CHAPTER 12 - Colposcopy services

Summary

Key points

1. ✓ Colposcopy has a well-developed training programme and commitment to continuing professional development.

2. ✓ Quality assurance is given high priority and the whole service is subject to formal assessment on a regular basis.

3. ✓ The training programmes were established over 10 years ago as a partnership between the British Society for Colposcopy and Cervical Pathology and the Royal College of Obstetricians and Gynaecologists, for medical or nursing qualified staff.

4. ✓ Research and audit data are relevant in a national screening programme before the widespread introduction of new guidelines and technologies.

5. ✓ The roll-out of liquid based cytology is now complete and data are awaited from other national initiatives that will inform the future screening and colposcopy services.

Introduction

Colposcopy services have been established in the UK since the 1960s, after colposcopy was introduced into clinical service by the early pioneers. Around that time, an ad hoc cervical screening service existed but it was not until 1988 that the programme was established nationally in a systematic manner under the auspices of the National Health Service Cancer Screening Programme (NHSCSP). The systemic approach has, to a large degree, underpinned the success of the screening programme, although latterly the service has been devolved to the individual countries (England, Wales, Scotland and Northern Ireland).

The national cervical screening programmes in the UK have led to high coverage of the at-risk population. For example, in England the NHSCSP currently achieves 78.6% coverage. There has been a gradual decline in the coverage rate (screened at least once in the previous 5 years) having been at a commendably high level of 82.5% in 1998.

There has been improvement in the provision of a rapid turnaround time for cervical cytology results and the aim is for all women to have communication within 2 weeks of the test being performed for screening purposes by 2010. Increasingly, direct referral systems are being established for abnormal cervical cytology to the colposcopy service. Recent guidance states that cervical cancers detected through the screening programme will be part of the Government's 62-day target for cancer treatment. This will require a rapid assessment of all high-grade (moderate dyskaryosis or worse) cytological abnormalities and it is suggested this should be within 2 weeks of the results being available.