Colposcopy referrals
Updated 25 May 2022
Applies to England
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This publication is available at https://www.gov.uk/government/publications/be-clear-on-cancer-first-national-cervical-screening-saves-lives-campaign/colposcopy-referrals
This is one of a series of summaries produced for the campaign, each focusing on a different evaluation measure (referred to as a metric) which reflects a key point in the patient pathway. These metrics should not be considered in isolation. Please refer to the considerations when interpreting these results.
Main findings
The first national ‘Cervical Screening Saves Lives’ campaign appears to have had a short-term impact on referrals to colposcopy.
Background
This metric considers whether the ‘Cervical Screening Saves Lives’ campaign had an impact on the number of women referred to colposcopy.
Colposcopy is an outpatient appointment at a hospital for a visual examination of the cervix using a colposcope. Referrals may follow an abnormal screening test, or a GP may refer individuals with symptoms.
Following the colposcopy examination, the individual may be offered treatment, or a biopsy may be taken for histological diagnosis.
An increase in referrals may show that the campaign has improved the response of individuals to their cervical screening invitations, particularly those who had delayed attending and could have an increased chance of having an abnormal screening result. The campaign may also have encouraged those individuals experiencing symptoms to see their GP.
Methods
The analysis period was quarter 4 (January to March 2019) to quarter 3 (October to December 2019). Data for this period was compared to the same 4 quarters in 2018. Further information on the methodology used for the campaign analysis is available.
The campaign ran in quarter 4 (January to March 2019) and quarter 1 (April to June 2019). However, referrals to colposcopy take place after the sample result is reported by the laboratory so there is a time lag before referrals are made of at least 2 weeks from the date of the screening test. This time period may be longer if the programme is busy.
For this reason, the analysis also looked at quarter 2 (July to September 2019), and at quarter 3 (October to December 2019). If the campaign has an effect, it is most likely to be seen from quarter 1.
Results for screening referrals
These are individuals referred for colposcopy examination due to an abnormal screening result.
Figure 1 below compares screening referrals for the same quarters in the years 2018 and 2019.
Figure 1: Screening referrals to colposcopy in England, for years 2018 and 2019
| Year | Year 2018 | Year 2019 |
|---|---|---|
| Quarter 4 (Jan to Mar) | 27,513 | 30,105 |
| Quarter 1 (Apr to Jun) | 29,784 | 33,321 |
| Quarter 2 (Jul to Sep) | 28,506 | 33,077 |
| Quarter 3 (Oct to Dec) | 29,563 | 30,463 |
The data show that:
- in quarter 4 (January to March) there was a significant 9.4% increase from 27,513 in 2018 to 30,105 in 2019 (p<0.001)
- in quarter 1 (April to June) there was a significant 11.9% increase from 29,784 in 2018 to 33,321 in 2019 (p<0.001)
- in quarter 2 (July to September) there was a significant 16.0% increase from 28,506 in 2018 to 33,077 in 2019 (p<0.001)
- in quarter 3 (October to December) there was a small but significant 3.0% increase from 29,563 in 2018 to 30,463 in 2019 (p<0.001)
Screening referrals were slightly above the long term trend before, during and just after the campaign, but subsequently fell back to trend.
Figure 2 below shows a longer term trend for screening referrals to colposcopy from 2017 to 2020.
Figure 2: Screening referrals to colposcopy, from quarter 1 2017 to 2018 to quarter 4 2019 to 2020 (April 2017 to March 2020)
The dotted line shows the linear trend for screening referrals over this time.
The line graph above shows an overall change from 29,965 for quarter 1 2017 to 2018 (April to June 2017) to 29,449 for quarter 4 2019 to 2020 (January to March 2020). The lowest point of the line is 26,964 for quarter 3 2017 to 2018 (October to December 2017). The highest point of the line is 33,323 for quarter 1 2019 to 2020 (April to June 2019).
Results for low and high grade screening referrals
Screening referrals may be low or high grade, depending on the severity of the abnormality found.
For low grade referrals, an individual should be offered a colposcopy appointment within 6 weeks of referral. Those with high grade referrals are at higher risk of developing cancer and should be offered an appointment within 2 weeks of referral.
Figures 3 and 4 below compare low grade and high grade referrals for the same quarters in the years 2018 and 2019.
