Guidance

Cervical standards data report: 1 April 2020 to 31 March 2021

Published 10 March 2022

Applies to England

In this report we use ‘screening year 2020 to 2021’ to refer to 1 April 2020 to 31 March 2021. See more information about the terminology used in this report in section 5.

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This is the third data report on the national cervical screening programme standards and the first report published since the transfer of screening functions from Public Health England (PHE) to NHS England and NHS Improvement on 1 October 2021.

This report focuses on performance in England from April 2020 to March 2021 but also includes trend data from previous years where this is available.

These standards contribute to assessing the quality of the cervical screening programme (CSP) across England. Publishing the data ensures stakeholders and the public have access to reliable and timely information on the quality and performance of the screening programme.

The standards focus on some of the important targets providers have to meet and maintain to make sure local screening services are high quality, safe and effective.

This report provides data on coverage, timeliness of receiving results, laboratory and colposcopy clinical standards.

Where the data show that standards are not met or there are data collection issues, providers and commissioners should ensure appropriate action is taken to address the issue. NHS England and NHS Improvement’s section 7a commissioning and operations team works with the screening quality assurance service (SQAS) to provide advice and support to this process.

The data in this report complements that published jointly by NHS Digital and NHS England and NHS Improvement in the annual cervical screening statistical bulletin for 2020 to 2021. The coverage data differs slightly to the statistical bulletin because it is based on clinical commissioning group rather than local authority.

The report covers the first full year of HPV primary screening since the implementation of the new screening pathway in December 2019. This involved a large decrease from 48 laboratory cytology services in the screening year ending in March 2020 to the 8 laboratories operating throughout the screening year 2020 to 2021.

The coronavirus (COVID-19) pandemic, which began in early 2020, is likely to have had some impact on the data. All individuals who were due to be invited throughout the screening year 2020 to 2021 were invited by the CSP, but attendance for screening was affected by the pandemic. As a result, the data in this report should be interpreted with caution.

For those standards based on quarterly colposcopy data submissions, the data presented in this report has gone back to the usual method of using an annual submission. For the previous report (2019 to 2020 screening year) the data were calculated by adding together all 4 quarters of the submissions. The change in approach for that year was made to reduce the burden on providers during the COVID-19 pandemic.

1. Coverage

This section covers standards CSP-S01 and CSP-S02.

We measure coverage of the screening programmes to provide assurance that screening is offered to the eligible population.

Eligible individuals are those entitled to an offer of screening. For cervical screening, this is individuals aged 24 years and 6 months up to 64 years, who have a cervix.

Coverage is an important indicator for the programme to achieve its aims of reducing incidence and mortality.

CSP-S01: coverage for women aged 25 to 49 years

68.9% of women in the resident population eligible for cervical screening aged 25 to 49 at the end of the period reported who were screened adequately within the previous 3 and a half years (where the eligible population is 10,264,947).

Region	Women aged 25 to 49 (%)
England	68.9
London	60.7
Midlands and East	70.6
North	71.3
South	71.6

Figure 1: Cervical screening – coverage performance, for women aged 25 to 49, England, screening year 2020 to 2021

Coverage for those aged 25 to 49 is historically lower than for those aged 50 to 64 (see standard S02 below).

Figure 2: CSP-S01: coverage for women aged 25 to 49, England, screening year ending March 2017 to the year ending March 2021

The line graph above shows a slight decrease from 69.7% to 69.4% over the screening years ending March 2017 to 2018, before increasing to 70.9% in the screening year ending March 2020. There is then a small decrease to 68.9% in the screening year ending March 2021.

Figure 3: CSP-S01: map of coverage for women aged 25 to 49, England, screening year 2020 to 2021

The map above shows that at March 2021, none of the 135 clinical commissioning groups (CCGs) in England met or exceeded the 80% acceptable threshold, compared with 6 CCGs in the screening year ending in March 2020. This is most likely to be due to the effect of the COVID-19 pandemic.

