KC53/61/65 Statistical Report Adroddiad Ystadegol 2012/13 Prepared by Cervical Screening Wales

Transcription

1 KC53/61/65 Statistical Report Adroddiad Ystadegol 2012/13 Prepared by Cervical Screening Wales

2 CERVICAL SCREENING WALES STATISTICAL REPORT CERVICAL SCREENING PROGRAMME, WALES: 2012/2013 For more information about this report contact: Helen Beer, Senior Information Manager and Research Specialist, Cervical Screening Wales, Screening Division, Public Health Wales, 18 Cathedral Road, Cardiff, CF11 9LJ Tel: (029) WHTN: or 7803 Fax: (029) September 2013

3 CONTENTS Introduction and Commentary... 4 KC53: Cervical Cytology Table 1 Test status of women and coverage, by age... 6 Figure 1a: Screening coverage of all age groups... 6 Figure 1b: Screening coverage of target age group (20-64 years), 2002/ / Table 2: Test status and coverage of target age group (20-64 years), by Health Board... 7 Figure 2: Percentage of target age group (20-64 years) screened within the last 3 and 5 years, by Health Board... 7 Tables 3a/b: Women invited, by type of invitation and age at test (numbers and percentages)... 8 Figure 3a: Percentage of invitations, by type of invitation and age... 9 Figure 3b: Percentage of invitations, where repeat advised in less than 3 years, by reason and age... 9 Tables 4a/b: Women aged invited in the year, by type of invitation and Health Board (numbers and percentages) Figure 4a: Percentage of invitations to women aged 20-64, by type of invitation and Health Board Figure 4b: Percentage of invitations to women aged 20-64, where repeat advised in less than 3 years, by reason and Health Board Tables 5a/b: Women tested, by type of invitation and age at test (numbers and percentages) Figure 5a: Percentage of women tested, by type of invitation and age Figure 5b: Percentage of women tested, where repeat advised in less than 3 years, by reason and age Table 6: Women tested in the year, by Health Board Figure 6: Number of women tested in the year, all ages and target age group, by Health Board Tables 7a/b: Women aged tested in the year, by type of invitation and Health Board (numbers and percentages) Figure 7a: Percentage of women aged tested, by type of invitation and Health Board Figure 7b Percentage of women aged tested, where repeat advised within 3 years, by reason and Health Board Tables 8a/b: Test results, by age (numbers and percentages) Figure 8: Low grade and high grade results as a percentage of adequate test results, by age. 17 Tables 9a/b: Test results of women aged 20-64, by Health Board (numbers and percentages) Figure 9: Low grade and high grade results of women aged 20-64, as a percentage of adequate test results, by Health Board Tables Xa/b: Sample turnaround times, by Health Board (numbers and percentages) Figure X: Sample turnaround times, by Health Board Cervical Screening Wales, Information Team Page 1 Cervical Screening Programme, Wales: 2012/2013

4 Tables Ya: Number of women invited in the year, by age group, 2002/ / Tables Yb: Number of women tested in the year, by age group, 2002/ / Figure Y: Women aged invited and tested each year KC61: Pathology laboratories Cervical cytology and biopsies Table 10: Number of samples examined, by pathology laboratory and source of test Figure 10a: Percentage of inadequate tests, by laboratory Figure 10b: Percentage of high grade results, by laboratory Figure 10c: Percentage of inadequate tests and high grade results, by source of test Tables 11a/b Result of test, by laboratory (numbers and percentages) Figure 11a: Result of test, by laboratory Figure 11b: Low grade and high grade results as a percentage of adequate samples, by laboratory Tables 12a/b: Adequate samples examined, by result of test and age (numbers and percentages) 25 Figure 12a: Abnormal tests, by age and result Figure 12b: Positive tests, by age and result Table 13a: Inadequate tests, by age and laboratory Table 13b: Inadequate tests as a percentage of total samples, by age and laboratory Figure 13: Inadequate tests as a percentage of total samples, by age Tables 14a/b: Outcome for women recommended for gynaecological referral following a result of inadequate, borderline or mild dyskaryosis Figure 14a: Outcome of referral following a result of inadequate, borderline or mild dyskaryosis Tables 14c/d: Outcome for women recommended for gynaecological referral following a result of moderate dyskaryosis or worse Figure 14b: Outcome of referral following a result of moderate dyskaryosis or worse Table 15: Positive Predictive Value (PPV) for high grade referrals, by laboratory Figure 15: Positive Predictive Value (PPV) for high grade referrals, by laboratory KC65: Colposcopy Clinics Tables 16a/b: New patients seen, by referral test result and colposcopy clinic (numbers and percentages) Figure 16: Percentage of new patients seen, by referral test result and colposcopy clinic Table 17: Figure 17a: Figure 17b: Time from receipt of referral to first offered appointment, by colposcopy clinic (excluding patient instigated delays) Percentage of all new referrals offered an appointment within 8 weeks, by colposcopy clinic (excluding patient instigated delays) Percentage of all new referrals with a result of moderate dyskaryosis or worse, offered an appointment within 4 weeks, by colposcopy clinic (excluding patient instigated delays) Cervical Screening Wales, Information Team Page 2 Cervical Screening Programme, Wales: 2012/2013

