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Preventative medicine Women's health

Cervical screening

Last revised in January 2026.

Cervical screening aims to reduce the incidence of, and mortality from, cervical cancer by systematic, quality assured population-based screening

Cervical screening: Summary

  • Cervical cancer is the 14th most common cancer in females in the UK, with around 3200 new diagnoses every year.
    • Incidence rates in the UK are highest in females aged 30–34 years.
    • Cervical cancer is rare in people aged under 25 years, despite cervical abnormalities being common in this age group.
  • The NHS Cervical Screening Programme (NHSCSP) aims to reduce the incidence of, and mortality from, cervical cancer through a systematic, quality assured population-based screening programme for eligible people.
    • Since the programme was introduced, the number of women dying from cervical cancer has halved.
    • The programme is estimated to save around 4500 lives every year in England.
  • In England, cervical screening is available to women and people with a cervix who are aged 25–64 years. The programme sends screening invitations to all eligible people at the following ages and intervals: 
    • Age 24.5 years — the first invitation is issued to ensure that the screening test can be completed by their 25th birthday.
    • Age 25–64 years — recall every 5 years.
  • People aged 65 years of age or older are invited if a recent cervical cytology sample is abnormal, or they have not had a cervical screening test since 50 years of age and they request one.
  • The NHSCSP is nationally coordinated and locally managed. It involves:
    • Primary human papillomavirus (HPV) screening — to identify people with high-risk HPV (hrHPV), which has been implicated in the development of cervical cancer. 
    • Liquid-based cytology (if hrHPV is found) — to detect early abnormalities of the cervix, which if untreated could lead to cervical cancer.
    • Colposcopy — to diagnose cervical intraepithelial neoplasia (CIN) and to differentiate high-grade lesions from low-grade abnormalities in people with abnormal cytology.
  • People can withdraw from the screening programme voluntarily by written request. However, they should be provided with enough information to enable them to make an informed decision.

Have I got the right topic?

From age 25 years to 65 years (Female).

This CKS topic covers the management of people who are on the NHS call and recall system for cervical screening. 

This CKS topic does not cover when to suspect or how to manage cervical cancer.

There are separate CKS topics on Cervical cancer and HPV and Gynaecological cancers - recognition and referral.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

January 2026 — minor update. Section 'What is the Cervical Screening Programme' also updated to a 5 year recall. 

Previous changes

September 2025 — minor update. Revised screening interval to 5 years for women aged 25-49 years in line with the national cervical screening programme [NHS England, 2025a]. 

May 2025 — minor update. QOF indicators updated in line with the NHS England Quality and Outcomes Framework guidance for 2025/26.

September 2022 — reviewed. A literature search was conducted in August 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been restructured, but no major changes to clinical recommendations have been made. 

April 2022 — minor update. The section on follow-up screening after hysterectomy has been updated to align with the Public Health England (PHE) 2021 guidance Colposcopic diagnosis, treatment and follow up [PHE, 2021].

December 2021 — minor update. The section on follow-up screening after cervical intraepithelial neoplasia (CIN) treatment has been updated to align with the PHE guidance Cervical screening: programme and colposcopy management to incorporate details of primary HPV screening.

May 2021 — minor update. Information that cervical dysplasia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

September 2020 — minor update. The topic has been updated in line with the PHE guidance Cervical screening: programme and colposcopy management to incorporate details of primary human papillomavirus (HPV) screening.

August to September 2017 — reviewed. A literature search was conducted in August 2017 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. 

November 2016 — minor update. The link to the patient information leaflet NHS Cervical screening has been updated. Information that the leaflet is now available in different languages has been added.

January to February 2015 — reviewed. A literature search was conducted in December 2014 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. Only one recommendation has changed since the last revision: for women who have mild dyskaryosis or borderline abnormal results following cervical cytology, the cervical cytology sample is now tested for HPV by the laboratory.

June 2013 — minor update. The 2013 Quality and Outcomes Framework (QOF) options for local implementation have been added to this topic.

