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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, 6 months. Women are invited by the Scottish and Welsh cervical screening programmes at age 20 years.)
  • Routine 5 yearly recall between the ages of 50 to 64 years inclusive
  • Cease cervical screening at age 65 years, only screen those who are currently on follow-up for a previous abnormality (Women over 64 years should only be screened if they are currently on follow-up for previous abnormal cytology or follow-up after treated CIN/invasive cervical cancer.)

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.

gynae images

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

Cervical screening in pregnancy

  • If called for routine screening, the test should be deferred
  • If previous test was abnormal, then woman becomes pregnant, test should be taken mid-trimester unless clinically contraindicated
  • If colposcopy or cytology is required after treatment (or follow-up of untreated CIN1) delay assessment until after delivery
  • If colposcopy or cytology is required after treatment for CGIN or CIN2/3 with involved or uncertain margins do not delay assessment

 

(Last updated March 30th 2016)