5 Tables 18a/b: Attended visits, by type of visit and colposcopy clinic (numbers and percentages) Figure 18: Percentage of attended visits, by type of visit and colposcopy clinic Tables 19a/b: New patients seen, by referral test result and most significant procedure at first visit (numbers and percentages) Figure 19: Percentage of new patients seen, by referral test result and most significant procedure at first visit Tables 20a/b: New patients seen, by most significant procedure at first visit and colposcopy clinic (numbers and percentages) Figure 20: Percentage of new patients seen, by most significant procedure at first visit and colposcopy clinic Tables 21a/b: New patients seen, by colposcopic opinion and worst outcome of histology (numbers and percentages) Figure 21: Percentage of new patients seen having colposcopic assessment, by colposcopic opinion and worst outcome of histology Tables 22a/b: New patients having a biopsy taken, by colposcopy clinic and worst outcome of histology (numbers and percentages) Figure 22: Percentage of new patients having a biopsy taken, by colposcopy clinic and worst outcome of histology Tables 23a/b: Cervical biopsies taken, by type and outcome of histology (numbers and percentages) Figure 23: Percentage of cervical biopsies taken, by type and outcome of histology Tables 24a/b: Correlation of outcome from an initial punch biopsy with a subsequent LLETZ (numbers and percentages) Figure 24: Correlation of outcome from an initial punch biopsy with a subsequent LLETZ Cervical Screening Wales, Information Team Page 3 Cervical Screening Programme, Wales: 2012/2013

6 CERVICAL SCREENING PROGRAMME: WALES 2012/2013 Introduction This report continues the series of detailed summaries of information gathered from three sources on work undertaken by Cervical Screening Wales (CSW): 1. Information from the NHAIS call and recall system (the Exeter System ) collected by the Cervical Screening Administration Departments (KC53). This is the tenth report to show the KC53 statistics by Health Board (HB) area. Current information relates to the new HB structure introduced in October Information on cervical screening tests examined by the pathology laboratories (KC61) following the uptake of invitations for screening including opportunistic tests. 3. Information about colposcopy activity (KC65) collected from the CANISC-Colposcopy Information System, previously known as ISCO, which records clinical and administrative data from colposcopy services in Health Boards. The series of statistical reports published by CSW were originally produced by the Welsh Government s (WG) Health Statistics and Analysis Unit. Statistics from previous years may be found on the CSW website and in Health Statistics bulletins published by WG. Policy for the cervical screening programme in Wales was established on the introduction of CSW in Women are invited to be screened at least once every three years within the age group of years. This report includes this target age range and also the age range years for comparison with the NHSCSP bulletin on cervical cytology (Note Policy on the age range and test frequency was under review at the time that this report was compiled). Key Facts At 31 March 2013, 76.3% of women in the target age group (20-64 years) had been screened with an adequate result at least once in the last 5 years, whilst coverage exceeds 73% in all Health Boards. At 31 March 2013, coverage for year olds was 79.5%. 220,500 women were screened in 2012/13, (including those with inadequate results); the majority in response to a formal invitation from the screening programme. Laboratories, examined around 230,300 samples on Welsh residents in 2012/ ,800 were screened in welsh labs and a further 5,500 in English labs. 8,400 new patients were seen at colposcopy clinics in Wales in 2012/13, 75% having been directly referred by Cervical Screening Wales. Changes in definition Any changes in definition are noted in the text. Coverage figures in particular are not directly comparable year on year. Prior to 1997/98, all women classified as recall ceased by the programme (for medical, age or other reasons) were excluded from the denominator used to calculate coverage In 1998/99 the definition changed to exclude only those women with recall ceased for clinical reasons (no cervix Since 2001/02, coverage figures include only those women who received an adequate test in the last 3 or 5 years in the numerator Coverage (Tables and Figures 1 and 2) Coverage of women aged was 62% in 1989/90 when population screening was introduced and has been over 8 from 1992/93 to 2001/02. In 2012/ % of women aged years had been tested with an adequate result in the last 5 years. There is some variation in coverage between Health Boards (HB), ranging from 73.7% in Cardiff and Vale UHB to 80.1% in Powys THB. Overall coverage has decreased slightly across Wales. Invitations for screening (Tables and Figures 3 to 7) Standard procedures for first and subsequent reminders are: A 6 month interval between first and second invitation A 6 month interval between second invitation and the final non-responder card. In 2012/13 around 311,100 women aged were invited for screening (Table 3). The invitation was a first call for screening for 19. of these women and a routine recall for 60.3%. For 19.3% it was the result of a repeat sample being advised, and for 1.4%, a recall because the previous sample was inadequate. In 2012/13, CSW tested 217,500 women aged (table 5). 7.5% of these were tested in response to a first invitation and 57.1% following a routine recall. 13.4% were reported to be opportunistic screening ie women screened who had not responded to an invitation. The number of opportunistic tests examined in the target age group has fallen from just over 50,000 in 1999/2000 to 29,200 in 2012/13. The number of samples taken from women aged under 20 years has fallen from 3,647 in 1999/2000 to 30 in 2012/13, and 81.1% of these are opportunistic tests. A category showing those women who have been tested whilst ceased from recall has been included since 2003/04. CSW recommends that screening is not undertaken in women under 20 years of age, even if sexually active. Note that the uptake of invitations cannot be precisely measured as some tests undertaken in the screening year (1 st April to 31 st March) may result from marginal invitations, either issued in the previous screening year, or taken up in the following year. Cervical Screening Wales, Information Team Page 4 Cervical Screening Programme, Wales: 2012/2013