June to October 2010 — this is a new CKS topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Update

New evidence

Evidence-based guidelines

NHS England, 2025 Cervical screening: programme overview [Free full-text]

HTAs (Health Technology Assessments)

No new HTAs since 1 August 2022.

Economic appraisals

No new economic appraisals relevant to England since 1 August 2022.

Systematic reviews and meta-analyses

No new systematic review or meta-analysis since 1 August 2022.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 August 2022.

New policies

NHS England, 2025 Cervical screening: programme overview [Free full-text].

New safety alerts

No new safety alerts since 1 August 2022.

Changes in product availability

No changes in product availability since 1 August 2022.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Encourage eligible people to attend for the NHS Cervical Screening Programme (NHSCSP). 
  • Provide information on the NHSCSP.
  • Conduct the NHSCSP.
  • Manage screening results.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

Table 1. Indicators related to cervical screening in the Quality and Outcomes Framework (QOF) 2025-26.

IndicatorPointsThreshold
CS005 The proportion of women eligible for screening aged 25-49 years at end of period reported whose notes record that an adequate cervical screening test has been performed in the previous 3 years and 6 months745–80%
CS006 The proportion of women eligible for screening and aged 50-64 years at end of period reported whose notes record that an adequate cervical screening test has been performed in the previous 5 years and 6 months
445–80%
Data from: [NHS England, 2025b]

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

  • GPs have direct access to diagnostic endoscopy, ultrasound, MRI, X-ray and CT for people with suspected cancer.
  • People with suspected cancer who are referred to a cancer service are given written information encouraging them to attend.

[NICE, 2017]

Background information

What is the NHS Cervical Screening Programme?

  • Cervical cancer is the 14th most common cancer in females in the UK, with around 3200 new diagnoses every year [Cancer Research UK, 2021].
  • The NHS Cervical Screening Programme (NHSCSP) aims to reduce the incidence of, and mortality from, cervical cancer through a systematic, quality assured population-based screening programme for eligible people [NHS England, 2025a]
  • In England, cervical screening is available to women and people with a cervix who are aged 25–64 years [NHS England, 2025a].
    • The programme sends screening invitations to all eligible people at the following ages and intervals [NHS England, 2025a]: 
      • Age 24.5 years — the first invitation is issued to ensure that the screening test can be completed by their 25th birthday.
      • Age 25–64 years — recall every 5 years (with invitations issued 58.5 months after the previous test).'
      • The high negative predictive value of hrHPV testing and lower false negative rate means screening intervals have been lengthened in individuals aged 24.5 to 49 years to 5 years. Those who test negative for hrHPV and have no recent hrHPV positive result are now recalled in 5 years, whilst those who test negative for hrHPV but have had a recent hrHPV positive test result are called in a further 3 years. At the next test in 3 years’ time a further negative hrHPV test result means the individual can have their recall set in 5 years’ time.
    • People aged 65 years of age or older are invited if:
      • A recent cervical cytology sample is abnormal.
      • They have not had a cervical screening test since 50 years of age and they request one.
  • The NHSCSP is nationally coordinated and locally managed. 
    • It involves:
      • Primary human papillomavirus (HPV) screening — to identify people with high-risk HPV (hrHPV), which has been implicated in the development of cervical cancer [Newcastle upon Tyne NHS Hospitals Foundation Trust, 2017]. 
      • Liquid-based cytology (if hrHPV is found) — to detect early abnormalities of the cervix, which if untreated could lead to cervical cancer.
      • Colposcopy — to diagnose cervical intraepithelial neoplasia (CIN) and to differentiate high-grade lesions from low-grade abnormalities in people with abnormal cytology.
    • Cervical screening is not a test for cancer.
  • People can withdraw from the screening programme voluntarily by written request. However, they should be provided with enough information to enable them to make an informed decision.

Who is eligible for routine cervical screening?

