Guidance

Extended Screening Interval Clinical Pathway protocol

Published 1 July 2025

Applies to England

This document describes the management of individuals offered cervical screening according to the primary HPV screening pathway, following the implementation of an extended 5-year screening interval for those aged 24.5 to 49 years.

The UK National Screening Committee (UK NSC) have recommended that participants aged 24.5 to 49 who test negative on a routine primary hrHPV test move to a 5-year screening interval. People aged 50 to 64 are already offered screening at this interval, but for younger people the interval has been 3 years, requiring the screening pathway to be updated.

The interval change will be implemented from an agreed date, on a national basis to a single national policy. From this date any person aged 24.5 to 49 having routine screening whose primary hrHPV test result is reported as hrHPV negative will have their next test due date set at 5 years, with non-responders becoming eligible for 5-year screening intervals depending on their screening history.

Screening intervals will not be changed retrospectively; therefore, a participant should be re-invited as originally informed at the time of their last test. Only when attenders have a subsequent routine hrHPV test performed on a clinician taken sample and reported as hrHPV negative, should they be placed on the extended interval.

Notes

• Recent hrHPV positive history

This is defined as any hrHPV positive result recorded in a participant’s screening history in the preceding 5-year period that is not subsequently followed by a clinician-sampled hrHPV negative result. If the previous hrHPV positive result was greater than or equal to 5 years previously then it is not considered recent.

** Included for Scottish results entered using historic English code combinations

1. For participants aged 24.5 to 49 years who have their next test due date (NTDD) updated when the test result is reported (also includes results uploaded from other nations when participants transfer to England)

1.1 Test result is hrHPV negative (Primary HPV) with a routine recall action code with no recent* hrHPV positive history

• NTDD 5 years

1.2 Test result is hrHPV negative (triage/test of cure test** (TTOC)) with either negative cytology, borderline change in squamous cells, borderline change in endocervical cells, low-grade dyskaryosis or ?glandular neoplasia (non-cervical) and a routine recall action code with no recent* hrHPV positive history

• NTDD 5 years

1.3 Test result is cytology negative or ?glandular neoplasia (non-cervical)** with no hrHPV test result and a routine recall action code

• Remain on 3-year recall regardless of any previous hrHPV negative result in screening history

1.4 Test result is HPV negative (self-sampling) with a routine recall action code

• Remain on 3-year recall regardless of any previous hrHPV negative (Primary or TTOC) result in screening history

1.5 Test result is hrHPV negative (Primary or TTOC) with a routine recall action code. Previous recent* test result either:

• hrHPV positive/cytology negative or ?non cervical glandular neoplasia with a 12-month recall action code
• hrHPV positive/cytology inadequate with a 3-month recall action code

• hrHPV positive/cytology either negative, borderline change in squamous cells, borderline change in endocervical cells, low-grade dyskaryosis or ?glandular neoplasia (non-cervical) and an ‘S’ action code or HPV unreliable/no cytology/S action code following an HPV positive result with inadequate cytology/repeat in 3 months

• Remain on 3-year recall. At 36-month recall test if hrHPV negative (Primary) NTDD 5 years

2. Participants aged 24.5 to 49 years called/recalled for a routine screening test who become non-responders (excludes early recall invitations including those after a previous inadequate result)

2.1 Most recent test result - primary cytology negative (no hrHPV test)

• NTDD 3 years, serial non-responders to have their recall in 3 years on each occasion until primary hrHPV test carried out

Prior to the most recent cytology-only test result, any hrHPV negative result (Primary, Self-sampling or TTOC) in the screening history will not affect the recall, continue to set to 3 years until a further hrHPV negative screening test result (Primary) is reported.

2.2 No screening test history - including those becoming non-responders following a first invitation

• NTDD 3 years, serial non-responders to have their recall in 3 years on each occasion.

2.3 Most recent test result – clinician sample hrHPV negative (Primary) or hrHPV negative (TTOC) following a recent* hrHPV positive result

• NTDD 3 years

2.4 Most recent test result – clinician sample hrHPV negative (Primary) or hrHPV negative (TTOC) with no recent* hrHPV positive result

• NTDD 5 years, serial non-responders to have their recall in 5 years on each occasion.

