quality assurance service (SQAS) works to provide advice and support to this process.

The data in this report complements that published jointly by NHS Digital and PHE Screening in the annual cervical screening statistical bulletin for 2019 to 2020.

The report covers a time of significant changes to the programme with the implementation of the HPV primary screening pathway, as this involved a large decrease in laboratory cytology services from 45 at the start of the year to 8 by the end of March 2020.

The coronavirus (COVID-19) pandemic, which began in early 2020, is likely to have had some limited impact on the data toward the end of the time period this report covers. The main effect of the pandemic will be apparent in next year’s data.

For those standards based on quarterly colposcopy data submissions, the annual data presented in this report is calculated by adding together all 4 quarters of the submissions. This is a change to the previous report where an annual submission was used. The change in approach for this year was made to reduce the burden on providers during the COVID-19 pandemic. Colposcopy clinics that did not submit data for all 4 quarters are shown with a nil return.

Coverage

This section covers standards CSP-S01 and CSP-S02.

We measure coverage of the screening programmes to provide assurance that screening is offered to the eligible population.

Eligible individuals are those entitled to an offer of screening. For cervical screening, this is individuals aged 24 and a half to 64 who have a cervix.

Coverage is an important indicator for the programme to achieve its aims of reducing incidence and mortality.

CSP-S01: Coverage for women aged 25 to 49 years

70.9% of women in the resident population eligible for cervical screening aged 25 to 49 at the end of the period reported who were screened adequately within the previous 3 and a half years (where the eligible population is 10,238,440).

Test	Women aged 25 to 49 (%)
England	70.9
London	63.1
Midlands and East	72.5
North	73.5
South	73.4

Figure 1: Cervical screening – coverage performance, for women aged 25 to 49, England, screening year 2019 to 2020

Coverage for those aged 25 to 49 is historically lower than for those aged 50 to 64 (see standard S02).

Figure 2: CSP-S01: Coverage for women aged 25 to 49, England, screening year ending 2016 to that ending 2020

The line graph above shows a decrease from 70.3% to 69.4% over the screening years ending 2016, 2017 and 2018, before increasing to 70.9% in the screening year ending 2020.

Figure 3: CSP-S01: Map of coverage for women aged 25 to 49, England, screening year 2019 to 2020

At March 2020, of 191 clinical commissioning groups (CCGs) in England, 6 met or exceeded the 80% acceptable threshold. These were:

• Rushcliffe (83.5%)
• Nottingham North and East (81.2%)
• North Norfolk (81.0%)
• North Cumbria (80.5%)
• Nottingham West (80.1%)
• Hambleton, Richmondshire and Whitby (80.0%)

CSP-S02: Coverage for women aged 50 to 64 years

76.4% of women in the resident population eligible for cervical screening aged 50 to 64 at end of period reported who were screened adequately within the previous 5 and a half years (where the eligible population is 5,076,264).

Test	Women aged 50 to 64 (%)
England	76.4
London	73.8
Midlands and East	77.0
North	76.7
South	76.8

Figure 4: Cervical screening – coverage performance, for women aged 50 to 64, England, screening year 2019 to 2020

Coverage for those aged 50 to 64 has historically been higher than for younger women (see standard S01).

Figure 5: CSP-S02: Coverage for women aged 50 to 64, England, screening year ending 2016 to that ending 2020

The line graph above shows a decrease from 78.1% to 76.3% over the screening years ending 2016, 2017 and 2018 and then remains at 76.4% for the screening years ending 2019 and 2020.

Figure 6: CSP-S02: Map of coverage for women aged 50 to 64, England, screening year 2019 to 2020

At March 2020, of 191 CCGs in England, 6 met or exceeded the 80% acceptable threshold. These were:

• Rushcliffe (84.6%)
• South Lincolnshire (81.8%)
• Nottingham West (81.6%)
• Nottingham North and East (80.7%)
• Greater Huddersfield (80.7%)
• South West Lincolnshire (80.2%)

Test – timely receipt of result letter

This section covers standard CSP-S03. This standard covers the screening pathway from the date the sample is taken to the date the result letter is expected to be received.

