Cervical Screening Programme

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1 Cervical Screening Programme England

2 The NHS Information Centre is England s central, authoritative source of health and social care information. Acting as a hub for high quality, national, comparative data, we deliver information for local decision makers, to improve the quality and efficiency of care. Author: The NHS Information Centre, Screening and Immunisations team Responsible Statistician: Clare McConnell, Section Head Version: 1.1 Date of Publication: 24 th November

3 Contents Contents 3 Executive Summary 4 Introduction Background Quality Statement Report Structure Experimental Statistics Changes to the Report User Feedback 15 Analysis and Commentary 16 Call and Recall Programme 16 Cervical Cytology 34 Colposcopy 43 Data Tables 52 Appendices 98 Appendix A - Definitions 98 Appendix B - Glossary 101 Appendix C Feedback from Users 103 Appendix D Data Validation and Data Quality 104 Appendix E - Related Publications and Useful Web Links 107 3

4 Executive Summary Cervical Screening Programme, England Women between the ages of 25 and 64 are invited for regular cervical screening under a national Cervical Screening Programme. This is intended to detect abnormalities within the cervix that could, if untreated, develop into cancer. This report presents information about the NHS Cervical Screening Programme in England in and includes data about the call and re-call system, screening samples examined by pathology laboratories, and referrals to colposcopy clinics. The statistics in this report are used to inform policy and to monitor the quality, effectiveness and safety of screening services. The statistics are based on information that is routinely collected by the NHS Cancer Screening Programmes for the operation of the screening programme including quality assurance and performance management purposes. They are presented by Primary Care Organisation (PCO), Strategic Health Authority (SHA), pathology laboratory and colposcopy clinic. The current target age group for the Cervical Screening Programme of years is used to report statistics. Main Findings At 31 st March 2011, the percentage of eligible women (aged 25 to 64) who were recorded as screened at least once in the previous 5 years (coverage) was 78.6%. This compares to 78.9% in 2010 and to 79.5% five years ago (in 2006). Time from screening to receipt of results is measured using an expected delivery date. In , 78.9% of test results were reported to have an expected delivery date of within 2 weeks of the sample being taken (i.e. women would be expected to receive the results of their tests within 2 weeks). 4

5 In previous years time from screening to availability of result, which is measured as the number of days from the sample being taken to the result being sent by the PCO, has been reported. The percentage of test results available within 2 weeks has increased each year since when it first became possible to monitor 2 week availability. In , 44.6% of test results were available within 2 weeks. In , this figure was considerably higher at 82.8%. Just under 3.7 million samples were examined by pathology laboratories in ; similar to the numbers examined in Of the 3.7 million samples examined in , 3.4 million (93.2%) were submitted by GPs and NHS community clinics. The percentage of laboratory tests authorised (i.e. test results confirmed) within 2 weeks of receipt at the laboratory increased in to 92.9% from 60.5% in A further 6.1% were authorised within 4 weeks. In , 27.9% of women referred to colposcopy were offered an appointment within 2 weeks. This percentage rose to 65.5% for those offered an appointment within 4 weeks of referral. 5

6 Introduction This report presents information about the NHS Cervical Screening Programme in England in and includes data about the call and re-call system, screening samples examined by pathology labs and referrals to colposcopy clinics. The publication includes analysis and commentary along with a series of detailed tables and a Glossary to aid understanding of the technical terms used. The report focuses on England but also includes regional comparisons and coverage statistics from other UK countries. The statistics in this report are used to inform policy and to monitor the quality, effectiveness and safety of screening services. This publication has been in existence for a number of years and publications are available dating back to The report was originally published by the Department of Health Statistics Division. Responsibility for the publications transferred from DH to the NHS Information Centre when it was formed in Background Women between the ages of 25 and 64 are invited for regular cervical screening under a national Cervical Screening Programme. This is intended to detect abnormalities within the cervix that could, if untreated, develop into cancer. National policy is that women are offered screening every three or five years depending on their age. Women aged are invited every 3 years, whereas those aged are invited every 5 years. Prior to 2003, women were eligible for routine screening from age 20. In this bulletin, the current target group of years has been used to report statistics. The cervical screening process falls into three main phases: 6