2.5 Most recent test result - hrHPV negative (Self-sampling)

• NTDD 3 years, serial non-responders to have their recall in 3 years on each occasion until primary hrHPV test carried out

Any earlier hrHPV negative result (Primary, Self-sampling or TTOC) in the screening history will not affect the recall

3. Participants aged 24.5 to 49 years having follow up post colposcopy

3.1 Individual follow up protocols define post colposcopy testing requirements for:

• Treated CIN
• CGIN (completely excised)

Each follow up protocol is completed with recall set to 36 months (R36) following one or two hrHPV negative follow up test results. Individuals testing hrHPV negative again after 36 months and returning to routine recall are eligible to have their NTDD set in line with the extended interval.

• NTDD 5 years

In the absence of recorded colposcopy outcomes, individuals will be recalled in accordance with section 1.5 above. This is to ensure that individuals who default colposcopy but respond to a failsafe screening invitation (incidentally including those who do attend colposcopy with or without a final adequate examination) can be offered at least one further test before becoming eligible for 5-year routine recall.

3.2 Normal colposcopy examination following referral for hrHPV positive with negative cytology, borderline change in squamous cells, low-grade dyskaryosis or ?glandular neoplasia (non-cervical). These individuals are recalled in 36 months and if hrHPV negative are eligible to have their NTDD set in line with the extended interval.

• NTDD 5 years

In the absence of recorded colposcopy outcomes, individuals will be recalled in accordance with section 1.5 above. This is to ensure that individuals who default colposcopy but respond to a failsafe screening invitation (incidentally including those who do attend colposcopy with or without a final adequate examination) can be offered at least one further test before becoming eligible for 5-year routine recall.

Note that separate validation rules in the call/recall system prevent routine recall on the first test after a referral with high-grade cytology and so early recall (maximum 36 months) will apply in those cases.

3.3 Normal colposcopy following referral for a second consecutive hrHPV unavailable result or hrHPV positive/cytology inadequate. These individuals are recalled in 12 months and if hrHPV negative are eligible to have their NTDD set in line with the extended interval.

• NTDD 5 years

In the absence of recorded colposcopy outcomes, individuals will be managed in accordance with section 1.5 above.  This is to ensure that individuals who default colposcopy but respond to a failsafe screening invitation (incidentally including those who do attend colposcopy with or without a final adequate examination) can be offered at least one further test before becoming eligible for 5-year routine recall.

3.4 CIN1 untreated follow up – end of follow up pathway, test result hrHPV negative (Primary), previous test result was hrHPV negative or HPV positive/cytology negative with early recall in 36 months.

• NTDD 5 years

3.5 Some participants require follow up testing at 6 and 12 months, then annually for the next 9 years. These include those:

• treated for microinvasive carcinoma
• with incompletely excised CGIN or SMILE

Participants completing 10 years of annual follow up who are hrHPV negative at the final test will have their NTDD set to 36 months. Those remaining hrHPV negative at this 36-month test will have their NTDD set to the routine extended interval

• NTDD 5 years

4. Participants aged 25 to 49 years who are immunosuppressed

Participants with specific conditions (excepting HIV) or taking medication rendering them immunosuppressed are to be managed in line with the national protocols. Those testing hrHPV negative at a routine screening test will have their NTDD set to the routine extended interval

• NTDD 5 years

HIV positive individuals will continue to be screened annually. Their NTDD will be set to 12 months (R12m) following an hrHPV negative test result, provided that retroviral infection status is notified to the laboratory

• NTDD 12 months

5. Self-sampling evaluations

The UK National Screening Committee is currently consulting on the use of self-sampling for non-responders to screening. Screening intervals in relation to self-sampling will be published as part of these initiatives as and when they are implemented.

Until then, participants aged 24.5- 49 years whose last screening test was part of approved self-sampling evaluations and were hrHPV negative will not move to a 5-year recall interval.  Instead, these participants will remain on a 3-year recall interval until routine intervals in relation to self-sampling as part of the NHS Cervical Screening Programme are agreed.

• NTDD 3 years

6. For participants whose next test due date is recalculated after a change to their screening record

The above rules will apply on any occasion where a participant’s next test due date is reviewed and updated because of a change in her circumstances. This will include:

• participants who are returned to recall after a period of ceasing
• participants who return to England after a period away
• participants whose date of birth is changed/corrected
• participants who have a new test result added to their screening history (even if not the most recent test)
• participants who have a previously recorded test result changed/corrected e.g. after an incident investigation