Cervical Screening and Colposcopy Guidance During Covid-19

The coronavirus pandemic is affecting the cervical screening programme and colposcopy referral process. Cervical screening has now been paused in Scotland, Wales and Northern Ireland, and in many cases postponed in England. The majority of non-urgent GP appointments are being moved to phone consultations, which of course isn’t viable for an in-person screening test, and whilst gynaecology departments are not directly related to Covid-19 (unlike A&E for example), their resources (staff, equipment and space) are becoming increasingly limited. Staff must also consider if it is appropriate to expose women to the risk of Covid-19 while they travel in for a routine screening test.

The below information is accurate at the point of writing. We are keeping up to date with the latest guidance through our network of Healthcare Professionals, and will update this page accordingly.

Cervical Screening and Colposcopy Guidance During Covid-19

Cervical cancer is the only one of the five gynaecological cancers to have an effective screening programme.

In the UK, the NHS cervical screening programme begins at 25. Appointments are every three years between the ages of 25 and 49, then every five years until 64. If someone receives an abnormal result, or requires treatment for abnormal cells, they will be referred to colposcopy for diagnostic tests.  If treatment is required, they will be followed up in colposcopy at six months and returned to routine screening if all is well at this stage.

A cervical screening test isn’t a test designed to detect cervical cancer. Its job is to first of all look for high-risk HPV. HPV (human papillomavirus) is the name of a common group of viruses, with over a hundred different strains (types). There are certain strains that are classed as ‘high-risk’ because they have the potential to cause abnormalities to the cells of the cervix, which if left untreated, could develop into cervical cancer over a long period of time. If high-risk HPV is detected in a cervical screening test, the cells will then be examined under a microscope. If abnormal cells are found, then that person would normally be invited for a colposcopy appointment at the hospital, to further investigate these abnormalities.

Our Ask Eve team has put together a Q&A about cervical screening and colposcopies during Covid-19, and have written this with as much detail and transparency as possible. If you would like to talk to Ask Eve, please send an email to nurse@eveappeal.org.uk and they will reply ASAP. This is a very scary time for so many of us, and we want to help and support you as much as we can.

Q: I have my cervical screening appointment booked for next week. Will it be cancelled? 

A: The NHS cervical screening programme hasn’t officially stopped in England, but has been officially paused in Scotland, Wales and Northern Ireland, in England appointments will be delayed if resources aren’t available. The current guidance from the BSCCP (British Society for Colposcopy and Cervical Pathology) is that screening may have to go on hold for the time being. We know that not giving a definitive answer can be frustrating, but it really does depend on the clinic where you are due to have your screening appointment, which for most people is their GP surgery. If they don’t have the staff available, then your appointment will be postponed until a later date. We anticipate that your GP practice will notify you if your screening test is cancelled, but do call and check if them if you’re unsure.

Q: I’m having my screening tomorrow. Will it be any different to my previous tests?

A: Other than the nurse or doctor wearing a mask (and gloves), the actual screening procedure itself is no different. However there will be a few changes to your overall experience:

  • Prior to Covid-19, a friend/family member could accompany you to your cervical screening, but now you unfortunately can’t bring anyone into the appointment with you.
  • When you arrive at the clinic, instead of going straight into the reception/waiting room, you will need to either wait in your car or stand outside in a queue (2m apart).
  • You will need to phone the reception team inside and tell them that you have arrived. The receptionist will check with you that you don’t have any coronavirus symptoms. If you do, you will need to go home without having your screening.
  • The receptionist will phone you when they doctor/nurse is ready for you. You will be met at the doors to the clinic and directed to your room.

Q: My cervical screening has been cancelled. When do I rebook or will this happen automatically?

A: The cancellation will be recorded on the screening database and in theory, you will automatically be re-invited when resources are available at your practice. However, no computer system is 100% reliable, so we recommend phoning your GP if you haven’t received a new appointment after three months, just to see if they have an idea of timeframes. We appreciate that having your cervical screening appointment cancelled is frustrating, particularly if it’s something you had been worrying about.

Q: Will cervical screening results be delayed? 

A: If you have had your cervical screening test, we currently do not expect your results to be delayed. Normally people have to allow four to eight weeks, although sometimes they can be received within two weeks. If you haven’t received your results within eight weeks after your test, we suggest phoning your GP surgery to chase up.

Q: I have had an abnormal screening result. What happens now?

A: Please remember that a cervical screening test is not a test for cervical cancer, it is a test to check the health of the cervical cells and to detect any abnormalities, which if left untreated, could potentially become cancer in the future. Having an ‘abnormal’ cervical screening result does not mean that you have cervical cancer.

Your sample will be tested for high-risk (hr) HPV.

No hrHPV = come back for next cervical screening test in 3-5 years depending on your age.

If hrHPV is present, then the lab will run a cytology test, which means looking at the cells under a microscope.

  • No abnormal cells = No action needed at this stage. Re-tested for HPV in 12 months.
  • Abnormal cells = This means that some changes to your cervical cells have been detected. Cell changes are referred to as ‘dyskaryosis’ and can be grouped into three stages describing the level of ‘abnormality’ the cells have reached – mild, moderate and severe. These abnormal cells are known as CIN (Cervical Intra-epithelial Neoplasia), and can be graded as CIN1, CIN2 and CIN3. This describes how far into the surface of the cervix these abnormal cells have grown. The higher the grade, the deeper the abnormal cells can be found. In most cases, mild dyskaryosis correlates with CIN1, moderate dyskaryosis with CIN2 and severe dyskaryosis with CIN3. CIN1 will often ‘go back to normal’ on its own, CIN2 sometimes requires treatment to remove the abnormal cells, and CIN3 is always treated as these cells are closer to becoming an early cervical cancer if left alone.

