Recipient organisationInstitute of Cancer ResearchSource-published name: Institute of Cancer Research: Royal Cancer Hospital (the)
Funding£2.9M
PeriodJan 2006 — Sept 2011
In plain English
AI plain-English summary
Nearly one in three cervical screening smears in England between 1999 and 2003 were taken opportunistically, outside the official call-and-recall system, shortening the average screening interval in five-year policy areas to something closer to three years. This matters because the NHS cervical screening programme was designed around specific intervals—three years for younger women, five for older—to balance cancer prevention against cost and patient burden. The study of nearly 2 million women found that in areas with a nominal five-year policy, 43% of smears were opportunistic, compared to 17% in three-year policy areas. That extra screening drives up costs without clear evidence of additional cancer prevention. If the findings are heeded, policymakers can better monitor and manage opportunistic screening, particularly for women aged 50–64 who are now invited every five years. Without such monitoring, the programme risks spending more than necessary while delivering little extra health benefit. The research provides a concrete, data-driven basis for adjusting how the NHS tracks and responds to real-world screening behaviour.
View original technical description
BackgroundObjective: To study the prevalence of opportunistic smear taking in the NHS cervical screening programme between 1999 and 2003 and the relationship of this to screening interval policy.Design: A cohort study of nearly 2 million women, with data on screening at ages 20-64 from 1988-2003 has been constructed. Data from 1999-2003 have been used in this analysis. Screening episodes have been divided into those where the primary smear was initiated by the national call/recall system (invitational), normally at 3 or 5 yearly intervals, and those initiated by the GP or woman (opportunistic). Opportunistic smears were further classified as routine (occurring within 6 months of 3 or 5 years) or sporadic (occurring at other times).Setting: NHS cervical screening programme.Population: Four Health Authorities in England (now PCTs) with supplementary studies on national data. Results: In total, 72% of incident screen primary smears were invitational and 28% opportunistic. The proportion of opportunistic primary smears was 17% and 43% in 3 or 5 yearly screening policy areas respectively, resulting in a considerably reduced average screening interval for women aged 20-64 in five-year policy areas. Conclusion: The NHS cervical screening programme is strongly influenced by opportunistic smear taking. In particular, nominally five-year policy areas experienced much higher levels of opportunistic smear taking than those with a three- year policy, causing the average interval in the five-year areas to be much shorter than the policy would suggest. In future, with the change in national policy to inviting women aged 25-49 every 3 years and those aged 50-64 every 5 years, the level of opportunistic smear taking, particularly in the older group of women needs to be carefully monitored. A lack of compliance may result in greater than predicted costs with little or no additional cancer prevention. AimsHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Plan of InvestigationHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Potential ImpactHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Policy RelevanceUnknown
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