Title: Cervical Screening Wales Annual Statistical Report 2016-17

Screening Division of Public Health Wales / CSW Annual Statistical Report
2016/17

This report is a detailed summary of information on work undertaken by Cervical Screening Wales for the year from April 2016 to the end of March 2017.

Publication Details:

Title: Cervical Screening Wales Annual Statistical Report 2016-17

Date: This report published 24 October 2017

ISBN: 978-1-910768-59-4

For more information and to feedback about this report contact:

Helen Clayton, Lead Informatics and Data Services Manager,

Informatics Division, Floor 6, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Tel: 029 2010 4405

Email:

Quality Assurance Statement

Screening data records are constantly changing. The databases used by Public Health Wales Screening Division are updated on a daily basis when records are added, changed or removed (archived). This might relate to when a person has been identified as needing screening; has had screening results that need to be recorded, or has a change of status and no longer needs screening respectively. Data is received from a large number of different sources with varying levels of accuracy and completeness. The Screening Division checks data for accuracy by comparing datasets – for example GP practice data – and corrects the coding data where possible. It should be noted that there are sometimes delays in data collection – for example a person might not immediately register with their GP. These delays will therefore affect the completeness of the data depending on individual circumstances. In addition, the reader should be aware that data is constantly updated and there might be slight readjustments in the numbers cited in this document year on year because of data refreshing.

© 2017 Public Health Wales NHS Trust

Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context.

Acknowledgement to Public Health Wales NHS Trust to be stated.

Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust

Date: October 2017 / Version: 1 / Page: 1 of 43
Screening Division of Public Health Wales / CSW Annual Statistical Report
2016/17

Contents

1Introduction

1.1‘Key messages’ for the public

1.2Programme delivery

1.3Screening pathway

2Headline statistics

3Data

3.1Coverage

3.2Women Invited by Age Group and Health Board

3.3Women Tested by Age Group and Health Board

3.4Sample Result Turnaround Times by Health Board

3.5Samples Reported by Pathology Laboratory

3.6Colposcopy Activity

4Audit of Cervical Cancer in Wales

4.1Age at diagnosis

4.2Cancer type

4.3Cancer stage

4.4Screen-detected status

5Definitions

6Pre-Release List

Tables and Graphs

Table 1a: Cervical Screening Coverage by Age Group

Graph 1a1: Cervical Screening 5 year Coverage by Age Group

Graph 1a2: Cervical Screening 5 year Coverage of Target Age Group (25-64 years) by Year

Table 1b: Cervical Screening Coverage (25-64 year olds) by Health Board of Residence

Graph 1b: Cervical Screening Coverage of Target Age Group (25-64 years) by Health Board

Table 2: Women Invited by Age Group and Health Board

Table 3: Women Tested by Age Group and Health Board

Graph 3: Number of women (aged 25-64 years) invited and tested each year

Table 4: Time from date sample was taken to issue of result letter, by Health Board

Graph 4: Time from date sample was taken to issue of result letter, by Health Board6

Table 5a: Number of cytology samples reported by pathology laboratory and source of test

Table 5b1: Number of cytology samples reported by Health Board of residence and source of test

Table 5b2: Percentage of cytology samples reported by Health Board of residence and source of test

Table 5c1: Inadequate cytology samples reported by pathology laboratory

Table 5c2: High grade cytology samples reported by pathology laboratory

Graph 5c1: Percentage of Inadequate Tests by Pathology Laboratory

Graph 5c2: Percentage of High Grade Tests by Pathology Laboratory

Table 5d: Number of adequate cytology samples reported by Result of Test and Age Group

Table 5e: Number of adequate cytology samples reported with an HPV test

Table 5f: Outcome for women referred during April 2015-March 2016 following an inadequate or low grade result

Table 5g: Outcome for women referred during April 2015-March 2016 following a high grade cytology result

Table 5h: Outcome for women referred during April 2015-March 2016 following a high grade cytology result (%)

Table 5i: Turnaround Times for Pathology Laboratory, from date of receipt of sample, to date result first authorised

Graph 5i: Turnaround Times for Pathology Laboratory, from date of receipt of sample, to date result first authorised3

Table 6a: Number of colposcopy referrals by source of referral and colposcopy clinic

Table 6b: Number of new patients seen by referral test result and colposcopy clinic

Table 6c: Waiting Times by colposcopy clinic and type of referral

Graph 6c1: Percentage of all new referrals offered an appointment within 8 weeks by colposcopy clinic (excluding patient instigated delays)

