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Independent sector cervical screening samples

All eligible women (aged from 25-64) will automatically receive their invitation letter from the CSAS 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 screening in the private sector.  The GP/practice should then advise the woman that her private cervical screening 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
  • Routine 5 yearly recall between the ages of 50 to 64 years inclusive
  • Cease cervical screening at age 65 years, only screen those who:
    • Have never had a screening test and now request one
    • Did not attend for their lest test when aged 60 or over and now wish to have that final test
    • If the last 3 tests included an abnormal result and/or she is on follow-up for treatment of CIN/CGIN/invasive cancer
    • Over 65 and had fewer than 3 consecutive negative tests and patient has had a recall issued by CSAS ? is this correct AE to check

 Abnormal looking cervix

If there is a clinical suspicion of cervical disease, a cervical screening test i.e., an HPV test is not the appropriate test to investigate the symptoms.

Cervical cancer is rare in the UK. Many regular sample takers will never see a single case. Signs of malignancy include:

  • An enlarged cervix where the surface is irregular and friable, crumbling to the touch
  • Large blood vessels which bleed freely when rubbed by the end of the speculum
  • An offensive, watery discharge may also be present

If the cervix bleeds with clinical suspicion of malignancy and a clinician considers the cervical appearance is suspicious of malignancy, the woman must be urgently referred to a gynecologist through the cancer wait times (CWT) ‘two week wait’ pathway. A sample should not be taken. Cervical screening is screening test, not a diagnostic tool.

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 recommendations in Clinical Practice Guidance for the Assessment of Young Women aged 20-24 with Abnormal Vaginal Bleeding. Cervical screening does not form part of this management pathway. Note, this includes women under the age of 20 years.

The guidance states that women experiencing vaginal bleeding after sex and in-between periods require a pelvic examination. Vaginal bleeding is extremely common and can be caused by a range of different problems, including cervical ectropion, hormonal changes due to the contraceptive pill or benign cervical polyps or sexually transmitted infections such as chlamydia. The guidance explains the types of questions that practice nurses and GPs need to ask in order to establish if symptoms could be related to cervical cancer. A trained nurse, doctor or registered physician associate may perform a speculum examination. A trained GP can perform a pelvic exam.

 

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
  • Women with genital warts
  • Women with a vaginal discharge
  • Women with pelvic infection
  • Women who have had multiple sexual partners
  • Women who are heavy cigarette smokers

Symptomatic women

Women with symptoms of cervical cancer should be referred for gynaecological examination. Cervical screening i.e. an HPV test 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 only 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 Cervical screening: Programme and colposcopy management, February 2020 (Last updated 28th September 2021)

(Last reviewed March 2023)