  • Every person who has a cervix and is within the screening age range of 25–64 years is eligible for NHS cervical screening regardless of their gender identity.
    • A transgender man still registered as a female (or indeterminate) who has a cervix will automatically be included in the screening programme and will be invited for screening at appropriate intervals unless he chooses to opt-out of the programme.
    • A transgender man registered as a male who has a cervix cannot be invited for screening by the national programme as current cervical screening IT systems do not have the facility to include people registered ‘male’.
      • Screening invitations should be made either by his GP practice or the healthcare team managing his gender reassignment. Alternatively, he can request screening every 3 or 5 years (depending on his age).
      • The GP practice should take responsibility for the screening process and notify the laboratory to return the results to the practice and not the call and recall service. The practice should also make arrangements with the person regarding providing test results and ensure that local fail-safe systems include people who require further investigations, treatment, or follow-up.
    • A non-binary person must be invited by the GP practice to participate as current registration systems are unable to record the gender category of ‘non-binary'.
    • A transgender woman is ineligible for screening as she has no cervix. The GP practice should ensure that the person is ceased from the screening programme for the correct reason. This can be done as soon as her registration gender is changed (or a new registration is created under the new gender), or when the woman appears on a screening prior notification list.
  • Unscheduled cervical screening does not form part of the cervical screening programme.
    • If the person has undergone screening within the recommended interval (depending on their age), they should not be re-screened.
    • If the person is immunosuppressed, more frequent screening may be required. For more information, see the section on Screening if immunosuppressed.

[NHS England, 2025a]

How is the cervical screening programme coordinated and managed?

  • The NHS Cervical Screening Programme is nationally coordinated and locally managed.
    • The NHS call and recall system uses demographic data from GP registration IT systems to:
      • Send invitations and reminder letters at set periods.
      • Record test results on a person's screening history.
      • Send the results to the person.
    • The primary healthcare professional:
      • Encourages people to attend for screening.
      • Provides information on cervical screening.
      • Takes the sample.
      • Ensures a fail-safe is in place to ensure test results are followed up appropriately.
    • The laboratory:
      • Performs human papillomavirus (HPV) testing and screens cervical samples.
      • Sends the results to the person's GP and the call and recall service (possibly by electronic messaging) for them to notify the person by letter. The results should be sent within 14 days of the sample being taken.
      • Notifies the GP if the person needs an urgent referral for colposcopy.
      • Operates a fail-safe for people who require further investigation or treatment.
    • The colposcopy service:
      • Accepts direct referrals from the laboratory, or GPs (for example, if the cervix is difficult to visualize).
      • Investigates and treats people with abnormal results. 
      • Follows up treatment with further investigations as appropriate.
      • Discharges the person back to the call and recall system when appropriate.
      • Liaises with the laboratory, the call and recall service, and primary care if required.
      • Operates a fail-safe system to ensure follow-up of people who have not attended.

[NHS England, 2025a]

What are the benefits and harms of cervical screening?

  • Benefits of cervical screening include:
    • Early detection of cervical cancer — regular cervical screening can prevent around 70% of cervical cancers developing.
    • Reduction in cervical cancer mortality.
  • Harms of cervical cancer screening include:
    • Over-diagnosis —  screening can detect human papillomavirus (HPV) infection and minor abnormalities in cervical cells which would have cleared up on their own without people ever knowing about them.
    • Psychological distress, such as anxiety when a minor abnormality or HPV infection is found.
    • Pain, discomfort, and/or embarrassment during the procedure.
    • False reassurance —  no screening test is 100% effective. In cervical screening this is because:
      • HPV infection or abnormal cells can sometimes be missed (a ‘false negative’ result).
      • Abnormal cells can develop and turn into cancer in between screening tests.

[NHS England, 2025a]

Management

Scenario: Cervical screening

From age 25 years to 65 years (Female).

How should I take a cervical sample for screening?

All healthcare professionals taking cervical samples should ensure that they are competent to do so and have undergone the appropriate training.