CSP-S03: Test – timely receipt of result letter

44.0% of women received their screening results in writing within 14 days from the date of their screening sample being taken (where the number of result letters sent was 3,297,786).

Test	Results received within 14 days (%)
England	44.0
London	61.1
Midlands and East	32.6
North	50.6
South	37.7

Figure 7: Cervical screening – receiving results within 14 days, England, screening year 2019 to 2020

This standard is affected by transport of samples, reporting times in laboratories and result letter administration by the call and recall service.

HPV primary screening was implemented across England in December 2019. This affected the whole screening pathway throughout the screening year 2019 to 2020 and the previous 3 years while planning for the change took place. It meant the standard of at least 98% of women receiving their results within 14 days of their test being taken was not met.

Figure 8: CSP-S03: Percentage of women receiving their result within 14 days of their test, England, screening year ending 2014 to that ending 2020

The line graphs above shows a gradual decrease from 93.7% to 89.1% over the screening years ending 2014, 2015 and 2016, before a large decrease to 44.0% in the screening year ending 2020.

Figure 9: CSP-S03: Map of women receiving their result within 14 days, England, screening year 2019 to 2020

In March 2020, of 191 CCGs in England, 5 met or exceeded the 98% acceptable threshold. These were:

• Norwich (99.7%)
• North Norfolk (99.7%)
• South Norfolk (99.6%)
• West Norfolk (99.6%)
• Great Yarmouth and Waveney (99.0%)

Laboratory standards

This section covers standards CSP-S04, CSP-S05, CSP-S06, CSP-S07.

Laboratories provide data using the mandatory KC61 return apart from CSP-S04 which uses a special data request.

CSP-S04: Test – minimise false negative reporting

96.7% of all abnormalities (and 98.5% of high-grade abnormalities) were correctly identified at the initial review when compared with the results of a second, ‘rapid’ review (where the number of abnormal samples was 151,567 and the number of high-grade abnormalities was 32,440).

Test	proportion of abnormal samples correctly identified (%)	proportion of high-grade samples correctly identified (%)
England	96.7	98.5
London	95.5	97.6
Midlands and East	98.1	99.1
North	97.2	98.4
South	95.7	98.3

Figure 10: Cervical screening – proportion of samples correctly identified at the initial review, England, screening year 2019 to 2020

This standard, known as ‘sensitivity’, measures the proportion of all abnormalities or high-grade abnormalities that were correctly identified at the initial review when compared with the results of a second, ‘rapid’ review. This standard is important to monitor to reduce the chance of abnormalities not being detected.

Figure 11a: CSP-S04: proportion of samples correctly identified at the initial review, England, screening year ending 2017 to that ending 2020

The line graph for all abnormalities, above, is generally steady at between 96.2% to 96.1% over the screening years ending 2017 to 2019. It increases to 96.7% in the screening year 2019 to 2020.

Figure 11b: CSP-S04: proportion of samples correctly identified at the initial review, England, screening year ending 2017 to that ending 2020

The line graph for high-grade abnormalities, above, shows a decrease from 98.4% to 97.9% over the screening years ending 2017 and 2018. It shows an increase to 98.5% over the screening years ending 2019 and 2020.

Test	Performance < acceptable	Acceptable range for all abnormalities	Total
London	1	8	9
Midlands and East	0	12	12
North	0	9	9
South	0	11	11

Figure 12a: CSP-S04: sensitivity, number of laboratories below or within acceptable threshold and the total, by region, screening year 2019 to 2020

Test	Performance < acceptable	Acceptable range for high grade abnormalities	Total
London	1	8	9
Midlands and East	0	12	12
North	0	9	9
South	1	10	11

Figure 12b: CSP-S04: sensitivity, number of laboratories below or within acceptable threshold and the total, by region, screening year 2019 to 2020

CSP-S05: Test – inadequate cytology

1.2% of cervical screening samples were reported as cytology inadequate (where the number of samples reported was 3,024,025).

