Cervical Screening Programme, England - 2023-2024 [NS]

• 251,251 referrals to colposcopy were reported in 2023-24, an increase of 1.8% from 2022-23 (246,762).
• 63.3% of referrals were reported as being triggered by a screening test with abnormal or inadequate cytology, a decrease from 64.9% in 2022-23.
• 19.1% of referrals were clinically indicated (women referred because they had symptoms of a cervical abnormality), a decrease from 19.5% in 2022-23.
• The proportion of referrals for ‘other’ reasons increased from 15.7% in 2022-23 to 17.6% in 2023-24. The 'other' category also includes individuals referred with hrHPV positive cytology negative results, this category also includes persistent hrHPV unavailable results.

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 either the date of the screening test report or the date on the referral letter, and the first offered outpatient appointment, regardless of whether the appointment was attended or not¹.

In 2023-24:

• 26.2% of individuals were offered an appointment within 2 weeks of referral. This compares to 25.1% in 2022-23.
• 44.6% were offered an appointment within 4 weeks of referral. This compares to 42.5% in 2022-23.
• 76.9% were offered an appointment within 6 weeks of referral, compared to 78.6% in 2022-23. 
• 92.4% with a referral type of ‘High-grade dyskaryosis moderate/severe’ were offered an appointment within 2 weeks. This compares to 93.2% in 2022-23.
• 96.2% 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 and has increased from 96.1% in 2022-23.
• In 9.0% of cases, the time from referral to first offered appointment was over 12 weeks. This is an increase from 7.6% the previous year.

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

Time from referral to first offered appointment, England

Figures in this section reflect number of appointments, not number of people. A person may attend more than one appointment in the year. Additionally, a person may choose not to attend, or to cancel, more than one appointment in a year.

Of all appointments in 2023-24: 

• 71.8% were attended, a decrease from 73.4% in 2022-23.
• 13.8% were cancelled by patients in advance, an increase from 13.2% in 2022-23.
• 6.3% were cancelled by the clinic, an increase from 4.8% in 2022-23.
• 2.1% were cancelled by patients on the day.
• 5.8% involved the patient not attending with no advance warning.
• The lowest attendance was seen for follow up appointments (62.5%).

Comparison between 2022-23 and 2023-24 data is shown in the data table:

Note: The sum of components may not equal totals due to rounding.
Source: KC65, NHS England. 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 2023-24 will attend in the next year.

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

In 2023-24:

• 47.3% of all those attending for the first time had some treatment or procedure. This compares to 50.6% in 2022-23.
• The most common treatment or procedure was diagnostic biopsy (39.8%)
• The most common treatment differed between referrals for borderline or low-grade abnormalities (diagnostic biopsy – 47.8%) and high-grade abnormalities (excision – 44.6%)

Note: 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 England. See data table 23.

Colposcopy first attendance 'No Procedure' category:
Procedure may be carried out at a second visit. However, in the hrHPV positive and negative cytology or low grade cytological abnormality (low grade dyskaryosis or less) and a low grade or negative colposcopic examination do not necessarily require colposcopic biopsy and will be followed up with screening test at 12 months or be returned to 3 year recall.

Colposcopy procedure type for first attendances, England

In 2023-24:

• The percentage of all those receiving some treatment, or undergoing a procedure at their first visit ranged from 37.6% in the North West to 58.4% in the South East.
• Diagnostic biopsy was the most common procedure used across all regions, ranging from 29.1% of attendances in the North West of England to 50.1% in London.
• Excision was the next most common procedure, ranging from 1.1% in London to 8.6% in the South East.
• 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 2023-24:

• 53,132 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 32.9% of all cases, and in 44.1% of cases individuals were informed within 2 to 4 weeks.
• In 1.5% 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 2023-24. 77.0% of letters were sent within 4 weeks, and 95.9% with 8 weeks.

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

Of all biopsies reported in 2023-24 with an outcome recorded (53,132), 39.9% were diagnostic and the remaining 60.1% 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, 60.1% showed CIN2 or worse. This is a decrease from 2022-23, when the equivalent proportion was 63.9%.

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

* 4 month sample relates to data from biopsies taken during the first month of each quarter.

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