Cervical Screening Programme

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Cervical Screening

Programme

England

2010-11

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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.

www.ic.nhs.uk

Author: The NHS Information Centre, Screening and Immunisations team Responsible Statistician: Clare McConnell, Section Head

Version: 1.1

Date of Publication: 24th November 2011

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3 Executive Summary

4 Introduction

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1.1 Background 6 1.2 Quality Statement 8 1.3 Report Structure 13 1.4 Experimental Statistics 14 1.5 Changes to the Report 15 1.6 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

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Executive Summary

Cervical Screening Programme, England 2010-11

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 2010-11 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 25-64 years is used to report statistics.

Main Findings

At 31st 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 2010-11, 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).

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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 2007-08 when it first became possible to monitor 2 week availability. In 2009-10, 44.6% of test results were available within 2 weeks. In 2010-11, this figure was considerably higher at 82.8%.

Just under 3.7 million samples were examined by pathology laboratories in 2010-11; similar to the numbers examined in 2009-10. Of the 3.7 million samples examined in 2010-11, 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 2010-11 to 92.9% from 60.5% in 2009-10. A further 6.1% were authorised within 4 weeks.

In 2010-11, 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.

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Introduction

This report presents information about the NHS Cervical Screening Programme in England in 2010-11 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 1995. 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 2005.

1.1 Background

1.1.1 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 25-49 are invited every 3 years, whereas those aged 50-64 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 25-64 years has been used to report statistics.

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Call and recall programme

1.1.2 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.

1.1.3 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

1.1.4 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 2010-11 NHS Operating Framework which stated that the target should be achieved for all women by the end of 2010’1.

1.1.5 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.

1.1.6 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.

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Cancer Reform Strategy, 2007, Department of Health -

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Colposcopy

1.1.7 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:

www.ic.nhs.uk/pubs/cervscreen1011

Data Sources

1.2.1 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 2000-01.

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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 system2.

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 http://www.datadictionary.nhs.uk/data_dictionary/messages/central_return_for ms/community/kc53/kc53_fr.asp?shownav=1 KC61 http://www.datadictionary.nhs.uk/data_dictionary/messages/central_return_forms/comm unity/kc61/kc61_fr.asp?shownav=1 KC65 http://www.datadictionary.nhs.uk/data_dictionary/messages/central_return_forms/comm 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:

http://www.ic.nhs.uk/statistics-and-data-collections/publications-calendar/administrative-sources/list-of-administrative-sources

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

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(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.

1.2.2 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.

1.2.3 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:

http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-screening/cervical-screening-programme-england-2009-10

1.2.4 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:

http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-screening

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.

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1.2.5 Coherence and Comparability

Changes in Screening Policy

Screening policy changed in 2003. Prior to this, women aged 20-64 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 25-49 were invited for screening every 3 years whereas those aged 50-64 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 2.1.7

1.2.6 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:

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• 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.

1.2.7 Data Revisions

Subsequent to publishing the Cervical Screening Programme, England, 2009-10 report on 21st 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 22nd 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:

http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-screening/cervicalscreening-programme-england-2009-10

Where this report uses 2009-10 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.

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1.3 Report Structure

1.3.1 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

1.3.2 More detailed tables are presented in the Data Tables section.

1.3.3 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.

1.3.4 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.

1.3.5 Appendix A contains Definitions which users may find useful when reading this report. A definition of coverage is included in this appendix.

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1.4 Experimental Statistics

1.4.1 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: [email protected]

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: 0845 300 6016 [email protected]

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1.5 Changes to the Report

1.5.1 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

1.6.1 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:

www.ic.nhs.uk/pubscervscreen1011

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.

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Analysis and Commentary

Call and Recall Programme

2.1 Coverage

2.1.1 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 50-64.

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 64.

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The eligible population is the PCT’s responsible population3 excluding those women whose recall to screening has been ceased for clinical reasons (most commonly due to hysterectomy).

