Cervical Screening Programme, England - 2022-2023 [NS]

Call
Invitation for previously unscreened individuals

Recall
Invitation for subsequent screens

Screening coverage is the percentage of individuals in a population eligible for screening at a given point in time who were screened adequately¹ within a specified period.

Coverage is reported for the 25 to 49 years and 50 to 64 years age groups and is referred to as age appropriate coverage.

Acceptable performance is defined as achieving coverage levels of 80% or greater, assessed for the 25 to 49 and 50 to 64 years age groups².

Age-appropriate coverage definition

25 to 49 = % of those eligible and registered as female aged 25 to 49 screened within the last 3.5 years on 31 March

50 to 64 = % of those eligible and registered as female aged 50 to 64 screened within the last 5.5 years on 31 March

Coverage (all ages) definition

25 to 64 = % of those eligible and registered as female aged 25 to 64 screened within the last 3.5 or 5.5 years (depending on age) on 31 March

Coverage is measured at 3.5 and 5.5 years as this allows a 6 month period for invitations to be taken up.

At 31 March 2023:

• Coverage for those eligible and registered as female aged 25 to 64 was 68.7%, a decrease of 1.2 percentage points from the previous year.
• Coverage in the lower age cohort (25 to 49) decreased to 65.8%, from 67.6% in 2022.
• Coverage in the upper age cohort (50 to 64) decreased to 74.4% from 74.6% in 2022.

At 31 March 2023, for those registered as female aged 25 to 64:

• Coverage ranged from 61.3% in London to 72.5% in the North East.
• All 9 regions reported a decrease in coverage when compared with 2022.

At 31 March 2023, for those registered as female aged 25 to 64:

• No Local Authority achieved the acceptable performance level of 80%.
• 79 of 150 LAs had coverage levels of 70% and above, a decrease of 8 compared to 2022.
• Coverage ranged from 45.9% in Kensington and Chelsea (London) to 77.0% in Derbyshire (East Midlands).

This section uses data from the KC53 dataset, it uses a historic definition of coverage providing a more detailed age breakdown.

Until a more detailed breakdown of age-appropriate coverage is available, the KC53 remains a useful resource for more detailed age group comparisons.

KC53 coverage - historic definition

25 to 49 = % of those eligible aged 25 to 49 adequately screened within the last 3.5 years on 31 March

50 to 64 = % of those eligible aged 50 to 64 adequately screened within the last 5 years on 31 March

The key difference from the current coverage definition is the time since last screening for the older age cohort (50 to 64); 5 years rather than 5.5 years.  This means that the coverage rate reported for the oldest age cohort will be lower than it is in practice as an individual invited will not necessarily have time to attend for screening before the cut off point for the data collection.

In the 25 to 49 age cohort, coverage was lowest in the youngest age group (25 to 29) and highest in the oldest age group (45 to 49).

In the 50 to 64 age cohort, coverage was lowest in the oldest age group (60 to 64) and highest in the youngest age group (50 to 54).

In 2023, individuals aged 50 to 54 had the highest reported coverage at 76.7%.

The 25-29 and 30-34 age cohorts displayed the greatest change in coverage compared to 2022 (2.4% and 2.3% reductions respectively).

Cervical screening programmes in the UK countries have different target age groups and screening frequencies. When comparing coverage among UK countries, these differences should be considered.

For England, Scotland and Wales, coverage is calculated within the past 3.5 years (age 25 to 49) or 5.5 years (age 50 to 64).

For Northern Ireland, coverage is calculated within the past 3.5 years (age 25 to 49) or 5 years (age 50 to 64).

Links to the annual cervical screening statistics reports for Scotland, Wales and Northern Ireland are provided below.

Source for Scotland

Source for Wales

Source for Northern Ireland

Individuals are invited for screening by the programme either as part of routine screening or because of a repeat screen being required. More detailed information about invitation types can be found under the 'Types of invitation' section.