  • Before taking a sample, provide information and advice to enable the person to make an informed choice on whether to accept the offer of screening. Information on the NHS cervical screening programme is available from:
  • To take a sample:
    • Visualize the cervix (using a speculum).
    • Take a sample from the whole of the transformation zone.
      • If a person has 2 cervices, take a sample from each cervix.
      • If the cervix cannot be visualized, refer to colposcopy.
      • If the person has cervical stenosis, refer to the colposcopy clinic for consideration of cervical dilatation.
    • Detailed information on the practical aspects of taking cervical samples, including preparing for sample taking, taking the sample, and completing the request form, are available on the PHE website. 
  • Note that bleeding during sample taking is not uncommon, especially from the columnar epithelium.
    • If the cervix bleeds with no clinical suspicion of malignancy, assess the amount of bleeding, and consider possible causes. Send the sample to the laboratory, and explain to the person that the sample may be inadequate (and they may need to have the test repeated).
    • If bleeding is a repeated problem and causes repeated inadequate samples, or if the person has post-coital bleeding, consider referral to a gynaecologist for further investigations.
    • If the cervix bleeds and there is clinical suspicion of malignancy:
      • Do not take a sample.
      • Arrange urgent referral (within 2 weeks) to a gynaecologist.
      • For more information, see the CKS topic on Cervical cancer and HPV.
  • Delay cervical screening if the person:
    • Is menstruating.
    • Is less than 12 weeks post-partum.
    • Is less than 12 weeks after a termination of pregnancy, or miscarriage.
    • Is pregnant. For more information, see the section on Screening during pregnancy.
    • Has a vaginal discharge or pelvic infection — treat the infection and take the sample on another occasion. For more information, see the CKS topics on Vaginal discharge and Pelvic inflammatory disease.

Basis for recommendation

These recommendations are largely based on the NHS England guidelines Ceasing and deferring women from the NHS Cervical Screening Programme [NHS England, 2025a] and Topic 8: the practical aspects of taking cervical samples [NHS England, 2025a], and on expert opinion in a review article [BMJ, 2022].

  • Cervical screening samples are taken from the junction of the ectocervix and endocervix (the transformation zone or squamocolumnar junction, where 90% of cervical neoplasias originate) to identify pre-malignant or malignant lesions [BMJ, 2022].
  • It may not be possible to obtain a cytology sample that represents the entire transformation zone from people who have severe cervical stenosis. Cervical dilatation may be required [PHE, 2019].

How should I manage human papillomavirus (HPV) results?

  • People who test negative for high-risk human papillomavirus (hrHPV) are classified as ‘negative’ and can be safely returned to routine recall unless on:
    • The test of cure (TOC) pathway.
    • The untreated cervical intraepithelial neoplasia (CIN)1 pathway.
    • Follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN), stratified mucin producing intraepithelial lesion of the cervix (SMILE), or cervical cancer.
    • Follow-up for borderline changes in endocervical cells.
  • People who test positive for hrHPV should have a cytology test performed.

Basis for recommendation

These recommendations are largely based on the Public Health England (PHE) guidelines Management and referral guidelines for colposcopy [PHE, 2021a] and Topic 2: background to cervical screening [PHE, 2020b].

  • In 2016, the UK National Screening Committee (UKNSC) recommended that the NHS Cervical Screening Programme (NHSCSP) should adopt the test for human papillomavirus (HPV) as the first test carried out [PHE, 2020b]:
    • There are over 100 types of HPV. Most do not cause significant disease in humans. However, some high-risk strains (notably types 16 and 18) are implicated in cervical cancer.
    • Laboratories now screen all cervical samples for high-risk HPV (hrHPV) subtypes as the first test.
    • Cytology is the triage test, only used when hrHPV is found.
    • Over 99% of cervical cancers contain hrHPV DNA. Looking at cases of cervical intraepithelial neoplasia (CIN), the higher the grade of CIN, the more frequently hrHPV is found. This suggests that people who do not have hrHPV are extremely unlikely to develop cervical cancer in the short to medium term.
    • Primary testing for hrHPV means that those at high risk of cervical cancer can have further tests more quickly, and those at low risk can be reassured.