Graph 6c2: Percentage of high grade referrals offered an appointment within 4 weeks by colposcopy clinic (excluding patient instigated delays)

Table 6d: Total Attended Visits by type of visit and colposcopy clinic

Table 6e: New patients seen by most significant procedure at first visit and type of referral

Table 6f: New patients seen by most significant procedure at first visit and colposcopy clinic

Table 6g: New patients seen by colposcopic opinion and worst outcome of histology

Table 6h: New patients seen by type of referral and worst outcome of histology

Table 6i: New patients seen by colposcopy clinic and worst outcome of histology

Graph 7a: Cancers audited, diagnosed 2015-16

Graph 7b: Cervical Cancer Type and Age

Graph 7c: Cancer Stage by Age

Graph 7d: Cancer Stage and Screen-detected Status

Graph 7e: Age and Screen-detected Status

Graph 7f: Non Screen-detected cancers - Stage and Screening History

1 Introduction

Cervical Screening Wales is responsible for the NHS cervical screening programme in Wales. The aim of the cervical screening programme is to reduce the incidence of, and morbidity and mortality from, invasive cervical cancer.

Although this continues the series of annual statistical reports for the programme, this is the third report in the new format. Changes have been made to the report which reflects the policy changes around the age at which a woman is first invited for cervical screening and the frequency she is invited for screening. There have also been changes to the wording used to describe the results of a cervical screening test.

Information contained in this report is collected from the following sources:

1. NHAIS call and recall system used by the Cervical Screening Administration Departments.
2. Pathology laboratories.
3. Canisc – Colposcopy Information System which records clinical and administrative data from colposcopy services in Health Boards.

1.1 ‘Key messages’ for the public

• Cervical screening aims to prevent cancer from developing in the cervix at the neck of the womb.

• Women from the age of 25 are invited for screening every three years. Women aged 50 to 64 are invited every five years.

• Cervical screening (a smear test) is a free NHS test that is carried out at your GP surgery or at some sexual-health clinics.

• The test is quick and simple and should not be painful, but may be uncomfortable for some women.

• Screening will not prevent all cancers and not all cancers can be cured.

• Taking part in cervical screening is your choice. Read the information leaflet provided carefully to help you make your decision.

1.2 Programme delivery

Screening Division of Public Health Wales is responsible for managing, delivering and quality assuring the cervical screening programme in Wales. Cervical screening tests are mainly carried out in primary care by a practice nurse or GP or in a community or sexual health clinic. A small number of tests are taken in secondary care, in colposcopy clinics or gynaecology clinics.

The cervical screening programme is an All Wales programme, with three regional centres responsible for coordinating the screening programme in their area: North Wales, Mid and West Wales and South East Wales.

1.3 Screening pathway

Policy for the cervical screening programme in Wales was changed in September 2013, so that women aged 25-49 years are now invited every three years and women aged 50-64 years are invited every five years. Prior to this the lower age limit was 20 and all women were invited every three years. The changes were in line with UK policy, following recommendation from the National Screening Committee and based on evidence which supported the change in age range.

From September 2014, Cervical Screening Wales introduced testing for HPV into the Cervical Screening Programme with the introduction of HPV Test of Cure (ToC) for women having their first smear test following treatment. In November 2015, ToC was extended for women who were invited for early follow-up smears. From May 2016 HPV testing was extended to triage low grade abnormalities on smears.

Women are sent a letter inviting them to make an appointment for cervical screening, a reminder letter is sent if they do not attend for screening within a certain time. Demographic details are taken from GP registrations on the NHAIS system and it is important that women ensure that their name and address are up to date with their GP.

More information about the programme and copies of previous statistical reports are available at

2 Headline statistics

This report covers activity from April 2016 to March 2017 inclusive.