CSP-S02: Coverage for women aged 50 to 64 years

75.0% of women in the resident population eligible for cervical screening aged 50 to 64 at end of period reported who were screened adequately within the previous 5 and a half years (where the eligible population is 5,199,083).

Region	Women aged 50 to 64 (%)
England	75.0
London	71.6
Midlands and East	75.8
North	75.3
South	75.6

Figure 4: Cervical screening – coverage performance, for women aged 50 to 64, England, screening year 2020 to 2021

Coverage for those aged 50 to 64 has historically been higher than for younger women (see standard S01 above).

Figure 5: CSP-S02: Coverage for women aged 50 to 64, England, screening year ending 2017 to the year ending March 2021

The line graph above shows a decrease from 77.3% to 76.3% over the screening years ending 2017 and 2018 and then remains at 76.4% for the screening years ending 2019 and 2020.The graph then decreases to 75.0% in the screening year ending in March 2021.

Figure 6: CSP-S02: map of coverage for women aged 50 to 64, England, screening year 2020 to 2021

The map above shows that at March 2021, none of the 135 clinical commissioning groups (CCGs) in England met or exceeded the 80% acceptable threshold, compared with 6 CCGs in the screening year ending in March 2020. This is most likely to be due to the effect of the COVID-19 pandemic.

2. Test – timely receipt of result letter

This section covers standard CSP-S03. This standard covers the screening pathway from the date the sample is taken to the date the result letter is expected to be received.

CSP-S03: test – timely receipt of result letter

67.1% of women received their screening results in writing within 14 days from the date of their screening sample being taken (where the number of result letters sent was 2,869,804).

Region	Results received within 14 days (%)
England	67.1
London	64.4
Midlands and East	58.4
North	86.9
South	58.2

Figure 7: Cervical screening – receiving results within 14 days, England, screening year 2020 to 2021

This standard is affected by transport of samples, reporting times in laboratories and result letter administration by the call and recall service.

HPV primary screening was implemented across England in December 2019. This affected the whole screening pathway throughout the screening year 2019 to 2020 and the previous 3 years while planning for the change took place. It meant the standard of at least 98% of women receiving their results within 14 days of their test being taken was not met. Since the implementation of HPV primary screening, performance against this standard has significantly improved, although still does not yet meet the minimum level required.

Figure 8: CSP-S03: Percentage of women receiving their result within 14 days of their test, England, screening year ending March 2015 to the year ending March 2021

The line graph above shows a gradual decrease from 91.0% to 89.1% over the screening years ending 2015 and 2016, before a large decrease to 44.0% in the screening year ending 2020. There is then a large increase to 67.1% in the screening year ending March 2021.

Figure 9: CSP-S03: map of women receiving their result within 14 days, England, screening year 2020 to 2021

The map above shows that at March 2021, none of the 135 clinical commissioning groups (CCGs) in England met or exceeded the 98% acceptable threshold, compared with 5 CCGs in the screening year ending in March 2020. This is most likely to be due to combined effect of establishing the new HPV primary screening programme and the impact of the COVID-19 pandemic.

3. Laboratory standards

This section covers standards CSP-S04, CSP-S05, CSP-S06 and CSP-S07.

Laboratories provide data using the mandatory KC61 return apart from CSP-S04 which uses a special data request. Following the implementation of HPV primary screening in December 2019, there are now 8 cervical screening laboratories in England. The screening year ending in March 2021 is the first full year of HPV primary screening data collected from these 8 laboratory services.

Standards CSP-S06 and CSP-S07 rely on data from the previous screening year (so are not representative of a full year of HPV primary screening) and are calculated using data from the 48 laboratories operating during the screening year ending March 2020. Of these 48, 40 were able to submit the necessary data for these 2 standards.