The programme targets those who are registered as female and aged 25 to 64, with individuals receiving their first invitation from age 24 years and 6 months.

In 2022-2023:

• 4.62 million individuals aged 25 to 64 were invited for screening, most of whom were aged 25 to 49 (3.52 million).
• The number of individuals aged 25 to 64 years invited for screening decreased compared with the previous year (5.12 million in 2021-22)

The increase in invitations in 2021-2022 was in part due to the increased number of people being invited for early repeat tests due to hrHPV primary screening. This is in addition to the overall increase in the population eligible and a bounce back in activity in 2021-22 after disruption from COVID-19 during 2020-21.

Those in the programme may receive an invitation to screen in 1 of 5 scenarios:

The table below shows a breakdown of invitation type for 2021-22 and 2022-23, for those aged 25 to 64 in England.

Sum of components may not equal 100% due to rounding.
Source: KC53, NHS England. See data table 4.

Individuals who attend a cervical screening appointment will have their sample taken and it will then be sent to a screening laboratory for assessment. They may be tested following an invitation from the programme, or screened opportunistically i.e. if a test is overdue (not prompted by the programme) when visiting a GP or other health service.

In 2022-23, 3.43 million individuals aged 25 to 64 were tested, a decrease of 0.69 million from the previous year.

The increase in tests taken in 2021-2022 was in part due to the increased number of people being invited for early repeat tests due to hrHPV primary screening. This is in addition to the overall increase in the population eligible and a bounce back in activity in 2021-22 after disruption from COVID-19 during 2020-21. 

In 2022-23, 84.5% of individuals aged 25 to 64 who were tested, were tested following an invitation from the NHS screening programme.

Between 2021-22 and 2022-23 the total number of individuals tested following invitation decreased by 2.8% to 2.90 million.

The total number of tests not prompted by the programme increased by 2.7%, from 515,985 in 2021-22 to 529,890 in 2022-23.

Of all final results:

• 5% showed an abnormality (non-negative)
• 1% showed a high-grade abnormality

Where an individual has multiple tests during the year, the one with the most severe result will be used for classification purposes.

For detailed explanations of the different types of cytology see Appendix D.
*?invasive carcinoma means ‘suspected invasive carcinoma’
**?glandular neoplasia means ‘suspected glandular neoplasia of endocervical type’
Source: KC53, NHS England. See data table 8.

The percentage of results showing a high-grade abnormality varied with age; 1.4% for individuals aged 25 to 29 and 1.7% for those ages 30 to 34 falling to 0.6% in age bandings from 45 to 49 to 60 to 64. The decline in the percentage of high-grade abnormalities in the 25-29 age group over recent years may be connected to this age-cohort now including individuals vaccinated for HPV, which has taken place for girls aged 12 since 2008.

High grade abnormalities are more common in the younger age groups. Screening coverage is also lower in the 25-49 age group (65.8% in 2022-23) when compared to the 50-64 age group (74.4% in 2022-23).

115 of 150 LAs had between 3% and 6% of tests with an abnormal result. The maximum percentage of tests with an abnormal result was 10.2% (see data table 12).

The national standard is at least 98% within 2 weeks².

The implementation of HPV primary screening across England was completed in December 2019 and resulted in a consolidation of cytology laboratory services to 8 sites from the previous 48. This impacted on cytology workforce and reduced cytology screening capacity in the lead up to, and during the implementation.

The change to HPV primary screening and consolidation of services did impact on turnaround times for the cervical screening programme.

In 2022-2023, turnaround times declined, with 76.5% of letters received within 2 weeks, a decrease of 3.1 percentage points from the previous year. There was significant regional and local variation across England depending on the available capacity within laboratories.

Regional performance, 2021-2022 and 2022-2023, ages 25 to 64 years

In 2022-2023:

• No region met the standard of at least 98% of letters received within 14 days.
• The South-East reported the highest percentage of letters received within 2 weeks at 94.9%.
• The North West reported the lowest percentage of letters received within 2 weeks at 36.7%.
• Five of the nine regions decreased their performance compared to the previous year.