7 Call and recall programme Most women invited by the screening programme have their initial screening test at either their GP practice or a NHS Community Clinic. The standard age ranges and frequency of screening are detailed above. Women aged 65 or over whose last three consecutive tests were reported as negative are removed from the call/recall programme It is possible for women outside the age range to be invited for screening should a need be identified. Women over 65 who have not undergone a previous test or who require ongoing surveillance continue to be included in the programme. Cervical Cytology Samples from the testing process are passed to pathology laboratories for screening by a cytologist. The results of the test are returned to PCTs, the GP, and the sample taker (if not the GP). The Cancer Reform Strategy, states that women should receive their cervical screening tests result within 2 weeks and this commitment was highlighted in the NHS Operating Framework which stated that the target should be achieved for all women by the end of Most women receive a normal result and are recalled for another routine test in three or five years dependent on their age. Where the pathology laboratory identifies cell changes that require further investigation, women receive an abnormal test result. Following an abnormal test result, some women will be referred for colposcopy. However, not all abnormal changes require immediate treatment and some women may instead be recalled for a repeat test in 6 or 12 months time In a small proportion of cases the pathology laboratory is unable to assess the cells to give a result and the test is considered inadequate. In such cases women are asked to return for a repeat test. 1 Cancer Reform Strategy, 2007, Department of Health - 7

8 Colposcopy Women referred for colposcopy attend a colposcopy clinic where a colposcope (a lighted, low-powered microscope) is used to examine the cervix and to determine appropriate treatment. A biopsy may be taken from the cervix for diagnosis and/or the cervix may be treated. Alternatively, women may be asked to have a repeat test. 1.2 Quality Statement This Quality Statement presents information to aid interpretation of the data. A fuller Quality Statement is available on the publication webpage which can be accessed via the following link: Data Sources The statistics are based on information that is routinely collected by the NHS Cancer Screening Programmes for the operation of the screening programme including quality assurance and performance management purposes. They are presented by Primary Care Organisation, Strategic Health Authority, pathology laboratory and colposcopy clinic. The information is collected on the following three returns: KC53 information from the call and recall system, collected on all 151 Primary Care Organisations. KC61 information on screening samples examined by pathology laboratories, collected from 109 laboratories carrying out cervical cytology. KC65 information on referrals to colposcopy, subsequent treatment and outcome, collected from 217 clinics/trusts providing colposcopy services. In some instances, smaller clinics have included their data in the main hospital return. The KC65 return was first collected in

9 In addition to the above returns, data on time from screening to receipt of results is obtained from monthly reports produced by the open Exeter system 2. The NHS Data Model and Dictionary Service contains more information on the above returns including guidance on content, completion and definitions. Links to the returns are given below: KC53 ms/community/kc53/kc53_fr.asp?shownav=1 KC61 unity/kc61/kc61_fr.asp?shownav=1 KC65 unity/kc65/kc65_fr.asp?shownav=1 Further information on the underlying sources of information can be found in the NHS ICs List of Administrative Sources, available through the following link: The data from each of the three returns is collected at the end of each financial year in aggregate form. The NHS Cervical Screening Programme includes regional Quality Assurance (QA) Reference Centres (QARCs) which are responsible for quality assuring the screening programme including KC53, KC61 and KC65 returns. Data are quality assured by the QARCs on an annual basis. Aggregated data is provided to the NHS Information Centre 2 Connecting for Health (CfH) Exeter system (NHAIS), Cancer Screening Statistics VSA15 Report. 9

10 (NHS IC) in a defined format. Further validation and quality assurance checks are carried out at the NHS IC as part of the publication process Accuracy and Reliability These are established collections based on 100 per cent data, i.e. not a sample. Submissions have been made for all PCOs and by all pathology laboratories and colposcopy clinics. Appendix D contains further information on data validation and data quality. Data quality issues were identified in relation to figures submitted by a 8 laboratories carrying out cervical cytology and a 10 of clinics/trusts providing colposcopy services. Details of the data quality issues identified are reported in Appendix D Timeliness and Punctuality The cervical screening data are made available as soon as possible after they have been compiled and validated (usually October each year). A copy of last year s report can be found at: Accessibility and Clarity Most data fields are published in the Data Tables as part of this main report which is available on the NHS IC Cervical Screening web pages: The tables and graphs are also available as Excel files and tables are available as CSV files, which again are accessible through the web pages. Further analysis may be available on request, subject to resource limits and compliance with disclosure control requirements. 10

11 1.2.5 Coherence and Comparability Changes in Screening Policy Screening policy changed in Prior to this, women aged were screened at least every five years. From 2004 women did not receive their first invitation until they were 25. Prior to 2004, national policy was to invite women for screening at intervals of not more than 5 years and therefore there was some variation in local practice. This also changed in 2004 so that women aged were invited for screening every 3 years whereas those aged were invited every 5 years. The above changes in policy need to be borne in mind when considering trend data. The NHS IC maintains awareness of changes that may impact on the data through regular meetings and communication with the NHS Cervical Screening Programme and the Department of Health. Time series The main tables in the publication contain time series which enable examination of trends over a period of years. Throughout the report statistics are compared with the previous year. Comparisons with other countries This report includes coverage comparisons with other UK countries which can be found in section Confidentiality, Transparency and Security The standard NHS security and confidentiality policies have been applied in the production of these statistics. An annual risk assessment is undertaken prior to publication which addresses any potential issues around disclosure. The following disclosure controls have been applied to this publication: 11