CSP-S04: test – minimise false negative reporting

97.3% of all cytology abnormalities (and 98.7% of high grade cytology abnormalities) were correctly identified at the initial review when compared with the results of a second, ‘rapid’ review (where the number of abnormal samples was 141,386 and the number of high grade abnormalities was 33,685).

Region	proportion of abnormal samples correctly identified (%)	proportion of high grade samples correctly identified (%)
England	97.3	98.7
London	96.6	98.0
Midlands and East	97.8	98.8
North	98.1	99.0
South	96.9	98.8

Figure 10: Cervical screening – proportion of samples correctly identified at the initial review, England, screening year 2020 to 2021

Standard CSP-S04, known as ‘sensitivity’, measures the proportion of all cytology abnormalities or high grade cytology abnormalities that were correctly identified at the initial review when compared with the results of a second, ‘rapid’ review. This standard is important to monitor to help reduce the chance of abnormalities not being detected. The change to HPV primary screening has resulted in a small increase in sensitivity. This is likely to be because only screening samples that are known to be HPV positive receive a cytology review.

Figure 11a: CSP-S04: proportion of samples correctly identified at the initial review (all abnormalities), England, screening year ending 2018 to the year ending March 2021

The line graph for all abnormalities (above) is generally steady at between 96.3% to 96.7% over the screening years ending March 2018 to 2020. It increases to 97.3% in the screening year 2020 to 2021.

Figure 11b: CSP-S04: proportion of samples correctly identified at the initial review (high grade abnormalities), England, screening year ending 2018 to the year ending March 2021

The line graph for high grade abnormalities (above) shows a steady increase from 97.9% to 98.7% over the screening years ending March 2018 to 2021.

All 8 cervical screening laboratories met or exceeded the standard for all abnormalities and for high grade abnormalities.

CSP-S05: test – inadequate cytology

0.40% of cervical screening samples were reported as cytology inadequate (where the total number of samples reported was 2,915,396), compared with 1.2% in the screening year ending March 2020.

Region	Inadequate samples as %
England	0.40
London	0.37
Midlands and East	0.27
North	0.30
South	0.69

Figure 12: Cervical screening – proportion of samples reported as cytology inadequate, England, screening year 2020 to 2021

The inadequate rate is reported for women aged 25 to 64 who were screened at a GP practice or community clinic.

Rates should be low as tests reported as inadequate mean they need to be repeated to get a result for the woman. However, some inadequate results are expected due to technical or administrative reasons.

Prior to the screening year ending in March 2021, this standard was measured by calculating a 5% to 95% ‘acceptable’ range annually from the rates for all laboratories. As there are now only 8 laboratories, this is no longer an appropriate method to calculate a standard range. Whilst the method for calculating a standard is being reviewed, the range will be reported. The Section 7a commissioning and operations team with Screening Quality Assurance Service (SQAS) and commissioners will continue to monitor trends in the rate of inadequate cytology tests but will not apply a standard.

The minimum rate reported was 0.12%.

The maximum rate reported was 0.98%.

Figure 13: CSP-S05: Proportion of samples reported as cytology inadequate, England, screening year ending March 2015 to the year ending March 2021

The line graph above shows an increase from 2.5% to 2.7% over the screening years ending March 2015 to 2017. It then shows a decrease to 2.3% in the screening year ending March 2019 before a large decrease to 0.4% in the screening year ending March 2021. The large decrease in this period is likely due to the benefits of the roll out of HPV primary testing. HPV testing is more likely to obtain an adequate result than cytology and as all cytology samples tested are known to be HPV positive, there is less chance of an inadequate cytology result.

CSP-S06: test – cytological positive predictive value (PPV)

82.5% of women referred with high grade abnormalities who have a histological outcome of cervical intraepithelial neoplasia (CIN) 2, CIN 3, cervical glandular intraepithelial neoplasia (CGIN) (adenocarcinoma in situ) or cervical cancer (where the number of women referred whose histology outcome was no abnormality detected (NAD) or worse was 28,522), compared with 83.9% in the screening year ending march 2020.