Test	Inadequate samples as %
England	1.2
London	1.4
Midlands and East	1.1
North	0.7
South	1.8

Figure 13: Cervical screening – proportion of samples reported as cytology inadequate, England, screening year 2019 to 2020

Inadequate rate is reported for women aged 25 to 64 who were screened at a GP practice or community clinic.

Rates should be low as tests reported as inadequate mean they need to be repeated to get a result for the woman. However, some inadequate results are expected due to technical or administrative reasons. Calculating a range means that some laboratories will be outside the standard and this would warrant further investigation.

The 5% to 95% ‘acceptable’ range is calculated annually from the rates for all laboratories. For the screening year 2019 to 2020, this is 0.3% to 4.7%.

The minimum rate reported was 0.2%.

The maximum rate reported was 7.2%.

Figure 14: CSP-S05: Proportion of samples reported as cytology inadequate, England, screening year ending 2014 to that ending 2020

The line graph above shows an increase from 2.4% to 2.7% over the screening years ending 2014 to 2017. It then shows a decrease to 2.3 % over the screening years ending 2017 to 2019, before decreasing further to 1.2% in the screening year ending 2020. This is likely due to the roll out of HPV primary testing this year, which has reduced the number of cytology samples that need to be screened and therefore the chance of a sample being inadequate.

Test	Performance < acceptable	Acceptable range	Performance > acceptable	Total
London	0	9	0	9
Midlands and East	2	9	1	12
North	1	9	0	10
South	0	13	1	14

Figure 15: CSP-S05: Inadequate rate, number of laboratories below, within or above the acceptable range and the total, by region, screening year 2019 to 2020

CSP-S06: Test – cytological positive predictive value (PPV)

83.9% of women referred with high-grade abnormalities who have a histological outcome of CIN 2, CIN 3, CGIN (adenocarcinoma in situ) or cervical cancer (where the number of women referred whose histology outcome was no abnormality detected (NAD) or worse was 33,562).

Test	positive predictive value as %
England	83.9
London	78.6
Midlands and East	83.2
North	86.3
South	84.3

Figure 16: Cervical screening – proportion of high-grade referrals with histology of CIN 2 or worse, England, screening year 2019 to 2020

Positive predictive value (PPV) reports the correlation between a high grade cytology screening result and the subsequent histological outcome for women referred to colposcopy in the 12 months prior to the year reported.

Cytology is partly subjective and may be overcalled. PPV can be further influenced by histological diagnosis and colposcopy practice and disease prevalence. Calculating a range means that some laboratories will be outside the standard (above or below) and this would warrant further investigation.

The 5% to 95% ‘acceptable’ range is calculated annually from the rates for all laboratories. For the screening year 2019 to 2020, this is 76.6% to 91.6%.

The minimum rate reported was 76.1%.

The maximum rate reported was 93.0%.

Figure 17: CSP-S06: proportion of high-grade referrals with histology of CIN 2+, England, screening year ending 2014 to that ending 2020

The line graph above is generally steady at between 85.5% to 85.2% over the screening years ending 2015 to 2019, before a decrease to 83.9% in that ending 2020.

Test	Performance < acceptable	Acceptable range	Performance > acceptable	Total
London	1	8	0	9
Midlands and East	1	11	1	13
North	0	9	2	11
South	0	15	0	15

Figure 18: CSP-S06: PPV rate, number of laboratories below, within or above the acceptable range and the total performance against thresholds, by region, screening year 2019 to 2020

CSP-S07: Test – cytological abnormal predictive value (APV)

13.7% of women referred with borderline or low grade cytology results who have a histological outcome of CIN 2, CIN 3, CGIN (adenocarcinoma in situ) or cervical cancer (where the number of women referred whose histology outcome was NAD or worse was 81,769).