12 In Table 26b the actual number of biopsies by organisation has been suppressed, leaving totals by region available. The percentage showing CIN (cervical intra-epithelial neoplasia) or worse has been banded to 2.5% increments Data Revisions Subsequent to publishing the Cervical Screening Programme, England, report on 21 st October 2010, a number of changes were identified as being needed affecting Tables 1, 18, 18a, 19, 20, 21, 24, 25, 26a and 26b in the Data Tables and Tale O in the PDF report. These errors were mainly due to incorrect data submissions. There was a small impact on England level data in Tables 18 and 18a. The impact on England level data for all other tables affected was very limited. All relevant excel tables were reissued on 22 nd November 2011 except Table 1, which was footnoted. Please note that figures were not revised in the full PDF report. The re-issued excel tables and an Errata Note detailing the revisions can be found on the publication webpage: Where this report uses statistics, they are the correct, revised statistics. Where data is re-submitted post publication in the future, the NHS IC will assess whether the resubmitted data has a significant impact on England level data. Where this is the case, the affected excel tables will be re-issued. Where the impact to England level data is not significant, footnotes will be made to the affected tables. 12

13 1.3 Report Structure Statistics from the cervical screening programme are presented in the Analysis and Commentary section of this report in three sub-sections as follows: Call and Recall Programme Cervical Cytology Colposcopy More detailed tables are presented in the Data Tables section In presenting laboratory statistics in the Cervical Cytology section, data about samples from GP and NHS Community Clinics have been used in most tables in preference to data about samples from all sources, so as to reflect more closely the results from screening programme tests Due to the technical nature of some of the terms used in this report a Glossary is included as an aid to understanding see Appendix B Appendix A contains Definitions which users may find useful when reading this report. A definition of coverage is included in this appendix. 13

14 1.4 Experimental Statistics Time from screening to receipt of result In previous years, this publication has reported the time from screening to availability of result which is measured as the number of days from the sample being taken to the result being sent by the PCO to the woman (not to the woman receiving the result). This year, time from screening to receipt of result, as measured by expected delivery date, is reported as these data are considered to be of more interest to users of the statistics. They are published as experimental statistics as they are undergoing evaluation. A key part of the Experimental Statistics label is user engagement in the evaluation of those statistics. The NHS IC invites readers to comment on this publication, which will help inform the next report. Comments may be sent to: As in previous years, Table 9 and 9a in the Data Tables section of this publication present figures at both regional and local level for time from screening to availability of result. In addition, Tables 9b and 9c present figures at both regional and local level for time from screening to receipt of result as measured by expected delivery date. The NHS IC does not intend to publish statistics on time from screening to availability of results in future publications. Users of the publication who have any concerns about this change should contact the NHS IC: Tel:

15 1.5 Changes to the Report UK Coverage statistics Coverage in other UK countries is included in this year s report to enable comparison (see section 2.1.7). However, it should be noted that cervical screening programmes in other counties vary in terms of the age groups covered by the screening programmes, the frequency of screening and in how coverage is calculated. In comparing coverage in England to other counties, these differences (which are detailed in the text) should be considered. 1.6 User Feedback The NHS Information Centre welcomes feedback on all publications. If you wish to comment on this report a feedback form is available on the NHS IC website at: Feedback received from users via the publication webpage is summarised in Appendix C along with any action that has been taken as a result of this feedback. 15

16 Analysis and Commentary Call and Recall Programme 2.1 Coverage Coverage is defined as the percentage of women in a population eligible for screening at a given point in time who were screened adequately within a specified period. As the frequency with which women are invited for screening is dependent on age, coverage is calculated differently for different age groups, as follows: Women aged 25 to 49 Coverage is calculated as the number of women in this age group who have had an adequate screening test within the last 3.5 years as a percentage of the eligible population aged 25 to 49. Women aged 50 to 64 Coverage is calculated as the number of women in this age group who have had an adequate screening test within the last 5 years as a percentage of the eligible population aged Women aged 25 to 64 (the complete target age group) Coverage is calculated as the number of women in this age group who have had an adequate screening test within the last 5 years as a percentage of the eligible population aged 25 to