Region	positive predictive value as %
England	82.5
London	78.2
Midlands and East	81.8
North	84.7
South	83.1

Figure 14: Cervical screening – proportion of high grade referrals with histology of CIN 2 or worse, England, screening year 2020 to 2021

PPV reports the correlation between a high grade cytology screening result and the subsequent histological outcome for women referred to colposcopy in the 12 months prior to the year reported.

Cytology is partly subjective and may be overcalled. PPV can be further influenced by histological diagnosis and colposcopy practice and disease prevalence. Calculating a range means that some laboratories will be outside the standard (above or below) and this would warrant further investigation.

The 5% to 95% ‘acceptable’ range is calculated annually from the rates for all laboratories. For the screening year 2020 to 2021, this is 72.8% to 92.4% and represents data from the 40 laboratories operating during the screening year ending in March 2020. The data does not reflect referrals arising from a fully implemented HPV primary screening programme as these data will not be available until the next annual report (which will cover the period up to March 2022).

The minimum rate reported was 71.9%.

The maximum rate reported was 93.8%.

Figure 15: CSP-S06: proportion of high grade referrals with histology of CIN 2+, England, screening year ending March 2016 to the screening year ending March 2021

The line graph above is generally steady at between 85.4% to 85.2% over the screening years ending March 2016 to 2019, before a steady decrease to 82.5% in the year ending March 2021.

Region	Performance < acceptable	Acceptable range	Performance > acceptable	Total
London	1	6	0	7
Midlands and East	0	10	1	11
North	0	9	0	9
South	0	12	1	13

Figure 16: CSP-S06: PPV rate, number of laboratories below, within or above the acceptable range and the total performance against thresholds, by region, screening year 2020 to 2021

CSP-S07: test – cytological abnormal predictive value (APV)

13.1% of women referred with borderline or low grade cytology results who have a histological outcome of CIN 2, CIN 3, CGIN (adenocarcinoma in situ) or cervical cancer (where the number of women referred whose histology outcome was NAD or worse was 79,150), compared to 13.7% in the screening year ending March 2020.

Region	Abnormal predictive value as %
England	13.1
London	13.1
Midlands and East	11.9
North	13.6
South	13.7

Figure 17: Cervical screening – proportion of low grade referrals with histology of CIN 2 or worse, England, screening year 2020 to 2021

Abnormal predictive value (APV) reports the correlation between low grade cytology screening results and the subsequent histological outcome for women referred to colposcopy in the 12 months prior to the year reported. A small proportion of low grade screening results are expected to be found to have a high grade histology outcome.

Cytology is partly subjective and may be under-called. APV can be further influenced by histological diagnosis and colposcopy practice. Calculating a range means that some laboratories will be outside the standard (above or below) and this would warrant further investigation.

The 5% to 95% ‘acceptable’ range is calculated annually from the rates for all laboratories. For the screening year 2020 to 2021, this is 6.6% to 20.3% and represents data from the 40 laboratories operating during the screening year ending in March 2020. The data does not reflect referrals arising from a fully implemented HPV primary screening programme as these data will not be available until the next annual report (which will cover the period up to March 2022).

The minimum rate reported was 5.4%.

The maximum rate reported was 21.0%.

Figure 18: CSP-S07: proportion of low grade referrals with histology of CIN 2 or worse, England, screening year ending March 2016 to the screening year ending March 2021

The line graph above shows a decrease from 16.9% in the screening year ending March 2016 to 13.1% by the year ending March 2021. This shows that over time low grade referrals are less likely to have a high grade histology outcome.

Region	Performance < acceptable	Acceptable range	Performance > acceptable	Total
London	0	7	0	7
Midlands and East	2	9	0	11
North	0	7	2	9
South	0	13	0	13

Figure 19: CSP-S07: APV rate, number of laboratories below, within or above the acceptable range and the total, by region, screening year 2020 to 2021

4. Colposcopy standards

This section covers standards CSP-S08, CSP-S09, CSP-S10, CSP-S11 and CSP-S12.