2.1.2 At 31st 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).

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Table A: Cervical Screening: Coverage by Age Group, at 31st March 2010 and 2011

Coverage

Year

25-49 years

(less than 3.5 years since last adequate test) (%)

50-64 years

(less than 5 years since last adequate test) (%)

25-64 years

(less than 5 years since last adequate test) (%)

2010 74.0 78.9 78.9

2011 73.7 78.0 78.6

Source: KC53, The NHS Information Centre. See also Table 13 in Data Tables section.

Figure 1 shows coverage of the target age group since 2002.

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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.

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Figure 1: Cervical screening: Coverage of the target age group (25-64), England at 31st

March, 2002 to 2011 65 70 75 80 85 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2006 data as at 10th August 2006

since last adequate test)

2.1.3 The fall in coverage in 2010-11 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 2010. Among women in the older age range, 50 to 64 years (who are invited every 5 years), coverage on 31st 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 31st March, 2010 and 2011

62.8% 72.8% 76.9% 78.7% 79.1% 82.6% 78.3% 75.1% 62.5% 72.8% 76.5% 78.4% 78.7% 82.6% 76.9% 73.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 Age C ov e rage 2010 2011

25-49 (coverage <3.5 yrs since last test) 50-64 (coverage <5 yrs since last test)

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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 25-64 age group by SHA, 31st March 2010 and 2011

Coverage (Less than 5 years since last adequate test) (%) SHA

2010 2011

England 78.9 78.6

North East 80.1 79.5

North West 78.4 78.0

Yorkshire & the Humber 80.2 79.9

East Midlands 82.1 81.4

West Midlands 78.5 78.0

East of England 80.6 80.3

London 73.9 74.0

South East Coast 80.2 80.1

South Central 79.5 79.7

South West 80.9 80.5

2.1.5 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, 31st March 2011

2 26 66 57 0 0 25 50 75 65 70 75 80 85

Coverage (% of eligible population less than 5 years since last test)

65 70 75 80 85 90

Number of PCOs

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.

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Figure 3a - Cervical screening: coverage of the target age group (25-64) by Primary Care

Organisation, England, 31st March 2011

2.1.6 Where coverage is calculated to include those with recall ceased for clinical reasons4, 73.3% of women in the 25-64 age group were recorded as being tested within 5 years of their last adequate test on 31st March 2011. 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)

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Table C: Test status of women aged 25-64 at 31st 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 14681.1 991.3 4616.6 4146.6 682.3 1314.3 1005.5 337.5 252.3 26.3 1287.1 21.4 (%) 6.8 31.4 28.2 4.6 9.0 6.8 2.3 1.7 0.2 8.8 0.1

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.

2.1.7 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 20-60 years.

Table D: Coverage by Country at 31st 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) (%)

England5 13,689.8 10,759.7 78.6

Northern Ireland6 472.0 365.0 77.3

Scotland7 1,455.1 1,150.5 79.18

Wales9 744.1 592.4 79.6

Source for England figure: KC53, The NHS Information Centre. See also Table 2 in Data Tables section.

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In England women between the ages of 25-64 years are invited for screening. Women aged 25-49 are invited every 3 years and those aged 50-64 are invited every 5 years.

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The Northern Ireland screening programme targets women aged 20-64 but reports on those aged 25-64. Prior to January 2011, women in Northern Ireland were invited for screening every 5 years. However, since January 2011 women aged 25-49 have been invited every 3 years.

7 The Scottish screening programme targets women aged 20-60, who are invited for screening every 3 years.

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Scotland coverage figure is for within 5.5 years since last adequate test. For further information on Scottish data, please contact: [email protected]

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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 25-64 years

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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

2.2.1 The number of women aged 25 to 64 invited for screening increased by 259,085 (6.4%) in 2010-11, taking the total number of invitations for this age group to 4.3 million (see Table E). In 2009-10, 4.1 million women in this age group were invited for screening.

Within the 25-49 years age group, 3.4 million women were invited for screening in 2010-11 an increase of 120,024 (3.7%) from 2009-10.

A total of 955,331 women aged 50-64 were invited for screening in 2010-11, an increase of 139,061 (17.0%) from the previous year.

2.2.2 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 25-49 were invited for screening every 3 years whereas those aged 50-64 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.