17 The eligible population is the PCT s responsible population 3 excluding those women whose recall to screening has been ceased for clinical reasons (most commonly due to hysterectomy) At 31 st March 2011, the percentage of eligible women (aged 25 to 64) who were recorded as screened at least once in the previous 5 years (coverage) was 78.6%. This compares to 78.9% in 2010 (see Table A) and to 79.5% five years ago (in 2006).. Table A: Cervical Screening: Coverage by Age Group, at 31 st March 2010 and 2011 Coverage Year years (less than 3.5 years since last adequate test) (%) years (less than 5 years since last adequate test) (%) years (less than 5 years since last adequate test) (%) Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section. Figure 1 shows coverage of the target age group since The Primary Care Trust's responsible population comprises: - all persons registered with a GP whose practice forms part of the PCT, regardless of where the person is resident, plus - any persons not registered with a GP who are resident within the PCTs statutory geographical boundary. Note that persons resident within the PCTs geographic area, but registered with a GP belonging to another PCT, are the responsibility of that other Primary Care Trust. 17

18 Figure 1: Cervical screening: Coverage of the target age group (25-64), England at 31 st March, 2002 to 2011 % coverage (less than 5 years since last adequate test) data as at 10th August 2006 Data prior to 2005, re-used w ith the permission of the Department of Health Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section The fall in coverage in is also apparent in the different age groups. For those aged 25 to 49 (who are invited every 3 years), coverage at 31st March 2011 was 73.7% compared with 74.0% in Among women in the older age range, 50 to 64 years (who are invited every 5 years), coverage on 31 st March 2011 also fell to 78.0% from 78.9% the previous year (see Table A). Figure 2 shows a detailed breakdown of the change in coverage from 2010 by age group. Figure 2: Cervical screening: Coverage by age, England, at 31 st March, 2010 and % 80.0% 72.8% 72.8% 76.9% 76.5% 78.7% 78.4% 79.1% 78.7% 82.6% 82.6% 78.3% 76.9% 75.1% 73.4% % 62.8% 62.5% 60.0% Coverage 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Age (coverage <3.5 yrs since last test) (coverage <5 yrs since last test) Source: KC53, The NHS Information Centre. See also Table 1 in Data Tables section. 18

19 2.1.4 Coverage of the target age group (25-64) varied between Strategic Health Authorities, with 4 achieving 80% or more and 6 achieving below 80% (see Table B). The highest reported coverage was in the East Midlands at 81.4%, the lowest was London at 74.0%. Table B: Coverage for age group by SHA, 31 st March 2010 and 2011 Coverage (Less than 5 years SHA since last adequate test) (%) England North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East Coast South Central South West Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section Coverage was 80% or higher in 57 of the 151 PCOs - see Figures 3 and 3a. Figure 3 - Cervical screening: coverage of the target age group (25-64) by Primary Care Organisation, England, 31 st March 2011 Number of PCOs Coverage (% of eligible population less than 5 years since last test) NB: Due to rounding, the figures presented in the above bar chart may not exactly match those derived from aggregating the relevant columns from Table 13 in the Data Tables section. Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section. 19

20 Figure 3a - Cervical screening: coverage of the target age group (25-64) by Primary Care Organisation, England, 31 st March 2011 NB: Due to rounding, the figures presented in the above bar chart may not exactly match those derived from aggregating the relevant columns from Table 13 in the Data Tables section. Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section Where coverage is calculated to include those with recall ceased for clinical reasons 4, 73.3% of women in the age group were recorded as being tested within 5 years of their last adequate test on 31 st March A further 6.8% were tested within 10 years of their last test. 8.8% had been called but had never attended for screening (see Table C) 4 Ceased for clinical reasons usually indicates the women has no cervix. 20

21 Table C: Test status of women aged at 31 st March 2011 thousands Women who have been tested (time since last test) Women called but not tested Number of women resident (000s) Number of women ceased for clinical reasons less than 1.5 years 1.5 to 3 years 3 to 3.5 years 3.5 to 5 years 5 to 10 years 10 to 15 years 15 years and over no adequate sample never attended no cytology record (%) Source: KC53, The NHS Information Centre. See also Tables 2 and 3 in Data Tables section. NB: The sum of components may not equal totals due to rounding Table D shows coverage in other UK countries. It should be noted that cervical screening programmes in other counties vary in terms of the age groups covered by the screening programmes, the frequency of screening and in how coverage is calculated. In comparing coverage in England to other counties, these differences (detailed in the footnotes) should be borne in mind. Coverage in Table D below is calculated for women aged 25 to 64 years for all countries with the exception of Scotland where it is calculated for women aged years. Table D: Coverage by Country at 31 st March 2011 Country Number of eligible women (thousands) Number of women less than 5 years since last adequate test (thousands) Coverage (Less than 5 years since last adequate test) (%) England 5 13, , Northern Ireland Scotland 7 1, , Wales Source for England figure: KC53, The NHS Information Centre. See also Table 2 in Data Tables section. 5 In England women between the ages of years are invited for screening. Women aged are invited every 3 years and those aged are invited every 5 years. 6 The Northern Ireland screening programme targets women aged but reports on those aged Prior to January 2011, women in Northern Ireland were invited for screening every 5 years. However, since January 2011 women aged have been invited every 3 years. 7 The Scottish screening programme targets women aged 20-60, who are invited for screening every 3 years. 8 Scotland coverage figure is for within 5.5 years since last adequate test. For further information on Scottish data, please contact: 9 The Welsh screening programme targets women aged 20-64, who are invited for screening at least every 3 years. However, the coverage published above is reported for the age range years 21