Colposcopy clinics provide data using the mandatory KC65 return apart from CSP-S09 which uses a special data request. For those standards based on KC65 data, the data presented in this report has gone back to the usual method of using an annual submission. For the prior 2019 to 2020 screening year the data were calculated by adding together all 4 quarters of the submissions. The change in approach for that year was made to reduce the burden on providers during the COVID-19 pandemic.

In the screening year ending March 2021, 192 colposcopy clinics returned data for the majority of the standards (compared to 193 the year before). The reduction is due to the effect of the COVID-19 pandemic on the operation of some clinic sites which remained closed and on the staff resources to complete the data collection process.

CSP-S08: colposcopy – timely biopsy result letter sent

86.0% of women received their biopsy results within 4 weeks of the sample being taken (the acceptable threshold is 90% and above) and 98.3% received their results within 8 weeks (the achievable threshold is 100%). The number of results overall was 39,867. This compares to 81.0% and 98.3% respectively for the same standards in the screening year ending March 2020.

Region	Proportion received within 4 weeks (%)	Proportion received within 8 weeks (%)
England	86.0	98.3
London	86.5	99.2
Midlands and East	91.4	99.1
North	79.6	97.0
South	87.8	98.2

Figure 20: Cervical screening – proportion of biopsy results received within 4 or 8 weeks, England, screening year 2020 to 2021

This standard is important to ensure that women receive the results of their biopsy (diagnostic or treatment) in a timely manner. This ensures that those who require further treatment and those who do not are informed in writing at the earliest opportunity. Achievement of this standard is influenced by the timeliness of histology reporting and the efficiency of colposcopy clinic administration.

For results received within 4 weeks, the minimum rate reported was 12.3%.

For results received within 8 weeks, the minimum rate reported was 52.1%.

The data show that 114 of 192 clinics reported at least 90% of results were received within 4 weeks, and 108 of 192 reported all results were received within 8 weeks.

Figure 21a: CSP-S08: proportion of results received within 4 weeks, England, screening year ending 2015 to the screening year ending March 2021

The line graph above shows an increase from 81.6% to 86.2% over the screening years ending 2015 to 2018, before a decrease to 81.8% over the screening years ending 2019 and 2020. It then shows an increase to 86.0% in the screening year ending 2021.

Figure 21b: CSP-S08: proportion of results received within 8 weeks, England, screening year ending 2015 to the screening year ending March 2021

The line graph above shows generally steady performance from 98.5% in the screening year ending March 2015 to 98.3% in the screening year ending March 2021. It reached a maximum of 98.8% in the screening year ending March 2017 and a low of 97.9% in the screening year ending March 2016.

Region	Performance < acceptable	Acceptable range	Total
London	11	15	26
Midlands and East	16	40	56
North	34	28	62
South	13	31	44

Figure 22: CSP-S08: Received within 4 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2020 to 2021

Region	Performance < acceptable	Acceptable range	Total
London	10	16	26
Midlands and East	19	37	56
North	31	31	62
South	20	24	44

Figure 23: CSP-S08: Received within 8 weeks, number of clinics below or within the achievable range and the total, by region, screening year 2020 to 2021

CSP-S09: colposcopy – intervention or treatment (12-month follow-up after treatment)

2.9% of women seen at colposcopy within 12 months of previous treatment had a histology result of CIN or cancer (the acceptable threshold is 5.0% and under), where the number of women returning to colposcopy after treatment was 36,853. This compares to 2.9% in the screening year ending March 2021.

Region	Proportion with CIN or cancer (%)
England	2.9
London	2.9
Midlands and East	2.9
North	1.8
South	4.0

Figure 24: Cervical screening – proportion of women with CIN or cancer within 12 months of previous treatment, England, screening year 2020 to 2021

It is important to maximise successful treatment to ensure that the number of women with residual high grade disease or cancer within 12 months of treatment is as low as possible.