How should I manage cytology results?

  • People who test positive for high-risk human papillomavirus (hrHPV) should have a cytology test performed.
    • People who are hrHPV positive and receive a negative cytology report should have the HPV test repeated at 12 months.
      • If HPV testing is negative at 12 months, the person can be safely returned to routine recall.
      • If HPV testing remains positive at 12 months, the person should have a repeat HPV test in a further 12 months.
      • If HPV testing is negative at 24 months, the person can be safely returned to routine recall.
      • If HPV testing remains positive at 24 months, the person should be referred to colposcopy.
    • People who are hrHPV positive with cytology reported as abnormal at 12 or 24 months must be referred to colposcopy.
  • If the hrHPV test result is unavailable or cytology is inadequate at any screening episode in the pathway, the sample must be repeated in no less than 3 months. 
    • People who have inadequate cytology at the 24-month repeat test are an exception and are referred to colposcopy.
    • People who have 2 consecutive HPV results unavailable or inadequate cytology results, in any combination, are referred to colposcopy.
      • If colposcopy is normal and adequate, the person should be followed up in the community at 12 months. If hrHPV testing is negative at 12 months, the person is returned to routine recall.
      • If colposcopy is inadequate, the person should have a repeat screening test and colposcopy examination in 12 months. If the repeat colposcopy is normal and HPV negative, the person is discharged to routine recall.

 

How cytology results are reported

  • Cytology results are reported as:
    • Negative — no abnormality is detected.
    • Abnormal — the cervical samples may show:
      • Borderline changes in squamous or endocervical cells.
      • Low-grade dyskaryosis.
      • High-grade dyskaryosis (moderate).
      • High-grade dyskaryosis (severe).
      • Invasive squamous cell carcinoma.
      • Glandular neoplasia.
    • Inadequate — this may be because the cervical sample:
      • Was taken but the cervix was not fully visualized.
      • Was taken in an inappropriate manner (for example, using a sampling device not approved by the NHS Cervical Screening Programme).
      • Contains insufficient cells.
      • Contains an obscuring element (for example, lubricant, inflammation, or blood).
      • Was incorrectly labelled.

[PHE, 2021a; BMJ, 2022]

Colposcopy

  • At colposcopy the cervix is assessed in detail using a colposcope.
  • The colposcopist:
    • Looks for any abnormal changes in the cervix which may indicate pre-cancerous changes (cervical intraepithelial neoplasia [CIN]) or the presence of cancer.
    • Usually applies chemicals to the cervix, for example:
      • If acetic acid is applied to the cervix, abnormal areas (such as CIN) tend to turn white (sometimes referred to as acetowhite).
      • If an iodine solution is applied, normal tissue (on the outside of the cervix) stains dark brown. Pre-cancerous abnormalities may not stain with iodine. The cells on the inner part of the cervix do not stain brown.
    • May take a biopsy to confirm the diagnosis.

[British Society for Colposcopy and Cervical Pathology, 2013]

Basis for recommendation

These recommendations are largely based on the Public Health England (PHE) guideline Management and referral guidelines for colposcopy [PHE, 2021a].

How should I manage a person who has organisms reported on their cervical cytology result?

  • If Candida is present, see the CKS topic on Candida - female genital.
  • If bacterial vaginosis is present, see the CKS topic on Bacterial vaginosis.
  • If herpes simplex virus (HSV) is present, see the CKS topic on Herpes simplex - genital.
  • If Trichomonas vaginalis is present, see the CKS topic on Trichomoniasis.
  • If actinomyces-like organisms (ALOs) are present, manage as follows:
    • If the person has symptoms, such as pelvic pain:
      • Assess for signs and symptoms of pelvic inflammatory disease (PID). For more information, see the CKS topic on Pelvic inflammatory disease.
      • Assess for other more common causes of pain, including sexually transmitted infections (STIs).
      • If the person has an intrauterine contraception (IUC) in situ, consider removing it.
    • If the person is asymptomatic:
      • No follow up is required.
      • There is no need to remove the IUC.