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Table E: Number of women invited for screening by year and age group from 2006-07 to 2010-11 2006-07 2007-08 2008-09 2009-10 2010-11 %change from 2009-10 to 2010-11 Under 20 1,033 715 617 631 481 20-24 228,464 116,105 57,490 54,345 52,315 25-29 693,448 739,982 757,760 806,609 790,300 30-34 606,956 642,226 648,856 630,020 650,246 35-39 628,554 700,644 686,813 631,028 632,789 40-44 591,196 696,853 682,413 622,020 667,406 45-49 484,767 596,624 600,915 563,439 632,399 25-49 3,004,921 3,376,329 3,376,757 3,253,116 3,373,140 3.7% 50-54 380,122 409,116 382,686 345,924 390,952 55-59 337,906 222,787 144,092 244,993 293,530 60-64 284,406 169,737 117,117 225,353 270,849 50-64 1,002,434 801,640 643,895 816,270 955,331 17.0% 65-69 63,550 33,543 31,350 48,579 51,911 70-74 15,092 6,340 7,963 11,459 10,548 75 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 4,447,846 6.2% Total (25-64) 4,007,355 4,177,969 4,020,652 4,069,386 4,328,471 6.4%

Figure 4: Number of women invited for screening by age group and year, 2006-07 to 2010-11 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000 4,500,000 2006-07 2007-08 2008-09 2009-10 2010-11 Year Nu m b e r 25-49 50-64 25-64

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2.2.3 Table F shows that although most invitations to women aged 25 to 64 were calls10 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, 2009-10, 2010-11

Repeat in less than 3 years for reasons of

Year Total Call

Routine

Recall Surveillance Abnormality

Inadequate Sample

2009-10 4,069,386 16.2% 61.1% 15.8% 4.3% 2.5%

2010-11 4,328,471 16.5% 63.3% 14.5% 3.6% 2.1%

2.2.4 As the number of women invited for screening increased over the previous year, the number of women tested has also increased. In 2010-11, 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 2009-10 and 3.6 million in 2008-09.

Although the number of women aged 25-49 years invited for screening increased in 2010-11 (see paragraph 2.2.1), the number of women tested fell. A total of 2.6 million women aged 25-49 were tested in 2010-11, a fall of 51,681 (2.0%) from 2009-10.

A total of 0.8 million women aged 50-64 were tested in 2010-11, an increase of 130,641 (19.5%) from 2009-10.

2.2.5 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 2.2.2 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 2008-09 might be partly explained by the well publicised battle against cervical cancer of a high profile media personality.

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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.

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Table G: Number of women tested by year and age group from 2006-07 to 2010-11

Figure 5: Number of women tested by year and age group, 2006-07 to 2010-11

0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000 2006-07 2007-08 2008-09 2009-10 2010-11 Year Nu m b e r 25-49 50-64 25-64

2006-07 2007-08 2008-09 2009-10 2010-11 % change from 2009-10 to 2010-11 Under 20 3,508 2,840 3,595 2,874 1,885 20-24 138,935 96,926 76,661 55,068 38,040 25-29 454,349 472,712 588,957 565,990 549,768 30-34 461,154 461,219 562,404 508,757 494,047 35-39 511,226 527,867 622,815 526,415 488,798 40-44 497,917 539,477 632,643 525,848 523,001 45-49 414,496 469,231 550,703 476,331 496,046 25-49 2,339,142 2,470,506 2,957,522 2,603,341 2,551,660 -2.0% 50-54 318,443 336,905 364,016 308,269 323,305 55-59 283,898 223,852 157,573 185,676 235,426 60-64 229,157 191,976 128,262 174,881 240,736 50-64 831,498 752,733 649,851 668,826 799,467 19.5% 65-69 47,696 42,788 32,262 36,406 44,359 70-74 7,216 6,457 5,727 5,613 5,485 75 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 3,442,808 2.0% 25-64 3,170,640 3,223,239 3,607,373 3,272,167 3,351,127 2.4%

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2.2.6 Of those aged 25-64 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, 2007-08 to 2010-11

Invited Outside Programme Total

Number Number % Number %

2007-08 3,223,239 2,592,213 80.4 631,026 19.6

2008-09 3,607,373 2,870,904 79.6 736,469 20.4

2009-10 3,272,167 2,626,796 80.3 645,371 19.7

2010-11 3,351,127 2,795,131 83.4 555,996 16.6

2.3 Test results

2.3.1 Some women have more than one test during the year for clinical reasons12 and the 3.4 million women of all ages tested in 2010-11 generated 3.7 million tests (see Table I).

alysis (see paragraphs 3.1.2-3.1.5 below for more information on inadequate samples).