Not all clinics could supply data for this standard – 161 of 176 clinics returned figures. This is an improvement from the screening year ending March 2020 where 155 clinics returned data. Services and commissioners are responsible for taking action to ensure accurate and complete data are reported from all clinics.

The minimum rate reported was 0%.

The maximum rate reported was 20%.

Figure 25: CSP-S09: proportion of women with CIN or cancer within 12 months, England, screening years ending March 2018 to 2021

The line graph above shows a slight increase from 2.8% to 2.9% over the screening years ending March 2018 to screening year ending March 2019, then remaining steady at 2.9% to screening year ending March 2021.

Region	Acceptable range	Performance > acceptable	Total
London	22	3	25
Midlands and East	47	4	51
North	41	3	44
South	28	13	41

Figure 26: CSP-S09: proportion of women with CIN or cancer within 12 months, number of clinics within or above the acceptable range and the total, by region, screening year 2020 to 2021

CSP-S10: colposcopy – intervention or treatment (inadequate cytology)

72.7% of women referred for colposcopy after 3 consecutive inadequate cytology screening tests were offered an appointment within 6 weeks of referral (the acceptable threshold is at least 99%). The overall number of inadequate referrals was 1,191. This compares to 93.8% for the screening year ending in March 2020. The lower percentage against the standard is a result of the COVID-19 pandemic affecting the capacity of clinics to offer appointments.

Region	proportion offered an appointment within 6 weeks (%)
England	72.7
London	70.3
Midlands and East	56.1
North	67.0
South	84.5

Figure 27: Cervical screening – inadequate referrals offered a colposcopy appointment within 6 weeks, England, screening year 2020 to 2021

Standard CSP-10 is important to ensure that women have prompt referral for colposcopy assessment to reduce anxiety, and to make sure that no abnormality is missed and a definitive screening result is achieved.

This standard covers women referred to colposcopy following persistent inadequate cytology or unavailable HPV result, with the most recent result being inadequate cytology.

Not all clinics reported receiving inadequate referrals – 165 of 192 clinics had referrals in this category. The remaining 27 reported no inadequate referrals during the time period.

The minimum rate reported was 0%.

The data show that 61 of 165 clinics reported that all inadequate referrals were offered an appointment within 6 weeks.

Figure 28: CSP-S10: inadequate referrals offered a colposcopy appointment within 6 weeks, England, screening year ending March 2018 to the year ending March 2021

The line graph above shows a slight decrease from 95.2% to 93.8% over the screening years ending March 2018 to 2020, before a large decrease to 72.7% in the screening year ending March 2021.

Region	Performance < acceptable	Acceptable range	Total
London	16	6	22
Midlands and East	26	21	47
North	31	22	53
South	31	12	43

Figure 29: CSP-S10: inadequate referrals offered a colposcopy appointment within 6 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2020 to 2021

CSP-S11: colposcopy – intervention or treatment (6-week appointment)

72.5% of women referred for colposcopy after a positive high risk human papillomavirus (HR-HPV) test with negative or borderline or low-grade dyskaryosis cytology were offered an appointment within 6 weeks of referral (the acceptable threshold is 99%). The overall number of these referrals was 105,315. This compares to 93.0% in the screening year ending March 2020. The lower percentage against the standard is a result of the COVID-19 pandemic affecting the capacity of clinics to offer appointments.

Region	proportion offered appointment within 6 weeks (%)
England	72.5
London	73.3
Midlands and East	77.1
North	68.0
South	72.3

Figure 30: Cervical screening – offered a colposcopy appointment within 6 weeks of referral due to a positive HR-HPV test and negative or borderline or low-grade dyskaryosis cytology, England, screening year 2020 to 2021

Standard CSP-S11 is important to ensure that women are seen within 6 weeks of their abnormal screening result for further assessment. This ensures timely management and reduces anxiety.

