1. NHS CERVICAL SCREENING PROGRAMME AND REFERRAL PATTERNS FOR COLPOSCOPY Dr Sue Calvert

2. History of the screening programme Introduced in 1964 but not in a structured way Call-recall instituted 1988 –Recommended screening women aged 20-64 every 3-5 years Financial incentives to GPs introduced 1990

3. Results Gradual increase in number of women screened –40% 1989 –~85% now (83% of women 25-64 years screened once in last 5 years) 2000-01 (England) –4.1 million smears, –3.6 million as a result of the screening programme

4. Results 2000-01 (England) –9.6% inadequate Of adequate smears –92.9% negative –5.7% borderline / mild –0.7% moderate –0.7% severe or worse

5. Results Referrals to colposcopy (2000-01) –inadequate 10% –borderline 18% –mild 21% –moderate 18% –severe 13% –severe ?invasive <1% –?glandular 2% –other 17%

6. Results Referrals to colposcopy April to June 1998 Following persistent borderline / mild –0.2% cancer –22% CIN II/III Following moderate / severe or worse –2.7% cancer –72% CIN II/III

7. Effect of screening on cervical cancer Incidence of cervical cancer was 35% lower in 1995 than 1990 Since 1988 accelerated decrease in mortality from ~1% to ~7% / year Screening has saved ~8000 lives in England and Wales between 1988 and 1997 –Susieni P., Adams J. BMJ 1999;318:1244-45

10. National recommendations for colposcopy x3 borderline smears x2 mild smears Any smear showing –Moderate –Severe –?Invasive –Glandular abnormality

11. Local variants Leeds/Bradford and others x2 borderline Any smear mild or worse Surveys in Bradford (unpublished) –11/43 (25%) women referred with 2 borderline smears had high grade CIN