2.3.2 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 an

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.

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27 Table I: Number of tests and result, 2010-11

Result of Test _{Number of Tests} Percentage _(%)

Inadequate 102,779 2.8

Adequate 3,559,557 97.2

Total 3,662,336 100.0

2.3.3 For women tested again due to an earlier inadequate test, 11.1% of tests resulted in a repeated inadequate result, a decrease on 2009-10 (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, 2009-10, 2010-11

2009-10 2010-11 Result of Test Number of tests Percentage (%) Number of tests Percentage (%) Inadequate 11,547 11.4 9,818 11.1 Adequate 89,492 88.6 78,299 88.9 Total 101,039 100.0 88,117 100.0

2.3.4 Of the 3.3 million women aged 25-64 who had an adequate result in 2010-11, 93.4% were negative and 6.6% had a result categorised as abnormal (from borderline changes through to severe dyskaryosis and potential cancer13). Table K shows the breakdown of the results of adequate tests for the last 2 years.

13

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Table K: Results of adequate tests for women aged 25-64, 2009-10, 2010-11

Result* 2009-10 % 2010-11 % Negative 92.8 93.4 Borderline changes 3.7 3.5 Mild dyskaryosis 2.1 1.9 Moderate dyskaryosis 0.6 0.5 Severe dyskaryosis 0.7 0.6

Severe dyskaryosis/?invasive carcinoma 0.0 0.0

?Glandular neoplasia 0.1 0.0

Total 100.0 100.0

NB: The sum of components may not equal totals due to rounding. *Most severe result in year

2.3.5 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 60-64 (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 2010-11

1.70 0.97 0.64 0.45 0.30 0.25 0.26 0.21 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 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.

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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 2010-11

14 39 35 30 17 13 3 0 5 10 15 20 25 30 35 40 45 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Number of PCOs

Percentage of abnormal samples

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

2.4 Time from screening to receipt of results14

2.4.1 The Cancer Reform Strategy15, states that women should receive their cervical screening test result within 2 weeks and this commitment was highlighted in the 2010-11 NHS Operating Framework which stated that ‘all women should receive the results of their cervical screening tests within 2 weeks by 2010’16. 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 2010-11 for the NHS in England, 2009, Department of Health

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_ 110159.pdf

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2.4.2 In 2010-11, 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 2010-11 reporting period.

Table L: Time from screening to receipt of results, as measured by expected delivery date

of result letter (eligible women aged 25 – 64 years), 2010-11

2010-2011

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.

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 reported18. The percentage of test results available within 2 weeks has increased each year since 2007-8 when it first became possible to monitor 2 week availability19. In 2007-08, 11.1% of test results were available within 2 weeks of screening. By 2009-10, 44.6% of test results were available within 2 weeks and in 2010-11 this figure was considerably higher again at 82.8% (see Table 9 in Data Tables). The percentage of results available within 2 weeks in 2010-11 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 2007-8, the lowest timescale available was the percentage of tests results available within 4 weeks.

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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 25 – 64 years), 2010-11 78.9 90.1 68.7 89.5 80.3 70.6 87.8 81.8 71.0 63.9 88.4 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 England North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East Coast South Central South West % Up to 2 weeks

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.

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2.5 Recall status

2.5.1 Normal recall status, indicated by action code A (routine recall) is usually used only where the test result is negative. However, HPV sentinel sites20 (introduced in 2007-08) 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 2010-11, 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 care21 (see table M).