There was significant regional and local variation in turnaround times across England in 2022-2023.

An LA breakdown of this output is available both in the data tables and the interactive visualisation tool.

Following screening/testing, there are 3 types of recall status within the programme; normal (action code A), repeat (action code R) and suspend (action code S).

Normal (return to routine recall)

A normal recall status will be given when the hrHPV test is negative

Repeat (requires a further test which is earlier than routine recall)

Repeat recall required where the test result is:

• hrHPV unavailable
• hrHPV positive with inadequate cytology

An early recall of 12 months will be given if the result is hrHPV positive with negative cytology.

Early repeat can be used for negative test results during a period of follow up.

Suspend (recall suspended due to referral to colposcopy)

Only allowable status following a test result that is positive for hrHPV with abnormal cytology.

Also required:

• after testing positive for hrHPV and negative for cytology 3 times in a row
• after testing positive for hrHPV with inadequate cytology test results
• after a series of hrHPV unavailable results or cytology inadequate results

It can also be used when an individual remains under hospital care, regardless of test result.

Of those with only a negative result:

• 87.8% were given a normal recall status.
• 10.6% were given a repeat recall status as they were under surveillance or follow up. 
• 1.7% were given a suspend recall status either because they were under hospital care or because of a 3rd consecutive hrHPV positive result.

87.0% of those with an inadequate screening result were given a repeat recall status.

- = recall status not applicable for this result

* Value is not a true zero, however, it is less than 0.01%. Full figures available table 10.
** Negative includes hrHPV Negative as well as Cytology negative.  Borderline changes are hrHPV positive except for borderline/hrHPV-negative follow-up tests reported in Scottish laboratories. Low-grade dyskaryosis or worse are hrHPV positive.
***?invasive carcinoma means ‘suspected invasive carcinoma’, ?glandular neoplasia (endocervical) means ‘suspected glandular neoplasia of endocervical type’ NB. The sum of components may not equal totals due to rounding.
Source: KC53, NHS England. See data table 10.

Borderline and low-grade results

HPV primary screening was fully rolled out in December 2019. In the HPV primary screening pathway those with a non-negative cytology result (following a hrHPV result) are referred to colposcopy and given a suspend recall status.

Prior to the introduction of HPV primary screening, under the HPV triage protocol, only a proportion of those with borderline or low grade cytology would receive a suspend code as any patients who tested negative for high risk HPV would be returned to routine recall. This can be seen in graphs below in the years 2012-13 to 2018-19.

By the year 2020-21 practically all patients with borderline cytology (98.9%) received suspend codes. In 2021-22 this reached just short of 100% (41,538 out of 41,543).

In 2022-23, a very small number of individuals (0.006%) still received repeat recall status, an increase from the previous year (0.002% in 2021-2022). These will be investigated further by the NHSE Screening Quality Assurance Service.

As for borderline cases, by the year 2020-21 practically all patients with low grade cytology (99.6%) received suspend codes. In 2021-22 this reached almost 100%.

In 2022-23, a very small number of individuals still received repeat recall status, a decrease from the previous year. A few individuals also received normal status. These will be investigated further by the NHSE Screening Quality Assurance Service.

1. In a small proportion of cases the laboratory result may be either HPV unavailable or cytology inadequate and the test is considered inadequate.
2. https://www.gov.uk/government/publications/cervical-screening-programme-standards/cervical-screening-programme-standards-valid-for-data-collected-from-1-april-2018
3. Some individuals may receive multiple tests in a year for clinical reasons such as a previous inadequate sample or the need for a repeat test due to a previous abnormality (with or without treatment). See data table 7.
4. Those with a negative result and suspend recall status could include some who were referred to colposcopy for symptoms noted at the time of testing.