7 Test Results (Tables and Figures 8 to 9) The data for these tables and figures come from the KC53 return and differ from that shown in Tables 10 to 13 and associated figures, which come from the KC61 return. The former table relates to women and the latter to tests. Note that test results relate to the most severe result from 1997/98 onwards and not the most recent result as for those prior to From 2003/04 onwards, the tables and graphs show borderline, mild dyskaryosis and high-grade test results. This report, the seventh following conversion to liquid based cytology (LBC), summarises the results of all screening tests sent to laboratories. Workload figures from previous publications include conventional Pap smears, so caution must, be taken when comparing results from individual laboratories and previous all-wales figures. This is the fourth report to illustrate turnaround times, from taking the sample to issue of result letter (Table X). Across Wales 10. of results were issued within 2 weeks of the test being taken (range 0.3% to 55.8%). 95.6% of results were issued within 6 weeks (10 target). Data is presented showing the number of women in the target age group years who were invited and tested each year (Tables and Figure Y). Samples Examined (Tables and Figures 10 to 13) Laboratory screening has been reconfigured within Wales. The number of screening laboratories has been reduced to four. Three English labs (Chester, Shrewsbury & Hereford) screened samples from Wales. Around 230,300 samples were examined: 224,800 in Wales and 5,500 in England. 1.6% of tests were reported as inadequate with wide variation between laboratories, ranging from 0.8% to 2.. Most samples are taken in general practice (88.7%). The percentage of high-grade results (moderate dyskaryosis or worse) is generally higher from NHS hospitals than from GPs and NHS Community & Sexual Health Clinics. From 2003/2004 onwards, Table 10 and Figure 10 show the proportion of high grade results reported by source of test. Previous reports showed positive results (severe dyskaryosis or worse). In 2012/13, of the 205,300 women of all ages who had an adequate sample taken in GP or NHS Community & Sexual Health Clinics, 93.4% were negative, 3.9% showed borderline changes, 1.6% mild dyskaryosis, 0.4% moderate dyskaryosis and 0.7% were positive showing severe dyskaryosis or worse. Tables 13a/b and Figure 13 show the distribution of inadequate tests by age. The highest proportion of inadequate tests is for women aged Correlation with Histology (Tables and Figures 14 & 15) From 2002/2003, the results are shown for referrals during the previous twelve months. Table 14a shows referrals following tests reported as inadequate, borderline or mild dyskaryosis. Table 14c shows referrals following tests reported as moderate dyskaryosis or worse. The Positive Predictive Value (PPV) calculated from these data is used to correlate high-grade cytology with histology. It records the proportion of cases in which a biopsy, following a screening test reported as moderate dyskaryosis or worse, yields a histological diagnosis of CIN2 or worse. From 2007/08 onwards KC61 part C data shows outcomes for cervical and non-cervical cancers separately. Non-cervical cancers are excluded from PPV calculations. From 2012/13 the definition for calculating PPV has changed, the denominator now includes colposcopy NAD with no biopsy taken see page 29 for details. For 2012/13, the PPV for Wales remains high at 84%. Referrals to Colposcopy (Tables and Figures 16 to 24) CSW has collected colposcopy information on CANISC from clinics throughout Wales since April These statistics are derived directly from the system. CSW continues to provide training and data validation measures to improve the quality of the data collected. There were 8,400 new patients seen at colposcopy clinics during 2012/13 (Table 16). Of these, 75% were directly referred because of their screening test result and 25% were referred for clinical reasons. 27. of all referrals were for a result of moderate dyskaryosis or worse. Table 17 and Figure 17 show the time taken from the receipt of referral to the first appointment offered by the colposcopy clinic, excluding delays initiated by patients. 85.5% of referrals for a result of moderate dyskaryosis or worse were offered an appointment within four weeks (9 target). Over 92% of all referrals were offered an appointment within eight weeks (9 target). Table 18 and Figure 18 show activity at all attended visits in 2012/13. There were 22,600 recorded visits, with a wide range in the practice of select and treat (0. to 8.6% of visits). 17% of visits are for cytology or swab only. Tables and Figures 19 and 20 show procedures undertaken for new referrals, 35.9% do not receive invasive surgical intervention and 53.2% receive a diagnostic biopsy only. Diagnostic biopsies show variations between clinics ranging from 29.5% to 73.6%. Correlation between colposcopic opinion and worst histology result recorded is shown in Table 21 & Figure % of histology results reported as CIN2 or worse were similarly identified on assessment. 78.2% of lesions thought by the colposcopist to be high grade or worse were reported CIN2 or worse on histology, for all known results. Table 23 and Figure 23 show the number of biopsies taken and the results. The correlation Table 24 shows that for cases of CIN3 or worse found in LLETZ biopsies (not select and treat), 7.8% had an initial punch biopsy within three months reported as CIN1 or less. Cervical Screening Wales, Information Team Page 5 Cervical Screening Programme, Wales: 2012/2013

