Cervical Screening Programme, England - 2020-21 [NS]

• 176,561 referrals to colposcopy were reported in 2020-21, a decrease of 7.8% from 2019-20 (191,563).
• 68.2% of referrals were reported as being triggered by a screening test.
• 23.8% of referrals were clinically indicated (women referred because they had symptoms of a cervical abnormality).
• The proportion of referrals for ‘other’ reasons increased from 6.9% in 2019-20 to 7.9% in 2020-21. The other category also includes individuals referred with HPV positive cytology negative results following previous attendance at colposcopy.

For further information see data table 20 in the Excel data tables file.

Time from referral to first offered appointment is defined as the time between the date on the referral letter and the first offered outpatient appointment, regardless of whether the appointment was attended or not¹.

In 2020-21:

• 33.9% of individuals were offered an appointment within 2 weeks of referral. This compares to 36.1% in the previous year.
• 53.4% were offered an appointment within 4 weeks of referral. This compares to 60.7% in the previous year.
• 79.4% were offered an appointment within 6 weeks of referral. 
• 92.9% with a referral type of ‘High-grade dyskaryosis moderate/severe’ were offered an appointment within 2 weeks.
• 93.1% with a referral type of ‘High-grade dyskaryosis moderate or worse’ were offered an appointment within 2 weeks. This meets the programme standard for at least 93% to be offered an appointment within 2 weeks².  
• In 7.6% of cases, the time from referral to first offered appointment was over 12 weeks. This is an increase from 1.1% the previous year.

* ?invasive carcinoma means ‘suspected invasive carcinoma’, ?glandular neoplasia means ‘suspected glandular neoplasia of endocervical type’.
Source: KC65, NHS Digital. See data tables 20 and 21

In 2020-21: 

• 69.5% of all appointments were attended
• 2.1% of appointments were cancelled by patients on the day
• 7.3% of appointments involved the patient not attending with no advance warning
• The lowest attendance was seen for follow up appointments (56.4%)

Comparison between 2019-20 and 2020-21 data is shown in the data table:

NB. The sum of components may not equal totals due to rounding.
Source: KC65, NHS Digital. See data table 22
.

Most first attendances will relate to a referral in that year, although some individuals attending may have been referred in a previous year and some of those referred in 2020-21 will attend in the next year.

The data collected relate only to procedures undertaken the first time an individual attends. 

In 2020-21:

• 56.1% of all those attending for the first time had some treatment or procedure. This compares to 55.0% in 2019-20.
• For all referrals, the most common treatment or procedure was diagnostic biopsy (44.2%)
• The most common treatment differed between referrals for borderline or low-grade abnormalities (diagnostic biopsy – 54.3%) and high-grade abnormalities (excision – 53.7%)

NB: The sum of components may not equal totals due to rounding.

'-' indicates true zero, 0.0 indicates a value above zero that rounds to 0.0
* Includes ‘other’ referral indications that cannot be broken down into a specific category.
** Includes ?invasive carcinoma which means ‘suspected invasive carcinoma, and ?glandular neoplasia which means ‘suspected glandular neoplasia of endocervical type’.
Source: KC65, NHS Digital. See data table 23.

In 2020-21:

• The percentage of all those receiving some treatment or undergoing a procedure at their first visit ranged from 46.0% in the East of England to 65.9% in the South East.
• Diagnostic biopsy was the most common procedure used across all regions, ranging from 33.5% of attendances in the East of England to 52.4% in London.
• Excision was the next most common procedure, ranging from 3.0% in London to 14.1% in the East Midlands.
• See Table 23 in the Excel data tables file for a full breakdown of the data by region, type of procedure and referral indication.

This is the time between the date on which the biopsy was taken and the date on the letter that is sent to the patient.

In order to allow time for follow up of results, the data relates only to those biopsies taken in the first month of each quarter.
The data include all biopsies taken, not just those taken on first attendance. It is possible that more than 1 biopsy may be taken from the same individual.

There are 2 national standards relating to timeliness of biopsy result letters.

1. Acceptable level: At least 90% of result letters sent within 4 weeks.
2. Achievable level: 100% of result letters sent within 8 weeks.

In 2020-21:

• 38,796 biopsies with a time to result recorded, were reported by clinics in the 4 sample months.
• The individual was informed of their result within 2 weeks in 47.0% of all cases, and in 39.1% of cases, individuals were informed within 2 to 4 weeks.
• In 0.8% of cases, individuals had not been informed of their results within 12 weeks. This figure includes cases where the result had not yet been reported to the clinic.
• Neither national standard was met in 2020-21. 86.0% of letters were sent within 4 weeks, and 98.2% with 8 weeks.

Of all biopsies reported in 2020-21 with an outcome recorded (38,796), 67.0% were diagnostic and the remaining 33.0% were classed as treatment.

Excisional biopsies represent treatment to remove abnormal cells from the cervix. The outcome of most of these is therefore expected to be CIN2 or worse (CIN2, CIN3, adenocarcinoma in situ or cancer).

Of all known treatment biopsy outcomes, 73.2% showed CIN2 or worse. This is an increase from 2019-20, when the equivalent proportion was 72.5%. Increase in detection for CIN2 or worse is an expected consequence of the change to HPV primary screening.

NB: The sum of components may not equal totals due to rounding.
Source: KC65, NHS Digital. See data table 25.

1. This could include instances where patients had requested a delayed appointment for personal reasons or where treatment for another condition had to be completed before colposcopy could take place.
2. See https://www.gov.uk/government/publications/cervical-screening-programme-standards/cervical-screening-programme-standards-valid-for-data-collected-from-1-april-2018