Cervical Screening Programme, England - 2021-2022 [NS]

• 235,223 referrals to colposcopy were reported in 2021-22, an increase of 33.2% from 2020-21 (176,561).
• 67.7% of referrals were reported as being triggered by a screening test.
• 20.8% of referrals were clinically indicated (women referred because they had symptoms of a cervical abnormality).
• The proportion of referrals for ‘other’ reasons increased from 7.9% in 2020-21 to 11.6% in 2021-22. The other category also includes individuals referred with hrHPV positive cytology negative results following previous attendance at colposcopy.

• Increase in referrals to colposcopy are expected under hrHPV primary screening. Additionally, there are more surveillance recalls as well as  increased screening activity in 2021-22 compared to 2020-21 due to changes in the eligible population and bounce-back from COVID-19 disruption in 2020-21. 

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 2021-22:

• 29.6% of individuals were offered an appointment within 2 weeks of referral. This compares to 33.9% in the previous year.
• 47.7% were offered an appointment within 4 weeks of referral. This compares to 53.4% in the previous year.
• 80.4% were offered an appointment within 6 weeks of referral. 
• 93.7% with a referral type of ‘High-grade dyskaryosis moderate/severe’ were offered an appointment within 2 weeks.
• 95.6% 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% of people with high-grade referrals to be offered an appointment within 2 weeks².  
• In 6.2% of cases, the time from referral to first offered appointment was over 12 weeks. This is a decrease from 7.6% 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

Time from referral to first offered appointment, England

In 2021-22: 

• 75.4% of all appointments were attended
• 2.1% of appointments were cancelled by patients on the day
• 6.1% of appointments involved the patient not attending with no advance warning
• The lowest attendance was seen for follow up appointments (64.4%)

Comparison between 2020-21 and 2021-22 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 2021-22 will attend in the next year.

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

In 2021-22:

• 54.9% of all those attending for the first time had some treatment or procedure. This compares to 56.1% in 2020-21.
• The most common treatment or procedure was diagnostic biopsy (44.6%)
• The most common treatment differed between referrals for borderline or low-grade abnormalities (diagnostic biopsy – 53.8%) and high-grade abnormalities (excision – 47.4%)

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.

Colposcopy procedure type for first attendances, England

In 2021-22:

• The percentage of all those receiving some treatment or undergoing a procedure at their first visit ranged from 44.7% in the East of England to 65.5% in the South East.
• Diagnostic biopsy was the most common procedure used across all regions, ranging from 33.8% of attendances in the North West of England to 54.6% in London.
• Excision was the next most common procedure, ranging from 2.6% in London to 13.0% 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 2021-22:

• 53,521 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 35.8% of all cases, and in 45.4% of cases, individuals were informed within 2 to 4 weeks.
• In 0.7% 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 2021-22. 81.3% of letters were sent within 4 weeks, and 98.0% with 8 weeks.

Source: KC65, NHS Digital. See data table 24.

Of all biopsies reported in 2021-22 with an outcome recorded (53,521), 70.7% were diagnostic and the remaining 29.3% 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, 68.4% showed CIN2 or worse. This is a decrease from 2020-21, when the equivalent proportion was 73.2%.

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