8 Table 1 : Test status of women and coverage, by age Source: KC53 Part A Number of women Percentage resident with recall ceased for with no tested within the tested within the at 31 clinical age other cytology last 3 last 5 last 3 last 5 WALES March reasons reasons reasons record years years years 1,2 years 1,2 All ages 1,591, , ,754 93, , , , % 47.1% Ages ,557 61,621 13,358 6, , , % 76.3% Ages ,529 61,611 13,358 6, , , % 79.5% Under , , , ,449 59, % 54.5% , ,404 77, % , ,426 77, % 80.4% , ,025 71, % 81.5% ,495 3, ,987 85, % ,713 7, ,407 86, % 81.5% ,272 11, ,325 76, % 79.9% ,191 16, ,822 62, % 77.5% ,188 21,207 13,358 4, ,424 56, % 74.8% ,752 23,414 47,068 22, ,047 37, % 51.8% ,678 17,000 36,531 18, % 1.6% ,905 21,333 76,797 45,454 15, % 0.2% 10 Figure 1a: Screening coverage of all age groups 1, % 80.4% 81.5% % 79.9% 77.5% 74.8% 76.3% % 51.8% 47.1% % 0.2% Under All ages Ages Figure 1b : Screening coverage of target age group (20-64 years), 2002/ /13 1, % 76.8% 75.6% 75.4% 74.6% 74.2% 75.5% 76.5% 76.4% 76.5% 76.3% /03¹ 2003/04¹ 2004/05¹ 2005/06¹ 2006/07¹ 2007/08¹ 2008/09¹ 2009/10¹ 2010/11¹ 2011/12¹ 2012/13¹ ¹ Until 1996/97 the denominator used in calculating the percentage was the resident population less those women with recall ceased. In 1997/98 recall ceased was split into 'age', 'clinical' and 'other' reasons. Those with with recall ceased for reasons other than age were excluded from the denominator. This was revised again in 1998/99 to exclude only those women with 'recall ceased for clinical reasons' (ie no cervix). The figure for 1997/98 has been revised to the same basis. This may, however, differ from earlier figures produced. In 2001/02, this was revised again to count only adequate tests taken in the previous three and dfive years ² Percentage of women tested in the last 3 years (3.5 years in 1993/94) or 5 years (5.5 years in 1993/94) Cervical Screening Wales, Information Team Page 6 Cervical Screening Programme, Wales: 2012/2013

9 Table 2 : Test status and coverage of target age group (20-64 years), by Health Board Source: KC53 Part A Number of women Percentage resident with recall ceased for with no tested within the tested within the at 31 clinical age other cytology last 3 last 5 last 3 last 5 Health Board March reasons reasons reasons record years years years 1,2 years 1,2 Abertawe Bro Morg UHB 157,424 10,419 2,274 1, , , % 76.1% Aneurin Bevan HB 170,154 11,419 2,376 1, , , % 78.5% Betsi Cadwaladr UHB 196,855 14,164 3,278 1, , , % 76.9% Cardiff and Vale UHB 151,504 7,092 1, , , % Cwm Taf HB 88,813 6,523 1, ,644 63, % 77.2% Hywel Dda HB 109,859 8,628 1, ,644 74, % 74.1% Powys THB 37,085 3, ,337 27, % 80.1% WALES ³ 917,557 61,621 13,358 6, , , % 76.3% 9 8 Figure 2: Percentage of target age group (20-64 years) screened within the last 3 and 5 years, by Health Board 1,2 last 5 years last 3 years Cytological Abnormal Inadequate other test test 2 1 Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES ³ Key: Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB Abertawe Bro Morgannwg University Health Board Aneurin Bevan Health Board Betsi Cadwaladr University Health Board Cardiff and Vale University Health Board Cwm Taf Health Board Hywel Dda Health Board Powys Teaching Health Board ¹ Until 1996/97 the denominator used in calculating the percentage was the resident population less those women with recall ceased. In 1997/98 recall ceased was split into 'age', 'clinical' and 'other' reasons. Those with with recall ceased for reasons other than age were excluded from the denominator. This was revised again in 1998/99 to exclude only those women with 'recall ceased for clinical reasons' (ie no cervix). The figure for 1997/98 has been revised to the same basis. This may, however, differ from earlier figures produced. In 2001/02, this was revised again to count only adequate tests taken in the previous three and five years ² Percentage of women tested t in the last 3 years (3.5 years in 1993/94) or 5 years (5.55 years in 1993/94) 3 A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 7 Cervical Screening Programme, Wales: 2012/2013

10 Table 3a: Number of women invited in the year, by type of invitation and age at test Source: KC53, part B Repeat advised for reasons of Routine Cytological Abnormal Inadequate WALES Total Call recall Surveillance test test All ages 313,878 59, ,202 49,988 11,183 4,347 Ages ,076 59, ,579 49,025 11,081 4,286 Ages ,491 23, ,386 45,560 8,169 3,982 Under ,585 35,711 8,193 3,465 2, ,313 9,872 17,154 8,376 2, ,194 4,267 19,977 9,810 1, ,074 2,581 20,222 7, ,035 1,802 25,479 7,066 1, ,697 1,366 27,611 5, ,336 1,207 25,402 3, ,785 1,157 22,671 2, ,057 1,142 20,870 1, , , Table 3b: Percentage of women invited in the year, by type of invitation and age at test Repeat advised for reasons of Routine Cytological Abnormal Inadequate WALES Total Call recall Surveillance test test All ages % 60.3% 15.9% 3.6% 1.4% Ages % 15.8% 3.6% 1.4% Ages % 17.5% 3.1% 1.5% Under % % 38.5% % 16.2% 6.8% 5.8% 0.6% % 44.8% 21.9% 6.4% 1.2% % 55.2% 27.1% 4.3% 1.6% % 3.1% 1.8% % 19.6% 2.9% 1.8% % 77.3% 14.6% 2.5% 1.8% % 81.1% 11.6% 2.1% 1.4% % 84.6% 8.3% 1.4% 1.3% % 86.8% 6.3% 0.9% 1.3% % 62.6% 30.1% 3.2% 2.2% % 1.7% 88.1% 7.9% 1.7% % 3.7% 92.6% Cervical Screening Wales, Information Team Page 8 Cervical Screening Programme, Wales: 2012/2013

11 Source: KC53, part B Figure 3a: Percentage of invitations, by type of invitation and age 10 8 Repeat advised (all reasons) - see figure 3b below 6 Routine Recall 4 2 Call Under All ages The total number of invitations (all ages) where the type of invitation was "repeat advised within 3 years" is just over 65,500(or 20.9% of all invitations). The chart below (Figure 3b) shows the different reasons for the early recall. 10 Figure 3b: Percentage of invitations, where repeat advised in less than 3 years, by reason and age 9 8 Inadequate test Abnormality Surveillance Under All ages Cervical Screening Wales, Information Team Page 9 Cervical Screening Programme, Wales: 2012/2013