In the screening year 2020 to 2021, referrals due to positive high-risk HPV (HR-HPV) with a negative cytology result are recorded in the ‘other’ referral indication category alongside the small number of referrals not due to a screening abnormality or clinical indication. Clinics were only able to report the ‘other’ category as a whole and this was taken as an indication for HR-HPV positive with negative referrals. It is therefore possible that actual practice is better than the performance reported here.

The minimum rate reported was 7.5%.

The data show that 19 of 192 clinics reported all such referrals were offered an appointment within 6 weeks.

Figure 31: CSP-S11: women offered a colposcopy within 6 weeks of referral due to a positive HR-HPV test and negative or borderline or low-grade dyskaryosis cytology, England, screening year ending March 2018 to the screening year ending March 2021

The line graph above shows a slight decrease from 95.8% to 93.0% over the screening years ending March 2018 to 2020, before a large decrease to 72.5% in the screening year ending March 2021.

Region	Performance < acceptable	Acceptable range	Total
London	23	3	26
Midlands and East	51	6	57
North	57	6	63
South	42	4	46

Figure 32: CSP-S11: HPV positive referrals offered appointment within 6 weeks, number of clinics below or within the acceptable range, by region, screening year 2020 to 2021

CSP-S12: colposcopy – intervention or treatment (2-week appointment)

93.2% of women referred for colposcopy after a cytological report of high grade dyskaryosis (moderate) or worse were offered an appointment within 2 weeks of referral (the acceptable threshold is 93%). The overall number of such referrals was 29,909. This compares very closely to the 93.9% reported in the screening year ending March 2020. This is because colposcopy clinics were advised to prioritise referrals for those people with the highest chance of cervical abnormality during the COVID-19 pandemic to minimise risks to patients.

Region	proportion offered appointment within 2 weeks (%)
England	93.2
London	94.4
Midlands and East	93.1
North	92.1
South	93.7

Figure 33: Cervical screening – women offered a colposcopy within 2 weeks of referral due to a high grade (moderate dyskaryosis or worse) cytology result, England, screening year 2020 to 2021

Standard CSP-S12 is important to ensure that women are seen within 2 weeks of their high grade abnormal result for further assessment to ensure timely management and to reduce anxiety.

The minimum rate reported was 36.4%.

The data show that 133 of 192 clinics reported all high grade referrals were offered an appointment within 2 weeks.

Figure 34: CSP-S12: women offered a colposcopy within 2 weeks of a cytological report of high grade dyskaryosis (moderate) or worse, England, screening year ending March 2016 to the year ending March 2021

The line graph above shows an increase from 87.1% to 96.0% over the screening years ending March 2016 to 2018, then a steady decrease to 93.2% in the screening year ending March 2021.

Region	Performance < acceptable	Acceptable range	Total
London	6	20	26
Midlands and East	17	40	57
North	19	44	63
South	17	29	46

Figure 35: CSP-S12: high grade referrals offered a colposcopy appointment within 2 weeks, number of clinics below or within the acceptable range and the total, by region, screening year 2020 to 2021

5. Terminology

Cervical screening is offered to women between the ages of 24 years and 6 months and 64 years. Over 3 million women are tested in England every year.

Cervical intraepithelial neoplasia (CIN) is the medical term for abnormal cells in the cervix. CIN is not cancer, but it can sometimes go on to develop into cancer.

CIN is graded CIN 1, 2 or 3, where:

• CIN 1 (low grade) means the abnormality is unlikely to develop into cancer as the cells will often go back to normal on their own
• CIN 2 or 3 (high grade) means there is a greater chance the cells could develop into cancer; women with CIN 2 or 3 are usually offered treatment
• cervical glandular intraepithelial neoplasia (CGIN), also known as adenocarcinoma in situ, is an abnormality of the glandular tissue in the cervix; for any grade of CGIN, a woman will be offered treatment

Information about cervical screening standards and service specifications is available.