Table M: Recall status by most severe screening result, 2010-11

Recall status Normal (%) Repeat (%) Suspend (%) Inadequate 0 97.1 2.9 Negative 85.3 13.9 0.9 Borderline changes 2.7 70.5 26.8 Mild dyskaryosis 0.8 26.7 72.5 Moderate dyskaryosis 0 0 100 Severe dyskaryosis 0 0 100

Severe dyskaryosis/?invasive carcinoma 0 0 100

?Glandular neoplasia 0 0 100

2.5.2 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 2010-11,

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 tocolposcopy 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: www.cancerscreening.nhs.uk/cervical/hpv-triage-test-of-cure.html.

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.

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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.

2.5.3 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 2010-11, 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).

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Cervical Cytology

3.1 Samples examined

3.1.1 Just under 3.7 million samples were examined by pathology laboratories in 2010-11; similar to the numbers examined in 2009-10. Of the 3.7 million samples examined in 2010-11, 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, 2009-10, 2010-11

Total GP NHSCC GUM

NHS

Hospital Private Other

2009-10 3,676,196 3,294,448 120,977 19,816 218,290 10,690 11,975

2010-11 3,689,091 3,330,871 108,734 18,173 209,922 9,540 11,851

3.1.2 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 2004-05, a number of laboratories began the conversion to LBC and by the end of 2008-09 all laboratories had converted.

3.1.3 Before the introduction of Liquid Based Cytology (LBC) technology, rates of

inadequate samples submitted by GP and NHS Community Clinics for women aged 25-64 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 2008-09 was at a record low of 2.5%. In 2010-11 the rate of inadequate samples for women aged 25-64 was 2.7% (91,304 samples) - see Table O. Figure 9 shows the trend in the

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proportion of inadequate samples from GP and NHS Community Clinics since 2001-2 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, 2001-02 to 2010-11 Year No of samples examined No of inadequate samples Percentage inadequate samples 2001-02 - - 9.2 2002-03 - - 9.4 2003-04 - - 9.3 2004-05 3,347,878 299,652 9.0 2005-06 3,418,327 247,013 7.2 2006-07 3,187,577 149,064 4.7 2007-08 3,213,972 94,188 2.9 2008-09 3,584,346 90,401 2.5 2009-10 3,289,856 93,071 2.8 2010-11 3,337,248 91,304 2.7

NB: Before 2004-05 women aged 20-24 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

0 1 2 3 4 5 6 7 8 9 10 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Percentage

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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, 2010-11

Age % Inadequate Age % Inadequate

Under 20 3.5 50-54 2.8 20-24 2.5 55-59 3.6 25-29 2.4 60-64 3.5 30-34 2.6 65-69 3.8 35-39 2.7 70-74 4.3 40-44 2.6 75 and over 8.6 45-49 2.5 All ages 2.7 25-64 2.7

3.1.5 At laboratory level, there was variation in the proportion of samples judged to be inadequate. In 2010-11, 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 2010-11

9 28 33 21 10 5 3 0 5 10 15 20 25 30 35 % inadequate Number of laboratories 1 2 3 4 5 6 7 8

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3.2 Results

3.2.1 The percentage of adequate GP and NHS Community Clinic samples tested in 2010-11 for women aged 25-64, which were reported as being negative was 93.9%. Borderline changes were found in 3.5% of adequate tests, mild dyskaryosis in 1.6%, moderate dyskaryosis in 0.4% and severe dyskaryosis in 0.5%; suspected invasive carcinoma or glandular neoplasia were found in less than 0.1% of samples (see Table Q).

Table Q: GP and NHS Community Clinic adequate samples (women aged 25-64) examined by pathology laboratory by result, 2010-11

Test Result Number Percentage

Negative 3,046,658 93.9 Borderline changes 114,009 3.5 Mild dyskaryosis 52,306 1.6 Moderate dyskaryosis 14,102 0.4 Severe dyskaryosis 16,954 0.5 ?Invasive carcinoma 619 0.0 ?Glandular neoplasia 1,296 0.0 Total Adequate 3,245,944 100.0

Source: KC61, The NHS Information Centre. See also Table 15 in Data Tables section, which includes figures for inadequates.