22 With the exception of Scotland, coverage is calculated as the percentage of women in a population eligible for screening at a given point in time who were screened adequately within the past 5 years. The Scottish programme calculates coverage within the past 5.5 years. 2.2 Invitations for screening The number of women aged 25 to 64 invited for screening increased by 259,085 (6.4%) in , taking the total number of invitations for this age group to 4.3 million (see Table E). In , 4.1 million women in this age group were invited for screening. Within the years age group, 3.4 million women were invited for screening in an increase of 120,024 (3.7%) from A total of 955,331 women aged were invited for screening in , an increase of 139,061 (17.0%) from the previous year Examination of women invited by age group over the last 5 years shows some variation see Table E and Figure 4. In 2003 screening policy changed so that women aged were invited for screening every 3 years whereas those aged were invited every 5 years. Prior to 2004, women were screened from age 20 and at intervals of not more than 5 years which led to some variation in local practice. This change in policy may partly explain some of the trends in women invited for screening apparent in Table E and Figure 4. 22

23 Table E: Number of women invited for screening by year and age group from to %change from to Under 20 1, , ,105 57,490 54,345 52, , , , , , , , , , , , , , , , , , , , , , , , , , ,004,921 3,376,329 3,376,757 3,253,116 3,373, % , , , , , , , , , , , , , , , ,002, , , , , % ,550 33,543 31,350 48,579 51, ,092 6,340 7,963 11,459 10, and over 8,417 3,048 4,059 4,987 4,120 Total (all) 4,323,911 4,337,720 4,122,131 4,189,387 4,447, % Total (25-64) 4,007,355 4,177,969 4,020,652 4,069,386 4,328, % Source: KC53, The NHS Information Centre. See also Table 4 in Data Tables section. Figure 4: Number of women invited for screening by age group and year, to ,500,000 4,000,000 3,500,000 Number 3,000,000 2,500,000 2,000,000 1,500, ,000, , Year Source: KC53, The NHS Information Centre. See also Table 4 in Data Tables section. 23

24 2.2.3 Table F shows that although most invitations to women aged 25 to 64 were calls 10 or routine recalls, 14.5% were early recalls for surveillance and 3.6% were early recalls following an abnormality (i.e. persistent findings of borderline changes or mild dyskaryosis). Table F: Number of women (aged 25-64) invited in the year by type of invitation, , Year Total Call Routine Repeat in less than 3 years for reasons of Recall Surveillance Abnormality Inadequate Sample ,069, % 61.1% 15.8% 4.3% 2.5% ,328, % 63.3% 14.5% 3.6% 2.1% Source: KC53, The NHS Information Centre. See also Table 4 in Data Tables section As the number of women invited for screening increased over the previous year, the number of women tested has also increased. In , 3.4 million women in the Cervical Screening Programme target age range (25-64 years) were tested (see Table G). This compares with 3.3 million in and 3.6 million in Although the number of women aged years invited for screening increased in (see paragraph 2.2.1), the number of women tested fell. A total of 2.6 million women aged were tested in , a fall of 51,681 (2.0%) from A total of 0.8 million women aged were tested in , an increase of 130,641 (19.5%) from Analysis of the numbers of women tested by age group over the last 5 years shows some variation see Table G and Figure 5. The change in policy detailed in paragraph above may partly explain some of the trends in women tested over time that are apparent in Table G and Figure 5. The increase in the number of women tested in might be partly explained by the well publicised battle against cervical cancer of a high profile media personality. 10 Where the invitation type is call, this indicates that the invitation is a first call for screening. Women receiving this invitation type will not have been screened before. 24

25 Table G: Number of women tested by year and age group from to % change from to Under 20 3,508 2,840 3,595 2,874 1, ,935 96,926 76,661 55,068 38, , , , , , , , , , , , , , , , , , , , , , , , , , ,339,142 2,470,506 2,957,522 2,603,341 2,551, % , , , , , , , , , , , , , , , , , , , , % ,696 42,788 32,262 36,406 44, ,216 6,457 5,727 5,613 5, and over 2,851 2,576 2,434 2,118 1,912 Total 3,370,846 3,374,826 3,728,052 3,374,246 3,442, % ,170,640 3,223,239 3,607,373 3,272,167 3,351, % Source: KC53, The NHS Information Centre. See also Table 5 in Data Tables section. Figure 5: Number of women tested by year and age group, to ,000,000 3,500,000 3,000,000 Number 2,500,000 2,000,000 1,500, ,000, , Year Source: KC53, The NHS Information Centre. See also Table 5 in Data Tables section. 25