Test	Abnormal predictive value as %
England	13.7
London	12.1
Midlands and East	12.1
North	14.5
South	15.9

Figure 19: Cervical screening – proportion of low-grade referrals with histology of CIN 2 or worse, England, screening year 2019 to 2020

Abnormal predictive value (APV) reports the correlation between low grade cytology screening results and the subsequent histological outcome for women referred to colposcopy in the 12 months prior to the year reported. A small proportion of low grade screening results are expected to be found to have a high grade histology outcome.

Cytology is partly subjective and may be under-called. APV can be further influenced by histological diagnosis and colposcopy practice. Calculating a range means that some laboratories will be outside the standard (above or below) and this would warrant further investigation.

The 5% to 95% ‘acceptable’ range is calculated annually from the rates for all laboratories. For the screening year 2019 to 2020, this is 7.0% to 22.9%.

The minimum rate reported was 5.8%.

The maximum rate reported was 26.0%.

Figure 20: CSP-S07: proportion of low-grade referrals with histology of CIN 2 or worse, England, screening year ending 2015 to that ending 2020

The line graph above shows a decrease from 18.0% in the screening year ending 2015 to 13.7% by that ending 2020. This shows that over time low-grade referrals are less likely to have a high grade histology outcome.

Test	Performance < acceptable	Acceptable range	Performance > acceptable	Total
London	0	9	0	9
Midlands and East	2	10	1	13
North	0	10	1	11
South	0	14	1	15

Figure 21: CSP-S07: APV rate, number of laboratories below, within or above the acceptable range and the total, by region, screening year 2019 to 2020

Colposcopy standards

This section covers standards CSP-S08, CSP-S09, CSP-S10, CSP-S11, CSP-S12.

Colposcopy clinics provide data using the mandatory KC65 return apart from CSP-S09 which uses a special data request. For this year only, the 4 quarterly KC65 returns have been added together to produce the annual figures.

CSP-S08: Colposcopy – timely biopsy result letter sent

81.8% of women received their biopsy results within 4 weeks of the sample being taken (the acceptable threshold is 90% and above) and 98.3% received their results within 8 weeks (the achievable threshold is 100%). The number of results overall was 50,241.

Test	Proportion received within 4 weeks (%)	Proportion received within 8 weeks (%)
England	81.8	98.3
London	85.2	98.7
Midlands and East	85.3	98.6
North	76.3	97.5
South	82.0	98.7

Figure 22: Cervical screening – proportion of biopsy result received within 4 or 8 weeks, England, screening year 2019 to 2020

This standard is important to ensure that women receive the results of their biopsy (diagnostic or treatment) in a timely manner. This ensures that those who require further treatment and those who do not are informed at the earliest opportunity. Achievement of this standard is influenced by the timeliness of histology reporting and the efficiency of colposcopy clinic administration.

For results received within 4 weeks, the minimum rate reported was 6.7%.

For results received within 8 weeks, the minimum rate reported was 73.2%.

Twelve of 193 clinics reported all results were received within 4 weeks. Ninety-one of 193 reported all results were received within 8 weeks.

Figure 23a: CSP-S08: proportion of results received within 4 or 8 weeks, England, screening year ending 2014 to that ending 2020

The line graph above shows an increase from 81.1% to 86.2% over the screening years ending 2014 to 2018, before a decrease to 81.8% over the screening years ending 2019 and 2020.

Figure 23b: CSP-S08: proportion of results received within 4 or 8 weeks, England, screening year ending 2014 to that ending 2020

The line graph above shows a generally steady performance from 98.1% in the screening year ending to 98.3% in the screening year ending 2020. It reached a maximum of 98.8% in the screening year ending 2017 and a low of 97.9% in the screening year ending 2016.