3.2.2 Analysis of test results by age group showed that, up to the age of 64, the older the women the higher the proportion of tests found to be negative (see Table 15 in Data Tables). The proportion of tests showing suspected invasive carcinoma or glandular neoplasia was also higher in the older age groups. Borderline changes, mild dyskaryosis and moderate dyskaryosis occurred more frequently in samples from younger women; the proportion of tests showing severe dyskaryosis was highest in samples from women aged 20-29.

3.2.3 At laboratory level there was variation in the percentage distribution of results, in particular in the proportion reported as borderline or mild (see Table 19 in Data Tables).

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3.2.4 The distribution of the individual laboratory results is used for quality assurance purposes, as set out in sections 8.2 – 8.4 of the second edition of ‘Achievable standards, benchmarks for reporting and criteria for evaluating cervical cytopathology’, NHSCSP publication No 1, May 200023. This document sets achievable targets and standards for laboratories engaged in cervical screening.

3.2.5 Achievable standards for laboratory reporting are set from the 10th and 90th percentiles24 of the distributions of three key indicators. The ranges for 2009-10 and 2010-11 are set out in Table R which report on women aged 25-64 tested in GP or NHS Community Clinics.

Table R: Achievable Standards for Laboratory Reporting, 2009-10, 2010-11

Indicator 10th – 90th percentile range*

2009-10 2010-11

Mild/Borderline as % of adequate samples 3.9% - 7.4% 3.6% – 7.4%

Moderate or worse as % of adequate samples 0.8% - 1.5% 0.7% - 1.3%

PPV for CIN2 or worse 74.2% - 90.3% 77.0 – 90.0%

Number of laboratories whose results were used 113 109**

*Based on results for women aged 25-64 tested in GP & NHS Community Clinics

** The percentile range for PPV for CIN2 or worse is based on 104 laboratories as 5 were unable to provide data.

3.2.6 The percentage of laboratory tests authorised (i.e. test results confirmed) within 2

weeks of receipt at the laboratory increased in 2010-11 to 92.9% from 60.5% in 2009-10 – see Table S. A further 6.1% were authorised within 4 weeks. At a laboratory level there was wide variation within these timeframes (see Table 16a in the Data Tables). The percentage of tests authorised within 2 weeks in 2010-11 is likely to have been impacted by the requirement for all women to receive the results of their tests within 2 weeks by 2010 (see sections 2.4.1-2.4.2)

23

http://www.cancerscreening.nhs.uk/cervical/publications/cc-02.html

24

A percentile is the value of a variable below which a certain percent of observations fall. For example, the 10th percentile is the value (or score) below which 10 percent of the observations may be found.

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Table S: Samples examined by pathology laboratories - Time from receipt of sample to authorisation of report by laboratory, 2009-10, 2010-11

<2 weeks % 3-4 weeks % 5-6 weeks % 7-8 weeks % 9-10 weeks % >10 weeks % 2009-10 60.5 19.0 11.5 5.2 2.9 0.8 2010-11 92.9 6.1 0.8 0.2 0.0 0.0

3.3 Outcome of gynaecological referrals

3.3.1 Information about outcomes of gynaecological referrals following tests registered during April – June 2010 was provided by all laboratories with sizeable numbers of screening programme tests (see Table T).

Table T: Outcome of referrals for samples registered at the laboratory between April and June 2010

Outcome

Women referred after persistent non-negative samples

%

Women referred after single occurrence of potentially significant

abnormality %

Cervical Cancer 0.1 2.7

CIN3 & Adenocarcinoma in Situ 6.1 55.8

CIN2 9.7 23.5

CIN1 25.4 8.8

Non Cervical Cancer 0.0 0.4

HPV Only 13.7 2.3

No CIN/No HPV 11.2 3.3

Seen in Colposcopy – result n/k 0.5 0.3

Inadequate Biopsy 1.9 0.5

Other

Colposcopy – No Abnormality Detected

31.3 2.3

Source: KC61, The NHS Information Centre. See also Table 18a in Data Tables section.