12 Table 4a: Number of women aged invited in the year, by type of invitation and Health Board Source: KC53, part B Repeat advised for reasons of Routine Cytological Abnormal Inadequate Health Board Total Call recall Surveillance test test Abertawe Bro Morg UHB 52,566 9,600 32,121 8,250 1, Aneurin Bevan HB 56,838 8,683 34,819 10,553 2, Betsi Cadwaladr UHB 64,316 11,471 39,697 9,942 2, Cardiff and Vale UHB 53,248 13,962 29,377 7,164 2, Cwm Taf HB 30,634 5,238 17,979 5,679 1, Hywel Dda HB 39,393 8,202 24,276 5,310 1, Powys THB 12,591 1,764 8,408 1, WALES¹ 311,076 59, ,579 49,025 11,081 4,286 Table 4b: Percentage of women aged invited in the year, by type of invitation and Health Board Repeat advised for reasons of Routine Cytological Abnormal Inadequate Health Board Total Call recall Surveillance test test Abertawe Bro Morg UHB % 61.1% 15.7% 3.3% 1.6% Aneurin Bevan HB % 61.3% 18.6% 3.8% 1.1% Betsi Cadwaladr UHB % 61.7% 15.5% 3.7% 1.3% Cardiff and Vale UHB % 55.2% 13.5% 3.8% 1.4% Cwm Taf HB % 58.7% 18.5% 4.3% 1.4% Hywel Dda HB % 61.6% 13.5% 2.6% 1.5% Powys THB % 14.7% 3.1% 1.3% WALES¹ % 15.8% 3.6% 1.4% ¹ A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 10 Cervical Screening Programme, Wales: 2012/2013

13 10 Figure 4a: Percentage of invitations to women aged 20-64, by type of invitation and Health Board 8 Repeat advised (all reasons) - see figure 4b below 6 Routine recall 4 Call 2 Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB The total number of invitations (age 20-64) where the type of invitation was "repeat advised within 3 years"is nearly 64,400 (or 20.7% of all invitations). The chart below (Figure 4b) shows the different reasons for the early recall. 26% 24% 22% Figure 4b: Percentage of invitations to women aged 20-64, where repeat advised in less than 3 years, by reason and Health Board Hywel Dda HB Powys THB WALES¹ 2 18% 16% 14% 12% 1 Inadequate test Abnormality Surveillance 8% 6% 4% 2% Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES¹ ¹ A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 11 Cervical Screening Programme, Wales: 2012/2013

14 Table 5a: Number of women tested¹, by type of invitation and age at test Source: KC53, part C Repeat advised for reasons of Routine Cytological Abnormal Inadequate While recall While ceased Opportunistic WALES Total Call recall Surveillance test test suspended from recall² screening All ages 220,529 16, ,985 28,291 5,344 1,703 12, ,326 Ages ,496 16, ,247 27,799 5,323 1,688 12, ,160 Ages ,739 3, ,021 26,020 3,671 1,506 10, ,740 Under ,757 12,580 5,226 1,779 1, ,918-4, ,185 2,039 11,397 4,446 1, , , , ,168 5, , , , ,476 4, , , , ,240 4, , , , ,644 3, , , ,867 2, , , ,761 1, , , , , , , Table 5b: Percentage of women tested¹, by type of invitation and age at test Repeat advised for reasons of Routine Cytological Abnormal Inadequate While recall While ceased Opportunistic WALES Total Call recall Surveillance test test suspended from recall² screening All ages % 57.1% 12.8% 2.4% 0.8% 5.9% 0.3% 13.3% Ages % 57.1% 12.8% 2.4% 0.8% 5.9% 0.1% 13.4% Ages % 62.7% 13.7% 1.9% 0.8% 5.7% 0.2% 13. Under % % % % 18.8% 6.4% % 6.9% % % 41.9% 16.4% 4.4% 0.9% 12.4% % % 49.5% 21.4% 2.4% % % % 57.1% 19.3% 1.6% % % % 63.4% 15.4% 1.6% 0.9% 4.7% % % 69.5% 11.3% 1.6% 0.9% 3.5% % % 73.3% % 0.6% % % 78.5% 6.6% % 2.5% % % 81.8% 4.8% 0.6% 0.4% 2.1% 1.8% 8.3% % 61.7% 13.8% 0.6% 0.5% 5.7% 13.4% 4.2% % 0.8% % 13.6% 6.1% % 33.3% 20. ¹ Most recent test in year ² From 2003/2004, this is a new category for tests previously classed as opportunistic screening Cervical Screening Wales, Information Team Page 12 Cervical Screening Programme, Wales: 2012/2013

15 10 Figure 5a: Percentage of women tested, by type of invitation and age Source: KC53, part C Opportunistic screening While ceased from recall² While recall suspended Repeat advised³ 4 Routine recall 3 2 Call ³ see figure 5b 1 Under All ages The total number of women (all ages) tested where the type of invitation was "repeat advised within 3 years" is over 35,300 (or 16. of all tests). The chart below (Figure 5b) shows the different reasons for the early recall. Figure 5b: Percentage of women tested, where repeat advised within 3 years, by reason and age 7 65% 6 55% Inadequate test Abnormality Surveillance 5 45% 4 35% 3 25% 2 15% 1 5% Under All ages ¹ Most recent test in year ² From 2003/2004, this is a new category for tests previously classed as opportunistic screening Cervical Screening Wales, Information Team Page 13 Cervical Screening Programme, Wales: 2012/2013