26 2.2.6 Of those aged tested in the year, just under 2.8 million (83.4%) were tested following an invitation within the screening programme see Table H. The remaining 555,996 women (16.6%) had screening tests not prompted by the programme, i.e. tests initiated by the sample taker or opportunistically by the woman, without her necessarily having been invited. 11 In particular, some women are routinely recalled by their GPs, possibly earlier than at the locally agreed standard interval. Because women recorded as having a test not prompted by the programme may nevertheless have been invited through such a GP programme, it is not possible to calculate the percentage uptake of invitations from the call/recall database. Table H: Number of women (25-64 years) tested in the year by type of invitation, to Total Invited Outside Programme Number Number % Number % ,223,239 2,592, , ,607,373 2,870, , ,272,167 2,626, , ,351,127 2,795, , Source: KC53, The NHS Information Centre. See also Table 5 in Data Tables section. 2.3 Test results Some women have more than one test during the year for clinical reasons 12 and the 3.4 million women of all ages tested in generated 3.7 million tests (see Table I) Of the 3.7 million tests, 2.8% did not have a result, as the sample was inadequate i.e. it did not contain material suitable for analysis (see paragraphs below for more information on inadequate samples). 11 Opportunistic tests will most commonly be taken from women who are overdue for screening. 12 This can be if the sample is inadequate or if the results show borderline changes for which the woman is screened again after 6 months. 26

27 Table I: Number of tests and result, Result of Test Number of Tests Percentage (%) Inadequate 102, Adequate 3,559, Total 3,662, Source: KC53, The NHS Information Centre. See also Table 7 in Data Tables section For women tested again due to an earlier inadequate test, 11.1% of tests resulted in a repeated inadequate result, a decrease on (11.4%) - see Table J. These repeated inadequate samples accounted for 9.6% (9,818 out of 102,779) of all inadequate results in the year. Table J: Result of test where a repeat invitation was sent in less than 3 years due to a previous inadequate sample, , Result of Test Number of tests Percentage (%) Number of tests Percentage (%) Inadequate 11, , Adequate 89, , Total 101, , Source: KC53, The NHS Information Centre. See also Table 7 in Data Tables section Of the 3.3 million women aged who had an adequate result in , 93.4% were negative and 6.6% had a result categorised as abnormal (from borderline changes through to severe dyskaryosis and potential cancer 13 ). Table K shows the breakdown of the results of adequate tests for the last 2 years. 13 Potential cancer includes severe dyskaryosis/?invasive carcinoma and?glandular neoplasia. 27

28 Table K: Results of adequate tests for women aged 25-64, , Result* % % Negative Borderline changes Mild dyskaryosis Moderate dyskaryosis Severe dyskaryosis Severe dyskaryosis/?invasive carcinoma ?Glandular neoplasia Total Source: KC53, The NHS Information Centre. See also Table 8 in Data Tables section. NB: The sum of components may not equal totals due to rounding. *Most severe result in year Within the target age range the percentage of results which are severe dyskaryosis or worse shows a distinct pattern by age, being highest at 1.70% for women aged 25-29, falling to 0.21% for women aged (see Figure 6). Figure 6* - Cervical screening: women with test result severe dyskaryosis or worse as a percentage of all women with adequate test results, by age, England Percentage Age * This chart is shown to 2 decimal places due to the very small percentages involved. Note that the percentages in Figure 6 are aggregates of 3 test result groups (severe dyskaryosis, severe dyskaryosis/?invasive carcinoma and?glandular neoplasia). The aggregated figures shown in Figure 6 may not equal the sum of the individual components shown in Table 8 in the Data Tables due to rounding. Source: KC53, The NHS Information Centre. See also Table 8 in Data Tables section. 28