• At 31 March 2017, 77.0% of women in the target age group (25-64 years) had been screened with an adequate result at least once in the last 5 years. Coverage exceeds 75% in all Health Boards.
• In 2016/17 around 236,300 women aged 25-64 were invited for screening.
• 177,000 women were screened in 2016/17, (including those with inadequate results); the majority in response to a formal invitation from the screening programme.
• Laboratories examined around 182,200 samples on Welsh residents in 2016/17.
• All women having their first follow-up test or early recall test after a high grade abnormality or treatment for any grade of CIN/CGIN will have HPV testing as well as cytology.
• All women with a borderline/low grade abnormality have had HPV testing to ‘triage’ the abnormality since 31st May 2016.
• 3.8% of tests were reported as inadequate with variation between laboratories, ranging from 3.0% to 4.6%
• 1.3% of tests were reported as high grade, ranging from 1.1% to 1.5%.
• The Positive Predictive Value (PPV) correlates high grade cytology with histology. For 2016/17, the PPV for Wales remains high at 82.5%.
• 9,000 new patients were seen at colposcopy clinics in Wales in 2016/17, 70.5% having been directly referred by Cervical Screening Wales and 29.5% for clinical reasons.
• 59.4% of histology results reported as CIN2 or worse were similarly identified on assessment.
• 78.5% of lesions thought by the colposcopist to be high grade or worse were reported CIN2 or worse on histology, for all known results.
• 1 in 21 women were referred to colposcopy with cell changes. Of these 2 in 3 women needed treatment and 1 in 131 women had cancer.

3 Data

3.1 Coverage

Table 1a: Cervical Screening Coverage by Age Group Figure 1

Age Group / Eligible / Tested within 3.5 years / Tested within 5 years / % Coverage within 3.5 years / % Coverage within 5 years
Under 25 years / 446,084 / 13,886 / 16,805 / 3.1% / 3.8%
25-49 years / 492,722 / 350,841 / 385,059 / 71.2% / 78.1%
50-64 years / 272,868 / 180,954 / 204,719 / 66.3% / 75.0%
65+ years / 271,789 / 20,093 / 35,747 / 7.4% / 13.2%
All Wales / 1,483,463 / 565,774 / 642,330 / 38.1% / 43.3%

Note: The eligible age range for routine recall is 25-64 years. Women over 50 are routinely invited for screening every 5 years, coverage within 3.5 years is not applicable in this age group. Age appropriate coverage for 25-64 year olds has been calculated as 73.2%, please see definition section for more details.

Graph 1a1: Cervical Screening 5 year Coverage by Age Group Figure 2

Graph 1a2: Cervical Screening 5 year Coverage of Target Age Group (25-64 years) by Year Figure 3

Coverage of women aged 25-64 has been over 77% from 2006/07 to 2016/17. In 2016/17 77.0% of women aged 25-64 years had been tested with an adequate result in the last 5 years. There is some variation in coverage between Health Boards (HB), ranging from 75.5% in Hywel Dda University Health Board to 79.5% in Powys Teaching Health Board. Overall coverage has decreased slightly across Wales.

There are some women who may require screening outside of our 25-64 year age range, due to the follow-up of previous abnormalities.

Table 1b: Cervical Screening Coverage (25-64 year olds) by Health Board of Residence Figure 4

Health Board / Eligible / Tested within 3.5 years / Tested within 5 years / % Coverage within 3.5 years / % Coverage within 5 years
Abertawe Bro Morgannwg UHB / 126,961 / 86,729 / 96,664 / 68.3% / 76.1%
Aneurin Bevan UHB / 143,544 / 102,014 / 112,301 / 71.1% / 78.2%
Betsi Cadwaladr UHB / 162,676 / 113,402 / 125,953 / 69.7% / 77.4%
Cardiff and Vale UHB / 124,797 / 85,444 / 94,422 / 68.5% / 75.7%
Cwm Taf UHB / 72,802 / 50,544 / 56,277 / 69.4% / 77.3%
Hywel Dda UHB / 87,533 / 58,995 / 66,092 / 67.4% / 75.5%
Powys Teaching HB / 30,182 / 21,726 / 23,984 / 72.0% / 79.5%
All Wales / 765,590 / 531,795 / 589,778 / 69.5% / 77.0%

This shows the coverage stated of those women eligible for cervical screening on 1st April 2017, by the number and proportion with an adequate test within last 3.5 or 5 years. Note that a small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales.