16 Table 6: Number of women tested¹ in the year, by Health Board Source: KC53, part C Health Board Under All ages Abertawe Bro Morg UHB 2 4,658 4,548 4,556 4,046 4,497 4,579 4,125 3,280 2, ,063 32,405 37,599 Aneurin Bevan HB 6 5,202 5,150 4,955 4,413 5,223 5,290 4,344 3,615 2, ,161 35,959 41,702 Betsi Cadwaladr UHB 3 5,608 5,470 5,580 5,015 6,205 5,895 5,041 4,067 3, ,673 41,065 47,352 Cardiff and Vale UHB 10 5,371 5,197 4,928 4,198 4,067 4,033 3,352 2,665 2, ,938 30,567 36,307 Cwm Taf HB 8 2,911 2,938 2,786 2,331 2,728 2,519 2,195 1,768 1, ,700 18,789 22,022 Hywel Dda HB 5 2,904 2,742 2,781 2,562 3,074 3,124 2,834 2,382 2, ,696 21,792 25,091 Powys THB ,222 1,204 1, ,857 7,963 9,027 WALES² 37 27,757 27,185 26,614 23,617 27,204 26,823 23,017 18,813 16,466 2, , , ,529 50,000 Figure 6: Number of women tested in the year¹, by Health Board All ages ,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB ¹ Most recent test in year ² A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 14 Cervical Screening Programme, Wales: 2012/2013

17 Table 7a: Number of women aged tested¹ in the year, by type of invitation and Health Board KC53, part C Repeat advised for reasons of Routine Cytological Abnormal Inadequate While recall While ceased Opportunistic Health Board Total Call recall Surveillance test test suspended from recall² screening Abertawe Bro Morg UHB 37,063 2,669 21,820 4, , ,979 Aneurin Bevan HB 41,161 2,749 23,616 5, , ,129 Betsi Cadwaladr UHB 46,673 3,301 27,046 6,153 1, , ,070 Cardiff and Vale UHB 35,938 3,510 19,823 4,161 1, , ,870 Cwm Taf HB 21,700 1,532 11,953 3, , ,834 Hywel Dda HB 24,696 1,887 14,315 2, , ,392 Powys THB 8, ,292 1, ,179 WALES ³ 217,496 16, ,247 27,799 5,323 1,688 12, ,160 Table 7b: Percentage of women aged tested¹ in the year, by type of invitation and Health Board Repeat advised for reasons of Routine Cytological Abnormal Inadequate While recall While ceased Opportunistic Health Board Total Call recall Surveillance test test suspended from recall² screening Abertawe Bro Morg UHB % 58.9% 12.2% 2.4% 0.8% 4.8% 0.2% 13.4% Aneurin Bevan HB % 57.4% 14.5% 2.3% 0.6% 6.1% 0.1% 12.5% Betsi Cadwaladr UHB % 57.9% 13.2% 2.4% 0.8% 5.4% 0.2% 13. Cardiff and Vale UHB % 55.2% 11.6% % 0.1% 13.6% Cwm Taf HB % 55.1% 14.3% 2.3% 0.7% 7.3% 0.1% 13.1% Hywel Dda HB % % 2.2% 0.8% 6.6% 0.2% 13.7% Powys THB % 59.7% % 0.6% 5.8% 0.2% 13.3% WALES ³ % 57.1% 12.8% 2.4% 0.8% 5.9% 0.1% 13.4% ¹ Most recent test in year ² From 2003/2004, this is a new category for tests t previously classed as opportunistic ti screening 3 A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 15 Cervical Screening Programme, Wales: 2012/2013

18 KC53, part C Figure 7a: Percentage of women aged tested, by type of invitation and Health Board 10 8 Opportunistic screening 6 While ceased from recall² While recall suspended 4 Repeat advised - see figure 7b Routine recall 2 Call Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES ³ The total number of women (age 20-64) tested where the type of invitation was "repeat advised within 3 years" is over 34,800 (or 16. of all tests). The chart below (Figure 7b) shows the different reasons for the early recall. 18% Figure 7b: Percentage of women aged tested, where repeat advised within 3 years, by reason and Health Board 16% 14% 12% 1 Inadequate test Abnormality 8% Surveillance 6% 4% 2% Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB ¹ Most recent test in year ² From 2003/2004, this is a new category for tests t previosuly classed as opportunistic ti screening 3 A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES ³ Cervical Screening Wales, Information Team Page 16 Cervical Screening Programme, Wales: 2012/2013

19 Table 8a: Number of test results 1,2, by age Source: KC53, part D Mild Moderate WALES Total² Negative Borderline dyskaryosis dyskaryosis Positive³ All ages 218, ,065 8,664 4, ,718 Ages , ,182 8,587 4, ,706 Ages , ,288 6,035 2, ,368 Under ,541 22,894 2,552 1, ,856 23,655 1, ,336 24,351 1, ,319 21, ,942 25, ,588 25, ,853 22, ,697 18, ,383 16, ,805 2, Table 8b: Percentage of test results 1,2, by age Mild Moderate WALES Total² Negative Borderline dyskaryosis dyskaryosis Positive³ All ages % % 0.5% 0.8% Ages % % 0.5% 0.8% Ages % 3.2% 1.4% 0.4% 0.7% Under % 13.9% 2.8% % 9.3% 5.4% % % % 1.1% 17% 1.7% % % 0.5% 1.2% % 3.2% 1.4% 0.3% 0.8% % 2.9% 1.1% 0.3% 0.5% % 2.8% 0.9% 0.2% 0.4% % 2.4% 0.8% 0.1% 0.3% % 0.7% 0.1% 0.3% % 1.2% 0.5% 0.1% 0.2% % 1.1% % % 3.1% 3.1% % 4.7% 4.7% % Figure 8: Low grade 4 and high grade 4 results as a percentage of adequate test results 1,2, by age High Grade Mild Dysk Borderline 2 15% 1 5% Under All ages ¹ Most severe result in year ² Excluding those women whose tests during the year were classified as 'inadequate' ³'P 'Positive' ii 'includes ld results reported as 'severe dyskaryosis', i'' 'severe dyskaryosis/?invasive i/?i i carcinoma', or '?l '?glandular dl neoplasia 4 'Low grade' results are 'borderline' or 'mild dyskaryosis' whilst 'High grade' results are 'moderate dyskaryosis' or 'positive' Cervical Screening Wales, Information Team Page 17 Cervical Screening Programme, Wales: 2012/2013