29 2.3.6 At PCO level, in 118 of the 151 PCOs the proportion of women presenting with an abnormal result was between 4% and 8%. In 30 PCOs the proportion was between 8% and 10%; and in 3 PCOs the proportion was above 10% (the maximum was 10.6%) see Figure 7. Figure 7 - Cervical screening: Percentage of tests for women aged 25-64, with an abnormal result by Primary Care Organisation, England Number of PCOs Percentage of abnormal samples Source: KC53, The NHS Information Centre. See also Table 12 in Data Tables section. 2.4 Time from screening to receipt of results The Cancer Reform Strategy 15, states that women should receive their cervical screening test result within 2 weeks and this commitment was highlighted in the NHS Operating Framework which stated that all women should receive the results of their cervical screening tests within 2 weeks by National policy is that all result letters should be produced by the Primary Care Organisation. Time from screening to receipt of results is measured using an expected delivery date based on the date of letter printing and the postage class used by the Primary Care Organisation. 14 In previous years, this publication has reported the time from screening to availability of result which is measured as the number of days from the sample being taken to the result being sent by the PCO to the woman (not to the woman receiving the result). This year information on time from screening to receipt of result is available and so has been reported as this measurement is considered to be of more interest to users of these statistics. As in previous years, Table 9 and 9a of this publication present figures at both regional and local level for time from screening to availability of result. Tables 9b and 9c present figures at regional and local level for time from screening to receipt of results, as measured by expected delivery date 15 Cancer Reform Strategy, 2007, Department of Health 16 The Operating Framework for for the NHS in England, 2009, Department of Health pdf 29

30 2.4.2 In , 78.9% of test results were reported to have an expected delivery date of within 2 weeks of the sample being taken (i.e. women would be expected to receive the results of their test within 2 weeks) 17. Table L below shows the time from screening to receipt of test result. Note that as PCOs had until the end of 2010 to meet the two week requirement on time from screening to receipt of results, not all letters would be expected to have an expected delivery of within 2 weeks for the reporting period. Table L: Time from screening to receipt of results, as measured by expected delivery date of result letter (eligible women aged years), Total number of letters to women tested sent by the PCO 3,406,604 Expected Delivery Date Within 14 days (%) 78.9 More than 2 weeks and up to 3 weeks (%) 13.3 More than 3 weeks (%) 7.9 Source: National Cancer Screening Statistics VSA15 Report, Connecting for Health (CfH) Exeter system (NHAIS). See also Tables 9b and 9c in Data Tables section. NB: The sum of components may not equal totals due to rounding. In previous years time from screening to availability of result, which is measured as the number of days from the sample being taken to the result being sent by the PCO, has been reported 18. The percentage of test results available within 2 weeks has increased each year since when it first became possible to monitor 2 week availability 19. In , 11.1% of test results were available within 2 weeks of screening. By , 44.6% of test results were available within 2 weeks and in this figure was considerably higher again at 82.8% (see Table 9 in Data Tables). The percentage of results available within 2 weeks in is likely to have been impacted by the 2 week requirement on time from screening to receipt of results. 17 Time from screening to receipt of test results as measured by expected date of delivery is calculated from summing monthly data for primary care organisations. 18 This is based on letters being printed on the recorded date and NHS Cervical Screening Programme policy being that letters should be despatched on the same date. NB: The NHS IC does not intend to publish statistics on time from screening to availability of results in future publications (for further information see section on Changes to the Report). 19 Prior to , the lowest timescale available was the percentage of tests results available within 4 weeks. 30

31 2.4.3 Figure 8 shows the percentage of result letters with an expected delivery date of within 2 weeks of testing by Strategic Health Authority. Again, as regions had until the end of 2010 to meet the two week requirement on time from screening to receipt of result, some variation between SHAs is expected. Figure 8: Cervical Screening: Time from screening to receipt of results as measured by expected date of delivery of result letter by Strategic Health Authority (eligible women aged years), Up to 2 weeks % England North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East Coast South Central South West Source: National Cancer Screening Statistics VSA15 Report, Connecting for Health (CfH) Exeter system (NHAIS). See also Tables 9b and 9c in Data Tables section. Table 9b in the Data Tables section presents SHA figures on time from screening to receipt of results. Table 9c in the Data Tables section presents the same figures at PCO level. 31

32 2.5 Recall status Normal recall status, indicated by action code A (routine recall) is usually used only where the test result is negative. However, HPV sentinel sites 20 (introduced in ) show a small number of tests with normal recall status within the borderline changes and mild dyskaryosis categories (2.7% and 0.8% respectively) in accordance with the HPV triage protocol. In , 85.3% of women who had nothing other than a negative test result in the year had a normal recall status. Of the remaining women with negative results,13.9% had a repeat recall status as they were under surveillance or follow-up and 0.9% had a suspend recall status as they were under hospital care 21 (see table M). Table M: Recall status by most severe screening result, Recall status Normal (%) Repeat (%) Suspend (%) Inadequate Negative Borderline changes Mild dyskaryosis Moderate dyskaryosis Severe dyskaryosis Severe dyskaryosis/?invasive carcinoma ?Glandular neoplasia Source: KC53, The NHS Information Centre. See also Table 10 in Data Tables section. NB: The sum of components may not equal totals due to rounding Repeat recall status, action code R, requires a further test earlier than routine recall, typically within 6 months of the previous test. 22 This may be used where a test result is negative, inadequate, borderline changes or mild dyskaryosis. In , 20 Several areas have been operating an HPV triage programme, whereby women whose test shows mild dyskaryosis or a borderline test result are initially tested for the presence of HPV. This can speed up referral to colposcopy where required and avoid referral where HPV is not found. If this test is negative, the women are returned to the screening programme for routine recall. Further information is available from: 21 Those with a negative test result and suspend recall status could include some who were referred to colposcopy due to symptoms noted at the time of testing. 22 NB: Where the test result is negative with a repeat recall status, a further test is usually required within 12 months of the previous test. 32