Graph 1b: Cervical Screening Coverage of Target Age Group (25-64 years) by Health Board Figure 5

3.2 Women Invited by Age Group and Health Board

Table 2: Women Invited by Age Group and Health Board Figure 6

Health Board / Under 25 years / 25-49 years / 50-64 years / 65+ years / All Ages
Abertawe Bro Morgannwg UHB / 1,820 / 29,981 / 7,209 / 227 / 39,237
Aneurin Bevan UHB / 2,067 / 33,479 / 8,779 / 251 / 44,576
Betsi Cadwaladr UHB / 2,241 / 36,540 / 9,833 / 236 / 48,850
Cardiff and Vale UHB / 2,421 / 30,942 / 6,262 / 171 / 39,796
Cwm Taf UHB / 1,086 / 17,838 / 4,067 / 119 / 23,110
Hywel Dda UHB / 1,224 / 18,973 / 5,691 / 150 / 26,038
Powys Teaching HB / 331 / 5,916 / 1,971 / 39 / 8,257
All Wales / 11,607 / 179,004 / 44,527 / 1,208 / 236,346

3.3 Women Tested by Age Group and Health Board

Table 3: Women Tested by Age Group and Health Board Figure 7

Health Board / Under 25 years / 25-49 years / 50-64 years / 65+ years / All Ages
Abertawe Bro Morgannwg UHB / 1,225 / 20,295 / 6,970 / 177 / 28,667
Aneurin Bevan UHB / 1,565 / 24,079 / 8,197 / 180 / 34,021
Betsi Cadwaladr UHB / 1,474 / 25,542 / 9,594 / 223 / 36,833
Cardiff and Vale UHB / 1,410 / 21,702 / 6,211 / 139 / 29,462
Cwm Taf UHB / 856 / 12,374 / 3,959 / 95 / 17,284
Hywel Dda UHB / 759 / 12,882 / 5,414 / 162 / 19,217
Powys Teaching HB / 272 / 4,420 / 1,977 / 50 / 6,719
All Wales / 7,833 / 125,231 / 42,898 / 1,039 / 177,001

A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales.

In 2016/17 this data has been calculated directly from information taken from the call and recall system, more detailed definitions are given in section 4 of this report.

Note that the uptake of invitations cannot be precisely measured as some tests undertaken in the screening year (1st April to 31st March) may result from ‘marginal’ invitations, either issued in the previous screening year, or taken up in the following year.

Graph 3: Number of women (aged 25-64 years) invited and tested each year Figure 8

The reduction in the number of women invited during 2016-17 is due to the age and frequency changes implemented in September 2013.

3.4 Sample Result Turnaround Times by Health Board

Table 4: Time from date sample was taken to issue of result letter, by Health Board Figure 9

Health Board / Less than or equal to 2 weeks / >2 weeks up to 4 weeks / >4 weeks up to 6 weeks / >6 weeks / Total
Abertawe Bro Morgannwg UHB / 8,328 / 20,326 / 544 / 120 / 29,318
Aneurin Bevan UHB / 17,544 / 15,963 / 998 / 202 / 34,707
Betsi Cadwaladr UHB / 7,384 / 29,247 / 1,880 / 63 / 38,574
Cardiff and Vale UHB / 14,626 / 14,086 / 583 / 142 / 29,437
Cwm Taf UHB / 8,448 / 8,588 / 451 / 58 / 17,545
Hywel Dda UHB / 4,727 / 14,354 / 385 / 168 / 19,634
Powys Teaching HB / 2,266 / 4,308 / 157 / 44 / 6,775
All Wales / 65,068 / 109,719 / 5,140 / 820 / 180,747
% / 36.0% / 60.7% / 2.8% / 0.5% / 100.0%

A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales.

Graph 4: Time from date sample was taken to issue of result letter, by Health Board Figure 10

Across Wales 36.0% of results were issued within 2 weeks of the test being taken (range 19.1% to 50.5%) and 96.7% were issued within 4 weeks (100% target).

3.5 Samples Reported by Pathology Laboratory

Table 5a: Number of cytology samples reported by pathology laboratory and source of test Figure 11

Laboratory / GP / Integrated Sexual Health Clinics / NHS Hospital / Other / Total
Magden Park Laboratory / 50921 / 1420 / 4219 / 73 / 56633
North Wales Service / 35805 / 983 / 1114 / 76 / 37978
Royal Gwent Hospital / 28435 / 2387 / 1719 / 213 / 32754
S & W Wales Service / 49679 / 1523 / 3328 / 303 / 54833
All Wales / 164840 / 6313 / 10380 / 665 / 182198

A small proportion of samples from unknown sources are shown in the total for Wales.