20 Table 9a: Number of test results¹, of women aged 20-64, by Health Board Mild Moderate Health Board Total² Negative Borderline dyskaryosis dyskaryosis Positive³ Abertawe Bro Morg UHB 36,664 34,378 1, Aneurin Bevan HB 40,921 37,924 1, Betsi Cadwaladr UHB 46,254 43,272 1, Cardiff and Vale UHB 35,559 32,223 1, Cwm Taf HB 21,482 19, Hywel Dda HB 24,438 23, Powys THB 8,779 8, WALES 5 215, ,182 8,587 4, ,706 Table 9b: Percentage of test results¹, of women aged 20-64, by Health Board Source: KC53, part D Mild Moderate Health Board Total² Negative Borderline dyskaryosis dyskaryosis Positive³ Abertawe Bro Morg UHB % 4.1% 1.2% 0.4% 0.6% Aneurin Bevan HB % 3.7% 2.2% 0.6% 0.9% Betsi Cadwaladr UHB % 3.6% % 0.5% Cardiff and Vale UHB % 5.1% 2.3% 0.6% 1.4% Cwm Taf HB % 3.6% 2.6% 0.5% 1.1% Hywel Dda HB % 3.7% % 0.5% Powys THB % 1.8% 0.5% 0.5% WALES % % 0.5% 0.8% Figure 9: Low grade 4 and high grade 4 results, of women aged 20-64, as a percentage of adequate test results 1,2, by Health Board 1 9% High Grade Mild Dysk Borderline 8% 7% 6% 5% 4% 3% 2% 1% Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB ¹ Most severe result in year ² Excluding those women whose tests during the year were classified as 'inadequate' ³ 'Positive' includes results reported as 'severe dyskaryosis', 'severe dyskaryosis/?invasive carcinoma', or '?glandular neoplasia' 4 'Low grade' results are 'borderline' ' or 'mild dyskaryosis' whilst 'High grade' results are 'moderate dyskaryosis' or 'positiv i Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES 5 A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales Cervical Screening Wales, Information Team Page 18 Cervical Screening Programme, Wales: 2012/2013

21 Table Xa: Sample turnaround times 2, number by Health Board Source: KC53, part E Less than >2 weeks >4 weeks >6 weeks >8 weeks >10 weeks or equal up to up to up to up to up to Over Health Board to 2 weeks 4 weeks 6 weeks 8 weeks 10 weeks 12 weeks 12 weeks Total Abertawe Bro Morg UHB ,294 9, ,758 Aneurin Bevan HB 7,539 28,518 5, ,973 Betsi Cadwaladr UHB 7,321 37,321 3, ,765 Cardiff and Vale UHB 94 8,950 22,410 4, ,637 Cwm Taf HB 77 6,847 13,270 1, ,271 Hywel Dda HB ,463 8, ,676 Powys THB 5,022 3, ,000 WALES 1 22, ,272 62,218 9, ,502 Table Xb: Sample turnaround times 2, percentage by Health Board Less than >2 weeks >4 weeks >6 weeks >8 weeks >10 weeks or equal up to up to up to up to up to Over Health Board to 2 weeks 4 weeks 6 weeks 8 weeks 10 weeks 12 weeks 12 weeks Total Abertawe Bro Morg UHB 2.2% 72.3% % 0.2% Aneurin Bevan HB % 12.2% 1.8% 0.1% Betsi Cadwaladr UHB 15.3% 78.1% 6.4% 0.1% Cardiff and Vale UHB 0.3% 24.4% 61.2% 13.5% 0.5% 0.1% 0.1% 10 Cwm Taf HB 0.3% 30.7% 59.6% 8.8% 0.4% Hywel Dda HB 1.3% 58.6% 35.8% 3.9% 0.3% Powys THB 55.8% 39.8% % % 10 WALES % 28.1% 4.2% 0.2% Figure X: Sample turnaround times, by Health Board 10 >6 weeks 8 >4 weeks up to 6 weeks 6 >2 weeks up to 4 weeks Less than or equal to 2 weeks 4 2 Abertawe Bro Morg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys THB WALES 1 A small proportion of women could not be allocated to a Health Board, but are shown in the total for Wales 2 Calculated from date sample was taken to issue of result letter Cervical Screening Wales, Information Team Page 19 Cervical Screening Programme, Wales: 2012/2013