33 26.7% of women whose most severe test result in the year was mild dyskaryosis had a repeat recall status (see table M); the corresponding proportion for borderline was 70.5%, and for inadequate 97.1%. The remaining majority of women in these three groups had a suspend recall status Suspend recall status, action code S, is an indication that recall has been suspended due to referral. This is the only allowable status following a test result of moderate dyskaryosis or worse. It is also used for women who are referred after repeated low-grade abnormalities and for women who are to remain under hospital care regardless of their test result. In , all women whose most severe test result in the year was moderate dyskaryosis or worse had a suspend recall status; no women were recorded with repeat recall status (see Table M). 33

34 Cervical Cytology 3.1 Samples examined Just under 3.7 million samples were examined by pathology laboratories in ; similar to the numbers examined in Of the 3.7 million samples examined in , 3.4 million (93.2%) were submitted by GPs and NHS community clinics almost all these would have been samples taken as part of the screening programme. A further 0.2 million (5.7%) of the samples were from NHS hospitals - most of these were likely to have been samples taken following the discovery of symptoms or cytological abnormality (see Table N). Table N: Number of samples examined by pathology laboratories by source of sample, , NHS Total GP NHSCC GUM Hospital Private Other ,676,196 3,294, ,977 19, ,290 10,690 11, ,689,091 3,330, ,734 18, ,922 9,540 11,851 Source: KC61, The NHS Information Centre. See also Table 14 in Data Tables section The use of Liquid Based Cytology (LBC), which is a way of preparing cervical samples for examination in the laboratory, began in April 2001 with three pilot laboratories. In October 2003 the National Institute for Clinical Excellence recommended its use nationally. It was expected that the use of LBC would substantially reduce the proportion of inadequate samples, and figures for recent years confirm this. During , a number of laboratories began the conversion to LBC and by the end of all laboratories had converted Before the introduction of Liquid Based Cytology (LBC) technology, rates of inadequate samples submitted by GP and NHS Community Clinics for women aged were between 9% and 10% each year and these women had to be tested again. As LBC has been rolled out across the country this rate has fallen significantly and in was at a record low of 2.5%. In the rate of inadequate samples for women aged was 2.7% (91,304 samples) - see Table O. Figure 9 shows the trend in the 34

35 proportion of inadequate samples from GP and NHS Community Clinics since for women of all ages. Table O: Number of GP and NHS Community Clinic samples examined by pathology laboratories, number and proportion inadequate by year for women aged 25-64, to Year No of samples examined No of inadequate samples Percentage inadequate samples ,347, , ,418, , ,187, , ,213,972 94, ,584,346 90, ,289,856 93, ,337,248 91, Source: KC61, The NHS Information Centre. See also Table 15 in Data Tables section. NB: Before women aged were included in the screening programme, therefore only the percentage of inadequate samples are quoted for comparison. Figure 9 - Cervical cytology: Percentages of samples from GP & NHS Community Clinics found to be inadequate, from women of all ages, England 2002 to 2011 Percentage Data prior to 2005, re-used with the permission to the Department of Health Source: KC61, The NHS Information Centre. See also Table 15 in Data Tables section. 35

36 3.1.4 Analysis by age group has shown that the proportion of samples found inadequate was generally lower for women in the younger age bands, below 55 years (see Table P). Table P: GP and NHS Community Clinic samples examined by pathology laboratories, proportion inadequate by age of women, Age % Inadequate Age % Inadequate Under and over All ages Source: KC61, The NHS Information Centre. See also Table 15 in Data Tables section At laboratory level, there was variation in the proportion of samples judged to be inadequate. In , all laboratories had inadequate results of less than 8%, with only 8 laboratories with inadequate rates of over 5% - see Figure 10. Figure 10 - Cervical cytology: Percentage of samples from GP & NHS Community Clinics found to be inadequate, for women aged 25-64, by laboratory, England Number of laboratories % inadequate NB: Due to rounding, the figures presented in the above bar chart may not exactly match those derived from aggregating the relevant columns from Table 19 in the Data Tables section. Source: KC61, The NHS Information Centre. See also Tables 19 in Data Tables section. 36

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