Cervical screening and patient management protocols

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Independent sector cervical screening

Primary care colleagues have raised concerns regarding cervical cytology testing at independent facilities i.e. “private smear tests”.  Cervical cytology samples undertaken in the Independent Sector are not part of the national screening programme. Colleagues felt it would be helpful if GPs/practices were made aware of the issue.

All eligible women (aged from 25-64) will automatically receive their invitation letter from the Primary Care Support England (PCSE) to attend for screening.  Women who have cervical samples taken outside the NHS cervical screening programme may contact their GP to say that they have had cervical cytology done privately.  The GP/practice should then advise the woman that her private cervical cytology test results are not routinely captured in the NHS screening programme and that she is eligible for her routine test and should attend for this.

However, please be aware that there should be a 3-month interval between any private sample and one taken as part of the NHSCSP to ensure an adequate sample has been taken.

Inappropriate and ‘out of programme’ samples

Recall intervals for cervical screening

  • Routine 3 yearly recall between the ages of 24 years, 6 months to 49 years inclusive (the first invitation letter is sent at 24 years and six months).
  • Routine 5 yearly recall between the ages of 50 to 64 years inclusive
  • Cease cervical screening at age 65 years, only screen those who:

i) Have never had a screening test and now request one

ii) Did not attend for their last test when aged 60 or over and now wish to have that final test

iii) If the last 3 tests included an abnormal result and/or she is on follow-up for treatment of CIN/CGIN/invasive cancer

iv) Over 65 and had fewer than 3 consecutive negative tests

Abnormal looking cervix

If there is a clinical suspicion of cervical disease, cytology is not the appropriate test to investigate the symptoms. The woman should be referred urgently to colposcopy for investigation under the two-week-wait rule. Women with an abnormal looking cervix should be referred for gynaecological examination and onward referral to colposcopy if cancer is suspected.

Young women with abnormal bleeding

Women below the screening age range who present with symptoms such as postcoital bleeding or intermenstrual bleeding should be managed as per the latest recommendations in Clinical Practice Guidance for the Assessment of Young Women aged 20-24 with Abnormal Vaginal Bleeding. Cervical cytology does not form part of this management pathway. Note, this includes women under the age of 20 years.

Other inappropriate tests

  • On taking or starting to take an oral contraceptive
  • On insertion of an intrauterine contraceptive device (IUCD)
  • On taking or starting to take hormone replacement therapy (HRT)
  • In association with pregnancy – either antenatally or postnatally, or after termination unless a previous screening test was abnormal
  • In women with genital warts
  • In women with a vaginal discharge
  • In women with pelvic infection
  • In women who have had multiple sexual partners
  • In women who are heavy cigarette smokers

Symptomatic women

Women with symptoms of cervical cancer should be referred for gynaecological examination. Cervical cytology is not an appropriate investigation for:

  • Postcoital bleeding
  • Intermenstrual bleeding
  • Postmenopausal bleeding
  • Persistent vaginal discharge

Follow-up after total hysterectomy

Women who need vaginal vault sampling following surgery are not included in the NHS Cervical Screening Programme. Vault samples should be taken in a hospital setting e.g. colposcopy and therefore women requiring this should be referred to colposcopy or remain at colposcopy until all necessary vault samples have been taken.

The laboratory will reject vault samples taken in primary care.

The clinical indications for taking a vault sample are given in the  NHSCSP guidelines, Colposcopy & Programme Management Publication No.20, Third Edition, March 2016.

(Last reviewed December 2018)