Table 5b1: Number of cytology samples reported by Health Board of residence and source of test Figure 12

Health Board / GP / Integrated Sexual Health Clinics / NHS Hospital / Other / Total
Abertawe Bro Morgannwg UHB / 26948 / 369 / 1721 / 259 / 29297
Aneurin Bevan UHB / 30875 / 2243 / 1646 / 155 / 34919
Betsi Cadwaladr UHB / 36051 / 978 / 1146 / 74 / 38249
Cardiff and Vale UHB / 27307 / 612 / 1738 / 45 / 29702
Cwm Taf UHB / 14810 / 715 / 2169 / 25 / 17719
Hywel Dda UHB / 17106 / 1067 / 1421 / 38 / 19632
Powys Teaching HB / 6235 / 18 / 222 / 46 / 6521
All Wales / 164840 / 6313 / 10380 / 665 / 182198

A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales.

Table 5b2: Percentage of cytology samples reported by Health Board of residence and source of test Figure 13

Health Board / GP / Integrated Sexual Health Clinics / NHS Hospital / Other
Abertawe Bro Morgannwg UHB / 92.0 / 1.3 / 5.9 / 0.9
Aneurin Bevan UHB / 88.4 / 6.4 / 4.7 / 0.4
Betsi Cadwaladr UHB / 94.3 / 2.6 / 3.0 / 0.2
Cardiff and Vale UHB / 91.9 / 2.1 / 5.9 / 0.2
Cwm Taf UHB / 83.6 / 4.0 / 12.2 / 0.1
Hywel Dda UHB / 87.1 / 5.4 / 7.2 / 0.2
Powys Teaching HB / 95.6 / 0.3 / 3.4 / 0.7
All Wales / 90.5 / 3.5 / 5.7 / 0.4

A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales.

Table 5c1: Inadequate cytology samples reported by pathology laboratory 14Figure

Laboratory / GP / Integrated Sexual Health Clinics / NHS Hospital / Other / Total
Magden Park Laboratory / Total Samples / 50921 / 1420 / 4219 / 73 / 56633
No. inadequate / 2110 / 113 / 238 / 6 / 2467
% inadequate / 4.1 / 8.0 / 5.6 / 8.2 / 4.4
North Wales Service / Total Samples / 35805 / 983 / 1114 / 76 / 37978
No. inadequate / 1552 / 65 / 113 / 4 / 1734
% inadequate / 4.3 / 6.6 / 10.1 / 5.3 / 4.6
Royal Gwent Hospital / Total Samples / 28435 / 2387 / 1719 / 213 / 32754
No. inadequate / 768 / 97 / 94 / 11 / 970
% inadequate / 2.7 / 4.1 / 5.5 / 5.2 / 3.0
S & W Wales Service / Total Samples / 49679 / 1523 / 3328 / 303 / 54833
No. inadequate / 1436 / 74 / 182 / 12 / 1704
% inadequate / 2.9 / 4.9 / 5.5 / 4.0 / 3.1
All Wales / Total Samples / 164840 / 6313 / 10380 / 665 / 182198
No. inadequate / 5866 / 349 / 627 / 33 / 6875
% inadequate / 3.6 / 5.5 / 6.0 / 5.0 / 3.8

Table 5c2: High grade cytology samples reported by pathology laboratory Figure 15

Laboratory / GP / Integrated Sexual Health Clinics / NHS Hospital / Other / Total
Magden Park Laboratory / No. Adequate / 48811 / 1307 / 3981 / 67 / 54166
No. high grade / 620 / 30 / 145 / 2 / 797
% high grade / 1.3 / 2.3 / 3.6 / 3.0 / 1.5
North Wales Service / No. Adequate / 34253 / 918 / 1001 / 72 / 36244
No. high grade / 351 / 12 / 25 / 1 / 389
% high grade / 1.0 / 1.3 / 2.5 / 1.4 / 1.1
Royal Gwent Hospital / No. Adequate / 27667 / 2290 / 1625 / 202 / 31784
No. high grade / 347 / 58 / 58 / 0 / 463
% high grade / 1.3 / 2.5 / 3.6 / 0.0 / 1.5
S & W Wales Service / No. Adequate / 48243 / 1449 / 3146 / 291 / 53129
No. high grade / 469 / 18 / 82 / 15 / 584
% high grade / 1.0 / 1.2 / 2.6 / 5.2 / 1.1
All Wales / No. Adequate / 158974 / 5964 / 9753 / 632 / 175323
No. high grade / 1787 / 118 / 310 / 18 / 2233
% high grade / 1.1 / 2.0 / 3.2 / 2.8 / 1.3

High grade includes results reported as high grade dyskaryosis, ?invasive squamous carcinoma and ?Glandular neoplasia. The proportion is calculated from all adequate results.