Key Facts

The NHS Cervical Screening Programme is a national population-based screening programme that identifies women at increased risk of developing cervical cancer through HPV testing and cytological examination.

Epidemiology

• Approximately 15 million women are eligible for screening in England
• Coverage rate: approximately 72% (below the 80% target)
• Screening prevents an estimated 5,000 cervical cancer deaths per year in the UK
• HPV prevalence in screened population: approximately 12-15% for high-risk types

Aetiology

• Not applicable (screening programme)

Pathophysiology

• HPV primary screening detects persistent high-risk HPV infection, the necessary cause of cervical cancer
• HPV testing has higher sensitivity (>95%) than cytology alone (55-70%) for detecting CIN2+
• Negative HPV test provides greater reassurance of low risk than negative cytology

Screening Invitation

• Women receive invitation letter from NHS Cervical Screening Programme
• Sample collected by nurse/GP using a cervical brush (liquid-based cytology medium)
• Self-sampling (HPV) being piloted to improve uptake

Abnormal Results Communication

• HPV negative: routine recall
• HPV positive + normal cytology: 12-month recall
• HPV positive + abnormal cytology: colposcopy referral
• Inadequate sample: repeat within 3 months

Red Flags

• Symptoms should not wait for screening: refer symptomatic women directly
• Postcoital bleeding with normal screening: still requires clinical assessment
• Persistent HPV positivity at 24 months: colposcopy referral regardless of cytology

Bedside

• Speculum examination and cervical sample collection
• Visual inspection of cervix for any visible abnormality

Bloods

• Not required for screening

Imaging

• Not required for screening

Special Tests

• HPV testing: primary test; detects high-risk HPV DNA (types 16, 18, and others)
• Liquid-based cytology (LBC): performed on HPV-positive samples as reflex triage
• Colposcopy: magnified examination of cervix with acetic acid (acetowhite changes) and Lugol's iodine (Schiller test)
• Cervical biopsy: punch biopsy at colposcopy for histological diagnosis
• LLETZ: diagnostic and therapeutic excision under local anaesthesia

Non-pharmacological

• Ensure adequate information and counselling about screening
• Address barriers to attendance: anxiety, embarrassment, access, disability
• HPV vaccination programme (primary prevention)

Pharmacological

• No specific pharmacological management in screening
• Local anaesthetic for LLETZ (lidocaine with adrenaline infiltration)

Surgical/Interventional

• CIN1: observe; repeat colposcopy/cytology at 12 months (60% regression rate)
• CIN2: treat or observe in young women (<25) due to high regression rate; treat if persistent
• CIN3: treat with LLETZ (excision biopsy under local anaesthesia)
• Alternative treatments: cold coagulation, laser ablation, cone biopsy (cold knife)
• Hysterectomy: if recurrent high-grade CIN with completed family

Referral Criteria

• HPV positive + abnormal cytology: colposcopy referral
• HPV positive at 12 and 24 months: colposcopy referral regardless of cytology
• Visible cervical abnormality regardless of screening result: urgent 2-week wait referral
• Suspected glandular abnormality: urgent colposcopy referral

• HPV-negative women have <0.1% risk of CIN3 or cancer over 5 years
• CIN1: 60% regress, 30% persist, 10% progress to CIN3; <1% progress to cancer
• CIN2: 40% regress, 40% persist, 20% progress to CIN3
• CIN3: if untreated, approximately 30% progress to invasive cancer over 10-30 years
• Post-LLETZ: cure rate >95% for CIN; follow-up with test of cure (HPV test at 6 months)
• LLETZ and preterm birth: small increased risk (RR 1.5-2×); counsel women of reproductive age

NHS Cervical Screening Pathway

CIN Classification