Test	Performance < acceptable	Acceptable range	Total
London	10	16	26
Midlands and East	22	37	59
North	42	21	63
South	24	21	45

Figure 24: CSP-S08: Received within 4 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2019 to 2020

Test	Performance < acceptable	Acceptable range	Total
London	25	1	26
Midlands and East	53	6	59
North	60	3	63
South	43	2	45

Figure 25: CSP-S08: Received within 8 weeks, number of clinics below or within the achievable range and the total, by region, screening year 2019 to 2020

CSP-S09: Colposcopy – intervention or treatment (12-month follow-up after treatment)

2.9% of women seen at colposcopy within 12 months of previous treatment had a histology result of CIN or cancer (the acceptable threshold is 5.0% and under), where the number of women returning to colposcopy after treatment was 34,256.

Test	Proportion with CIN or cancer (%)
England	2.9
London	2.6
Midlands and East	3.0
North	2.4
South	3.4

Figure 26: Cervical screening – proportion of women with CIN or cancer within 12 months of previous treatment, England, screening year 2019 to 2020

It is important to 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.

Not all clinics could supply data for this standard – 155 of 193 clinics returned figures. Services and commissioners are responsible for taking action to ensure accurate and complete data are reported from all clinics.

The minimum rate reported was 0%.

The maximum rate reported was 13.6%.

Figure 27: CSP-S09: proportion of women with CIN or cancer within 12 months, England, screening years ending 2017 to 2020

The line graph above shows a decrease from 3.0% to 2.8% over the screening years ending 2017 to 2018, before an increase to 2.9% over the screening years ending 2019 and 2020.

Test	Acceptable range	Performance > acceptable	Total
London	22	1	23
Midlands and East	49	7	56
North	39	6	45
South	23	8	30

Figure 28: CSP-S09: proportion of women with CIN or cancer within 12 months, number of clinics within or above the acceptable range and the total, by region, screening year 2019 to 2020

CSP-S10: Colposcopy – intervention or treatment (inadequate cytology)

93.8% of women referred for colposcopy after 3 consecutive inadequate cytology screening tests were offered an appointment within 6 weeks of referral (the acceptable threshold is at least 99%). The overall number of inadequate referrals was 1,138.

Test	proportion offered an appointment within 6 weeks (%)
England	93.8
London	96.5
Midlands and East	95.5
North	93.4
South	90.7

Figure 29: Cervical screening – inadequate referrals offered a colposcopy appointment within 6 weeks, England, screening year 2019 to 2020

This standard is important to ensure that women have prompt referrals for colposcopy assessment to reduce anxiety and to make sure that no abnormality is missed and a definitive screening result is achieved.

This standard covers women referred to colposcopy following persistent inadequate cytology or unavailable HPV result, with the most recent result being inadequate cytology.

Not all clinics reported receiving inadequate referrals – 163 of 194 clinics had referrals in this category. The remaining 31 reported no inadequate referrals during the time period.

The minimum rate reported was 0%.

One hundred and twenty-three of 163 clinics reported that all inadequate referrals were offered an appointment within 6 weeks.

Figure 30: CSP-S10: inadequate referrals offered a colposcopy appointment within 6 weeks, England, screening year ending 2017 to that ending 2020

The line graph above shows an increase from 94.2% to 95.2% over the screening years ending 2017 to 2018, before a decrease to 93.8% over the screening years ending 2019 and 2020.

Test	Performance < acceptable	Acceptable range	Total
London	6	19	25
Midlands and East	11	39	50
North	9	37	46
South	14	28	42

Figure 31: CSP-S10: inadequate referrals offered a colposcopy appointment within 6 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2019 to 2020

CSP-S11: Colposcopy – intervention or treatment (6-week appointment)

93.0% of women referred for colposcopy after a positive high risk human papillomavirus (HR-HPV) test with negative or borderline or low-grade dyskaryosis cytology were offered an appointment within 6 weeks of referral (the acceptable threshold is 99%). The overall number of these referrals was 105,901.