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3.3.2 Figure 11 shows the outcomes for women referred following persistent

non-negative tests where the referral outcome was known. 0.1% were found to have cervical

cancers and 6.1% showed cervical intra-epithelial neoplasia (CIN) 325 or adenocarcinoma in situ. The first column of figures in Table T gives a full breakdown of the outcomes of these referrals (including the large ‘Other’ category in Figure 11) and shows that in 31.3% of referrals no abnormality was detected at colposcopy.

Figure 11 - Outcome of referral, following persistent non-negative test result, England, April 2010 - June 2010 Cervical Cancer, 0.1 CIN3 or Adenocarcinoma in situ, 6.1 CIN2, 9.7 CIN1, 25.4

Non Cervical Cancer, 0.0 Other, 58.6

3.3.3 For referrals with known outcomes following a single occurrence of a potentially

significant abnormality, 2.7% were found to be cervical cancers, and 55.8% showed CIN

3 or adenocarcinoma in situ – see Figure 12. The second column of figures in Table T gives a full breakdown of the outcomes of these referrals.

25

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Figure 12 - Outcome of referral, following single occurrence of potentially significant abnormality, England, April 2010 - June 2010

CIN3 or Adenocarcinoma in situ, 55.8

CIN2, 23.5 CIN1, 8.8

Cervical Cancer, 2.7

Non Cervical Cancer, 0.4

Other, 8.8

3.3.4 A positive predictive value (PPV) was calculated for each laboratory. Positive Predictive Value is a measure of the laboratory’s ability to predict CIN2 or worse from tests with result moderate dyskaryosis or worse. The PPV calculation for cervical screening is outlined in Appendix A on Definitions. Reported PPVs for laboratories ranged from 63% to 97% with the majority lying between 75% and 95% (see Figure 13). The achievable standard for 2011-12 which is based on the PPV distribution for 2010-11 is shown in Table R above.

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Figure 13 - Positive Predictive Value26, England, April 2010 - June 2010

2 5 10 20 22 26 18 2 0 5 10 15 20 25 30 35 40 55 60 65 70 75 80 85 90 95 Number of Laboratories

Positive Predictive Value (%)

55 60 65 70 75 80 85 90 95 100

NB: 3 laboratories did not provide this information and so are excluded from Figure 13.

3.3.5 Retrospective information regarding referrals from an earlier complete year was collected again in 2010-11, relating to referrals in the 12 month period April 2009 to March 2009-10. The results from the whole year (2009-10) were similar to the first quarter of 2010-11.

26

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Colposcopy

4.1 Referrals for colposcopy

4.1.1 Details of the first referrals of each quarter to each clinic were recorded. In 2010-11, 142,984 referrals to colposcopy were reported, a decrease of 7.9% from 2009-10 (155,265 referrals). Of these, 75.1% were reported as being triggered by a screening test and 20.0% were clinically indicated. Of women referred to colposcopy, 48.2% followed findings of borderline changes or mild dyskaryosis; 11.0% of referrals followed findings of moderate dyskaryosis and 14.4% followed findings of severe dyskaryosis or worse (see Table U).

Table U: Women referred to colposcopy: referral indication of first offered appointment, 2009-10, 2010-11

_{2009-10 2010-11}

Total number of referrals 155,265 142,984

% %

Screening sample – Total* 78.6 75.1

Inadequate 1.6 1.5

Borderline changes 17.9 19.2

Mild dyskaryosis 31.0 29.0

Moderate dyskaryosis 12.3 11.0

Severe dyskaryosis 14.6 13.2

Severe dyskaryosis/?invasive carcinoma** 0.4 0.4

?Glandular neoplasia** 0.8 0.8

Clinical indication – urgent 4.2 4.5

Clinical indication - non urgent 13.3 15.4

Other 3.9 5.0

Total 100 100

* Sum of inadequate, borderline changes, mild dyskaryosis, moderate dyskaryosis, severe dyskaryosis, severe dyskaryosis/?invasive carcinoma, ?glandular neoplasia

** ?invasive carcinoma means ‘suspected invasive carcinoma’, ?glandular neoplasia means ‘suspected glandular neoplasia’

Where categories are aggregated in the text (e.g. percentage of first referrals that are clinically indicated) they are calculated from the raw data and therefore may not match the summed categories in the table.

Cervical Screening Programme