Figure 3: Low grade referrals to colposcopy in England, for years 2018 and 2019
| Year | Year 2018 | Year 2019 |
|---|---|---|
| Quarter 4 (Jan to Mar) | 18,973 | 21,252 |
| Quarter 1 (Apr to Jun) | 21,314 | 23,750 |
| Quarter 2 (Jul to Sep) | 20,324 | 24,327 |
| Quarter 3 (Oct to Dec) | 20,641 | 22,793 |
The data for low grade referrals show that:
- in quarter 4 (January to March) there was a significant 12.0% increase from 18,973 in 2018 to 21,252 in 2019 (p<0.001)
- in quarter 1 (April to June) there was a significant 11.4% increase from 21,314 to 23,750 (p<0.001)
- in quarter 2 (July to September) there was a significant 19.7% increase from 20,324 to 24,327 (p<0.001)
- in quarter 3 (October to December) there was a significant 10.4% increase from 20,641 to 22,793 (p<0.001)
Figure 4: High grade referrals to colposcopy in England, for years 2018 and 2019
| Year | Year 2018 | Year 2019 |
|---|---|---|
| Quarter 4 (Jan to Mar) | 8,136 | 8,536 |
| Quarter 1 (Apr to Jun) | 8,151 | 9,263 |
| Quarter 2 (Jul to Sep) | 7,861 | 8,459 |
| Quarter 3 (Oct to Dec) | 8,615 | 7,395 |
The data for high grade referrals show that:
- in quarter 4 (January to March) there was a non-significant 4.9% increase from 8,136 in 2018 to 8,536 in 2019 (p=0.002)
- in quarter 1 (April to June) there was a significant 13.6% increase from 8,151 to 9,263 (p<0.001)
- in quarter 2 (July to September) there was a significant 7.6% increase from 7,861 to 8,459 (p<0.001)
- in quarter 3 (October to December) there was a significant -14.2% decrease from 8,615 to 7,395 (p<0.001)
Low grade referrals were slightly above the long term trend in the quarters after the campaign.
High grade referrals were above the long term trend during the campaign.
Figure 5 below shows a longer term trend for high and low grade referrals to colposcopy from 2017 to 2020.
Figure 5: high and low grade referrals to colposcopy, from Quarter 1 2017 to 2018 to Quarter 4 2019 to 2020 (April 2017 to March 2020)
The dotted line shows the linear trend for high and low grade referrals over this time.
For high grade referrals, the line graph above shows an overall change from 8,664 for quarter 1 2017 to 2018 (April to June 2017) to 7,343 for quarter 4 2019 to 2020 (January to March 2020). The lowest point of the line is 7,343 for quarter 4 2019 to 2020 (January to March 2020). The highest point of the line is 9,263 for quarter 1 2019 to 2020 (April to June 2019).
For low grade referrals, the line graph above shows an overall change from 20,911 for quarter 1 2017 to 2018 (April to June 2017) to 21,850 for quarter 4 2019 to 2020 (January to March 2020). The lowest point of the line is 18,614 for quarter 3 2017 to 2018 (October to December 2017). The highest point of the line is 24,327 for quarter 2 2019 to 2020 (July to September 2019).
Results for clinical referrals
These are individuals referred for colposcopy examination due to symptoms, such as post-coital bleeding.
Figure 6 below compares clinical referrals for the same quarters in the years 2018 and 2019.
Figure 6: Clinical referrals to colposcopy in England, for years 2018 and 2019
| Year | Year 2018 | Year 2019 |
|---|---|---|
| Quarter 4 (Jan to Mar) | 12,043 | 12,706 |
| Quarter 1 (Apr to Jun) | 12,221 | 13,580 |
| Quarter 2 (Jul to Sep) | 11,165 | 13,021 |
| Quarter 3 (Oct to Dec) | 12,488 | 13,317 |
The data show that:
- in quarter 4 (January to March) there was a significant 5.5% increase from 12,043 in 2018 to 12,706 in 2019 (p<0.001)
- in quarter 1 (April to June) there was a significant 11.1% increase from 12,221 in 2018 to 13,580 in 2019 (p<0.001)
- in quarter 2 (July to September) there was a significant 16.6% increase from 11,165 in 2018 to 13,021 in 2019 (p<0.001)
- in quarter 3 (October to December) there was a significant 6.6% increase from 12,488 in 2018 to 13,317 in 2019 (p<0.001)
Clinical referrals were slightly above the long term trend after the campaign but subsequently fell back to trend.
Figure 7 below shows a longer term trend for clinical referrals to colposcopy from 2017 to 2020.
Figure 7: Clinical referrals to colposcopy, from quarter 1 2017 to 2018 to quarter 4 2019 to 2020 (April 2017 to March 2020)
The dotted line shows the linear trend for clinical referrals over this time.
The line graph above shows an overall change from 11,814 for quarter 1 2017 to 2018 (April to June 2017) to 12,111 for quarter 4 2019 to 2020 (January to March 2020). The lowest point of the line is 11,165 for quarter 2 2018 to 2019 (July to September 2018). The highest point of the line is 13,580 for quarter 1 2019 to 2020 (April to June 2019).
Conclusions
There was a statistically significant increase in colposcopy referrals during and in the months immediately following the campaign.
This increase is more obvious during and immediately after the campaign, suggesting only a short-term boost. This is likely to be as a result of the increased number of individuals attending for screening during the campaign.
The increase in clinical referrals may be because the campaign prompted more women with symptoms to visit their GP. This would be a positive outcome for the campaign.
There was an increase in the proportion of low grade and high grade referrals immediately following the campaign. There was then a significant decrease in the proportion of high grade screening referrals. This may suggest that the additional people who attended due to the campaign did not have significant abnormalities. This could indicate they were not long term non-attenders for cervical screening.
The ‘Cervical Screening Saves Lives’ campaign appears to have had a short-term impact on referrals to colposcopy.
Get advice on the signs and symptoms of cancer from the NHS website. You can also find out more about the evaluation of Be Clear on Cancer campaigns.