Test	proportion offered appointment within 6 weeks (%)
England	93.0
London	94.5
Midlands and East	90.0
North	94.1
South	94.0

Figure 32: Cervical screening – offered a colposcopy appointment within 6 weeks of referral due to a positive HR-HPV test and negative or borderline or low-grade dyskaryosis cytology, England, screening year 2019 to 2020

This standard is important to ensure that women are seen within 6 weeks of their abnormal screening result for further assessment. This ensures timely management and reduces anxiety.

In the screening year 2019 to 2020, referrals due to positive HR-HPV with a negative cytology result are recorded in the ‘other’ referral indication category alongside the small number of referrals not due to a screening abnormality or clinical indication. Clinics were only able to report the ‘other’ category as a whole and this was taken as an indication for HR-HPV positive with negative referrals. It is therefore possible that actual practice is better than the performance reported here.

The minimum rate reported was 8.7%.

Forty-two of 193 clinics reported all such referrals were offered an appointment within 6 weeks.

Figure 33: CSP-S11: women offered a colposcopy within 6 weeks of referral due to a positive HR-HPV test and negative or borderline or low-grade dyskaryosis cytology, England, screening year ending 2017 to that ending 2020

The line graph above is steady from 95.4% to 95.6% over the screening years ending 2017 to 2019, before a decrease to 93.0% in that ending 2020.

Test	Performance < acceptable	Acceptable range	Total
London	9	17	26
Midlands and East	34	25	59
North	30	33	63
South	29	16	45

Figure 34: CSP-S11: HPV positive referrals offered appointment within 6 weeks, number of clinics below or within the acceptable range, by region, screening year 2019 to 2020

CSP-S12: Colposcopy – intervention or treatment (2-week appointment)

93.9% of women referred for colposcopy after a cytological report of high-grade dyskaryosis (moderate) or worse were offered an appointment within 2 weeks of referral (the acceptable threshold is 93%). The overall number of such referrals was 32,497.

Test	proportion offered appointment within 2 weeks (%)
England	93.9
London	98.3
Midlands and East	89.9
North	94.9
South	95.1

Figure 35: Cervical screening – women offered a colposcopy within 2 weeks of referral due to a high grade (moderate dyskaryosis or worse) cytology result, England, screening year 2019 to 2020

This standard is important to ensure that women are seen within 2 weeks of their high grade abnormal result for further assessment to ensure timely management and to reduce anxiety.

The minimum rate reported was 36.3%.

Forty-three of 193 clinics reported all high-grade referrals were offered an appointment within 2 weeks.

Figure 36: CSP-S12: women offered a colposcopy within 2 weeks of a cytological report of high grade dyskaryosis (moderate) or worse, England, screening year ending 2017 to that ending 2020

The line graph above shows an increase from 66.3% to 96.0% over the screening years ending 2015 to 2018, then a decrease to 93.9% in the screening year ending 2020.

Test	Performance < acceptable	Acceptable range	Total
London	1	25	26
Midlands and East	13	46	59
North	10	53	63
South	9	36	45

Figure 37: CSP-S12: high-grade referrals offered a colposcopy appointment within 2 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2019 to 2020

Terminology

Cervical screening is offered to women between the ages of 24 and a half and 64. Approximately 3.2 million women are tested in England every year.

Cervical intraepithelial neoplasia (CIN) is the medical term for abnormal cells in the cervix. CIN is not cancer, but it can sometimes go on to develop into cancer.

CIN is graded CIN 1, 2 or 3, where:

• CIN 1 (low grade) means the abnormality is unlikely to develop into cancer as the cells will often go back to normal on their own
• CIN 2 or 3 (high grade) means there is a greater chance the cells could develop into cancer; women with CIN 2 or 3 are usually offered treatment
• cervical glandular intraepithelial neoplasia (CGIN), also known as adenocarcinoma in situ, is an abnormality of the glandular tissue in the cervix; for any grade of CGIN, a woman will be offered treatment

Information about cervical screening standards and service specifications is available.