Basis for recommendation

The recommendation on managing people with actinomyces-like organisms is based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline FSRH Clinical Guideline: Intrauterine contraception (April 2015, amended September 2019 [CoSRH, 2019].

Should a pregnant person be offered cervical screening?

  • If a person has been called for routine screening and she is pregnant, the test should be deferred until she is at least 12 weeks post-partum.
  • If a previous screening test was abnormal and in the interim the person becomes pregnant, colposcopy should not be delayed.
    • People may undergo colposcopy in late first or early second trimester, unless there is a clinical contraindication. However, for low-grade changes, the assessment may be delayed until after delivery.
    • People seen in early pregnancy may require a further assessment in the late second trimester.

Basis for recommendation

These recommendations are based on the NHS England guideline Ceasing and deferring women from the NHS Cervical Screening Programme [NHS England, 2025a] and Topic 8: the practical aspects of taking cervical samples [PHE, 2020c].

How often should people who have been treated for CIN be offered cervical screening?

  • Encourage all people treated for cervical intraepithelial neoplasia (CIN) to attend follow up as they are between 2–5 times more likely than the general population to develop cervical cancer.
    • People treated for CIN should be followed up for a test of cure repeat cervical sample 6 months after treatment.
      • The colposcopy clinic is responsible for notifying the call and recall service with the due date for the next screening.
    • The nature and timing of follow up will depend on the screening result:
      • People who are negative for high-risk human papillomavirus (hrHPV) should be recalled for repeat cytology in 3 years, irrespective of their age. If the 3-year test is negative, they can return to routine recall.
      • People who are hrHPV positive should be referred for colposcopy. Reflex cytology is performed to help inform colposcopic examination.
      • If the HPV result is unavailable, a repeat test should be performed at 3 months.
      • People aged 65 years or over should be invited for follow-up tests and/or referred for further investigations as necessary until they have completed all follow-up protocols and have satisfied the requirements for being ceased from the programme.

Cervical intraepithelial neoplasia (CIN)

  • Cervical intraepithelial neoplasia (CIN) is a term that describes abnormal changes of the cells that line the cervix.
    • CIN is typically caused by infections with human papillomavirus (HPV), especially the high-risk HPV types, such as strains 16 and 18 (these two strains cause more than 70% of cervical cancers).
    • In some people, the immune system is unable to clear the virus, and persistent infection can lead to the development of abnormal cell changes in the cervix. 
    • CIN is detected by colposcopy and is characterized by cellular changes in the transformation zone of the cervix.
    • Cervical dysplasia is an HIV indicator condition. For more information, see the CKS topic on HIV infection and AIDS.  
  • CIN is graded depending on how deep the cell changes go into the surface of the cervix:
    • CIN1 (sometimes referred to as low-grade squamous intraepithelial lesions) — one-third of the thickness of the surface layer of the cervix is affected.
    • CIN2 — two-thirds of the thickness of the surface layer of the cervix is affected.
    • CIN3 (sometimes called high-grade or severe dysplasia or stage 0 cervical carcinoma in situ) — the full thickness of the surface layer is affected.
  • CIN may exist at any one of the three stages.
    • CIN1 lesions are morphological correlates of HPV infections. 
    • CIN2/3 lesions (collectively referred to as CIN2+) are correlates of cervical pre-cancers that, if left untreated, may progress to cervical cancer. 

[PHE, 2020b; Macmillan Cancer Support, 2021; PHE, 2021b; WHO, 2021]

Basis for recommendation

These recommendations are based on the Public Health England (PHE) guideline Topic 4. Colposcopic diagnosis, treatment and follow up [PHE, 2021c].

  • People who have been treated for cervical intraepithelial neoplasia (CIN) are 2–5 times more likely than the general population to develop cervical cancer, which may result from poor compliance with long-term follow up [PHE, 2021c].

