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NHSCSP guidelines

NHSCSP guidelines recommend hrHPV triage and test of cure

NHSCSP protocol on triage and test1

  • NHSCSP guidelines recommend triage with hrHPV testing for women with borderline or low-grade dyskaryosis (mild dyskaryosis) cytology results.1 
  • Triage of borderline and low-grade dyskaryosis samples is an appropriate cervical screening method for women 25-64 years old. Any low-risk woman with borderline or low-grade dyskaryosis cytology who receives a negative hrHPV test result should be returned to routine recall of 3 to 5 years, depending on her age.1 
  • Any woman with borderline or low-grade dyskaryosis cytology who receives a positive hrHPV test result should be referred to colposcopy. A negative colposcopy or biopsy with no CIN indicates low-risk and the woman can also be safely returned to routine recall of 3 to 5 years.1 
  • ‘Test of cure’ hrHPV testing should be performed for women with a normal, borderline or low- grade dyskaryosis cytology results at 6 months post treatment. Any low-risk woman who receives a negative hrHPV test result can be returned to 3 year recall. 1

In the screening guidelines, HPV refers only to high-risk HPV.

  • Other HPV types should not be used in cervical screening as part of the NHSCSP algorithm. 
  • Testing for low-risk HPV types has no clinical role in cervical screening or the evaluation of women with abnormal cytology.

NHSCSP guidelines overview

NHSCSP guideline overview

The following recommendations are based on good and consistent scientific evidence and were supported by the sentinel sites study:1,2,3

  • Cervical screening should begin at 25 years of age and should cease at 64 years. 
  • Cytology screening is recommended every 3 years for women between the ages of 25 years and 49 years. 
  • Women aged ≥50 years, who have normal cytology in all previous screening rounds, will be invited every 5 years.
  • Women in the Tes of Cure protocol who reach 65 must still be invited for screening and need to complete the protocol.
  • Women over 60 years of age with borderline changes or low-grade dyskaryosis (mild dyskaryosis) and who tested hrHPV negative at triage can be discharged from the programme, as their next screening round would be after they have reached 65 years of age.
  • Women over 60 years of age who have normal cytology, borderline changes or low-grade dyskaryosis, and tested hrHPV negative at test of cure, will return to 3 year recall irrespective of age. If the next follow-up cytology test is normal they can be discharged from the programme.
  • A woman who has received treatment for CIN prior to the age of 25 can be included in test of cure hrHPV testing at follow-up appointment irrespective of age.
    • Treated women who have normal, borderline or low-grade dyskaryosis cytology six months post-treatment and tested negative for hrHPV are at very low risk of cervical cancer and need not be screened again for three years.
  • Only women who have had a total hysterectomy should exit the programme. Women with subtotal hysterectomy, retained their cervix, continue to be at risk and should remain in the programme.4
  • Only liquid-based cytology (LBC) is acceptable for screening.

Additional Key considerations

Additional key considerations from the guidelines

Advice regarding the use of tests that have not been clinically validated

The guidelines recommend/caution:

  • Against the use of Lab Developed Tests for cervical screening. 
  • In the UK only NHSCSP approved test can be used for hrHPV testing as part of the cervical screening triage and test of cure protocol algorithm 
  • Guidelines were developed based on HPV tests that have performance characteristics similar to those of the HPV tests used in the supporting evidence. 
    • The guidelines cannot be expected to perform as designed (ie, to balance benefits and harms) when using HPV tests with different performance characteristics.

  • Acronyms:

References:

1. HPV Triage and Test of Cure Implementation Guide, NHS Cancer Screening  Programmes; HPV TRIAGE AND TEST OF CURE: IMPLEMENTATION GUIDANCE, NHSCSP Good Practice Guide No3, July 2011.

2. Kelly RS, Patnick J, Kitchener HC, Moss SM, on behalf of the NHSCSP HPV Special Interest Group. HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study. Brit J Cancer. 2011;105:983–988.

3. Moss S, Kelly R, Legood R, et al. Evaluation of Sentinel sites for HPV triage and test of Cure: Report to the NHS Cancer Screening Programmes, September 2011.

4. NHS Cervical Screening Programme. Colposcopy and Programme Management. Publication No 20. May 2010.