Prior to Covid-19: If your screening results showed abnormal cells (CIN)/cell changes (dyskaryosis) then you would be invited to the hospital for a colposcopy appointment. A colposcopy is a test that involves looking at the cervix in much more detail, using a large magnifying glass called a colposcope. The aim is to get a definitive answer to the ‘staging’ of the abnormal cells. A biopsy (small sample of tissue) may be taken and sent away for testing.

During Covid-19: If your screening shows that you have changes to your cervical cells, it’s important to remember that this isn’t cancer. The type of change to your cervical cells will dictate whether or not you need to be seen in the hospital for a colposcopy. At the moment, only people with CIN3/severe dyskaryosis will be referred for a colposcopy. Those with CIN1 or CIN2 are not currently being referred for a colposcopy. We don’t know yet if this means they will be given a colposcopy appointment as soon as resources permit, or if they will need to wait and be re-tested to see if the cell changes have reverted back to normal before being booked in for a colposcopy. CIN3 is less likely to return to normal if left untreated and is the stage prior to an early cancer, therefore a colposcopy and further investigation is required.

Q: My results letter says that I have cell changes, but doesn’t specify what stage they are. Do I need a colposcopy?

A: If your results letter doesn’t say that you will be invited for a colposcopy, then you will not need to book an appointment and can assume that the cell changes were low to moderate. We know that it’s going to be very hard for those who hear that if they had received their ‘abnormal’ screening result prior to the pandemic, they would have automatically been referred for a colposcopy and further investigation. The only reassurance we can hope to offer, is that you haven’t been referred because the doctors have seen that your cells changes are not severe enough to cause immediate concern.  Please send Ask Eve an email or give the team a call if you want to talk about your concerns. We know this isn’t easy and want to support you as much as we can.

Q: I received my results a few weeks ago and they said I had CIN1. My colposcopy was booked for this week but I’ve just had a call to say it’s cancelled. Why and what happens now?

A: Your colposcopy has been cancelled because the criteria for referring people with abnormal cervical screening results to colposcopy has changed. The mild changes to your cervix (CIN1) are not severe enough to cause the colposcopy team at your hospital concern for the time being, and do not warrant bringing you into the potentially dangerous hospital environment. The risks outweigh the benefits for you at the moment. Priority is being given to those with severe cell changes (CIN3) as this is more likely to develop into cancer if left untreated. Your data and ‘cancelled appointment status’ is stored securely in a database and you do not need to do anything. You will either be invited for a colposcopy as soon as resources at your hospital are available, or invited for another cervical screening or ‘re-testing’ with your GP, to see if your mildly abnormal cells have returned to normal, as is often the case for CIN1.

Q:  My results say I have severe cells changes and I need to have a colposcopy. When will this be?

A: We anticipate that this appointment will be within the next few weeks, maybe sooner. This depends on the resources in your area, including nurse and doctor availability. If these resources come under further strain in the coming weeks and months, then the wait time for colposcopies will be affected.

Q: My results said I have high-risk HPV and cell changes, and need a colposcopy. I then received my letter with my colposcopy appointment for next week. Should I still attend?

A: If you received your colposcopy appointment letter before the coronavirus outbreak, then the colposcopy department will be looking at your results letter and your history, i.e. previous abnormal results, missed screening appointments, any reported symptoms etc. and assessing whether or not you still need to be seen. The staff shortages due to Covid-19 are also taken into consideration. Unless you hear otherwise, turn up to your appointment. However, if you develop any coronavirus symptoms, e.g. a dry cough or fever, or you have been in contact with someone who is experiencing symptoms then you will need to cancel your colposcopy appointment. If the phone number for the colposcopy department isn’t on your appointment letter, phone your GP and ask how best to get in touch with the team.

Q: My colposcopy was cancelled a few weeks ago. I have now started bleeding after sex and I’m really worried. What should I do?

A: You will need to phone your GP, and explain that you have started to experience potential cervical cancer symptoms. Your GP will then contact the gynaecology team and discuss with them the best course of action for you. You will either be asked to have an in-person appointment with your GP, or be referred to the hospital for a gynaecology appointment. Both options will involve a vaginal examination. If your colposcopy has been cancelled and you begin to have symptoms, you will be seen by someone, it’s just a case of assessing whether that person is your GP or a gynaecologist. All cases are treated on an individual basis.

Q: I had treatment for abnormal cells almost six months ago, and am due to have a follow-up appointment with my GP in two weeks. Will this be cancelled?

A: We hope not, but it is quite possible that your follow-up will be rescheduled. This isn’t something to necessarily worry about, as you have already been treated for your abnormal cells. The success rate for treatment of cervical abnormalities is very high, and the chance of recurrence is low.

Q: I missed my last two cervical screening appointments. I had one booked in for next week but it’s been cancelled and now I’m worrying. What should I do?

A: We know that there are a number of reasons why people don’t attend their cervical screening appointments, and it can be a very difficult thing for some people to build themselves up to. Unfortunately, the Covid-19 situation means that a lot of GP surgeries are postponing all cervical screening appointments for now. There aren’t currently any special measures in place for people who are overdue their screening appointment or missed a test(s). All we can advise for the time being is to be aware of the symptoms of cervical cancer, and to contact your doctor if you have any concerns. We understand that having your overdue cervical screening cancelled might make you feel anxious. Please reach out to your GP or our Ask Eve team if you need someone to talk through these worries with.