Should people who have had a hysterectomy be offered cervical screening?

  • If a person has had a subtotal hysterectomy (still has a cervix), they should continue in the National Cervical Screening Programme (NHSCSP).
  • If a person has had a total hysterectomy (no longer has a cervix), they are not required to take part in the NHSCSP.
  • After a hysterectomy, the secondary care team will decide what follow up is required. The type and frequency of follow up will depend on the reason for the hysterectomy and if cervical intraepithelial neoplasia (CIN) was found in the hysterectomy specimen. People who have had a hysterectomy with CIN present are potentially at risk of developing vaginal intraepithelial neoplasia (VaIN) and invasive vaginal disease. The recommended follow up is that:
    • People on routine recall and with no CIN in their hysterectomy specimen do not require further follow up.
    • People who have completely excised CIN should be offered vault cytology 6 months after their hysterectomy.
      • If they have a negative human papillomavirus (HPV) result, they can be discharged.
      • If they are high-risk HPV (hrHPV) positive, cytology negative at 6 months, they should be referred to colposcopy. If there is no evidence of VaIN at colposcopy, they can be discharged.
    • People who have incompletely excised CIN (or excision is uncertain) should be followed up as if their cervix remained in situ and offered: 
      • If low-grade disease (CIN 1): cytology at 6, 12, and 24 months.
      • If high-grade disease (CIN 2 or CIN 3): cytology at 6 and 12 months, followed by annual cytology for 9 years (follow up continues to age 65 years or until 10 years after surgury, whichever is later).

Basis for recommendation

These recommendations are based on the Public Health England (PHE) guidelines Management of cases relating to pregnancy, menopause, contraception and hysterectomy [PHE, 2021d] and Colposcopic diagnosis, treatment and follow up [PHE, 2021: Colposcopic diagnosis, treatment and follow up].

Should people who are immunosuppressed be offered more frequent cervical screening?

  • For people with kidney failure who require dialysis (or any other disease with a high chance of needing organ transplantation):
    • Offer cervical screening at, or shortly after, diagnosis if they are not already up to date with screening.
  • For people who are about to undergo organ transplantation:
    • Offer cervical screening within a year before transplantation.
  • For people who are HIV positive:
    • Offer cervical screening at diagnosis and annually thereafter. Ideally, colposcopy should also be offered at diagnosis.
  • For people who are starting cytotoxic drugs for rheumatological disorders: 
    • Offer cervical screening if the screening history is incomplete at the start of treatment. Any abnormality should be referred immediately to colposcopy. 
  • There is no indication for increased surveillance in people taking: 
    • Post-transplantation immunosuppressive drugs after the first year in people with no history of cervical intraepithelial neoplasia (CIN). However, a person with an abnormal cervical cytology result should be referred promptly to colposcopy.  
    • Cytotoxic chemotherapy for non-genital cancers.
    • Oestrogen antagonists (such as tamoxifen).
    • Alemtuzumab.

Basis for recommendation

These recommendations are largely based on the Public Health England (PHE) guideline Screening and management of immunosuppressed individuals [PHE, 2021e].

  • The recommendation to offer cervical screening to eligible people who are starting cytotoxic drugs for rheumatological disorders if the screening history is incomplete at the start of treatment is based on what CKS considers to be good clinical practice.
  • For people for whom there is no indication for increased surveillance, PHE advises that they should have cervical screening according to the national guidelines for the general population. If there is an indication for increased surveillance relating to the prescribing of long-term biologic agents, local protocols should be developed as this indication for more intensive screening is outside the cervical screening programme standard practice [PHE, 2021e].

Supporting evidence

This CKS topic is largely based on the NHS England guidance Cervical screening: programme overview [NHS England, 2025a]. 

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of cervical screening.

Search dates

August 2017 - August 2022

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • cervical screening.tw, mass screening/, uterine cervical neoplasms/, vaginal smears/. liquid based cytology.tw. LBC.tw

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

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