22 Table Ya: Number of women invited in the year, by age group Source: KC53, part B WALES All ages 289, , , , , , , , , , ,878 Ages , , , , , , , , , , ,076 Ages , , , , , , , , , , ,491 Under 20 2,019 1,641 1, ,266 41,635 43,369 41,988 44,602 45,464 43,693 46,088 46,584 51,966 50, ,426 30,220 32,080 32,392 32,981 34,581 34,072 34,841 34,727 40,179 38, ,660 34,556 36,214 33,386 31,226 31,448 30,659 31,358 32,534 38,228 36, ,069 36,600 39,455 37,037 35,610 37,409 35,328 34,113 33,152 36,291 32, ,563 33,784 37,975 36,050 35,020 37,243 36,285 35,482 36,791 40,302 36, ,032 28,109 31,379 30,806 30,274 32,883 33,137 33,613 35,230 38,664 35, ,660 26,234 27,896 26,406 25,653 27,664 27,621 27,704 29,940 33,100 31, ,406 26,183 27,838 27,131 25,771 25,600 25,171 25,355 26,151 27,461 26, ,823 20,322 22,106 21,734 22,597 24,101 24,075 24,414 24,950 25,361 24, ,353 2,394 2,270 1,835 2,064 2,099 2,111 2,270 2,123 2,787 2, Table Yb: Number of women tested¹ in the year, by age group Source: KC53, part C WALES All ages 216, , , , , , , , , , ,529 Ages , , , , , , , , , , ,496 Ages , , , , , , , , , , ,739 Under ,570 23,157 22,297 22,326 22,427 22,765 28,855 28,752 27,042 29,763 27, ,829 21,637 21,965 23,344 22,773 23,560 29,229 27,411 25,351 27,607 27, ,687 26,227 25,994 25,343 22,917 22,099 26,849 24,884 24,037 26,818 26, ,184 28,724 28,783 29,367 26,876 26,799 31,173 27,186 24,289 25,381 23, ,747 26,903 27,971 29,035 27,381 27,180 31,756 28,262 26,840 28,936 27, ,410 22,334 23,520 24,870 23,418 24,342 28,422 26,548 25,768 28,195 26, ,687 20,840 20,581 21,204 19,676 20,349 22,684 21,431 21,642 23,577 23, ,216 20,057 20,028 21,327 19,338 18,338 20,175 18,869 18,404 19,447 18, ,651 14,460 14,897 16,171 15,843 16,239 18,754 17,399 17,183 17,873 16, ,805 2,418 2,344 2,320 2,199 2,214 2,573 2,496 2,295 2,959 2, ,000 Figure Y: Women aged invited and tested each year 300, , , , ,000 50,000 Invited Tested ¹ Most recent test in year Cervical Screening Wales, Information Team Page 20 Cervical Screening Programme, Wales: 2012/2013

23 Table 10: Number of samples examined, by pathology laboratories and source of test Source: KC61, part A NHS Community & Sexual GUM NHS Laboratory Total GP Health Clinics Clinic Hospital Private Other Magden Park Laboratory Total samples 69,260 61,471 2, , No. inadequate 1,357 1, % inadequate % 2.1% 2.5% 3.2% No. adequate 67,903 60,327 2, , No. high grade 1 1, % high grade 2 1.8% 1.4% 1.8% 4.1% 6.3% North Wales Service Total samples 49,004 45,520 1, , No. inadequate % inadequate 1.4% 1.4% 1.6% 0.6% 2.6% No. adequate 48,303 44,894 1, , No. high grade % high grade 2 0.8% 0.7% 0.5% 1.1% 2.7% Royal Gwent Hospital Total samples 39,885 34,038 2, , No. inadequate % inadequate 0.8% 0.8% % 1.3% No. adequate 39,550 33,775 2, , No. high grade % high grade 2 1.4% 1.2% 2.2% 1.5% 3.4% S & W Wales Service Total samples 66,607 58,414 2, , No. inadequate 1,179 1, % inadequate 1.8% 1.7% 1.6% 1.1% 2.4% No. adequate 65,428 57,411 2, , No. high grade % high grade 2 0.9% 0.7% % 2.6% WALES Total samples 224, ,443 8,999 1,829 14, No. inadequate 3,572 3, % inadequate 1.6% 1.5% 1.6% 1.9% 2.5% No. adequate 221, ,407 8,856 1,795 14, No. high grade 1 2,715 2, % high grade 2 1.2% % 2.4% 3.8% 'High grade' includes results reported as 'moderate dyskaryosis', 'severe dyskaryosis', 'severe dyskaryosis/?invasive carcinoma', or '?glandular neoplasia' 2 % high grade of all adequate results Cervical Screening Wales, Information Team Page 21 Cervical Screening Programme, Wales: 2012/2013

24 Figure 10a: Percentage of inadequate tests, by laboratory Source: KC61, part A 2.5% % 1.5% 1.4% 1.6% % 0.5% 0. Magden Park Laboratory North Wales Service Royal Gwent Hospital S & W Wales Service WALES Figure 10b: Percentage of high grade results 1,2, by laboratory % 1.5% 1.4% 1.2% % 0.9% 0.5% 0. Magden Park Laboratory North Wales Service Royal Gwent Hospital S & W Wales Service WALES Figure 10c: Percentage of inadequate tests and high grade results 1,2, by source of test 4% 3.8% % inadequate % high grade 3% 2.4% 2.5% 2% 1.5% 1.6% 1.5% 1.9% 1.6% 1.2% 1% 1. GP NHS Community & Sexual Health Clinic GUM Clinic NHS Hospital Private Other Total 1 'High grade' includes results reported as 'moderate dyskaryosis', 'severe dyskaryosis', 'severe dyskaryosis/?invasive carcinoma', or '?glandular neoplasia' 2 % high grade of all adequate results Cervical Screening Wales, Information Team Page 22 Cervical Screening Programme, Wales: 2012/2013

25 Table 11a: Result of test¹, by laboratory Source: KC61, part B Severe Total dyskaryosis adequate Borderline Mild Moderate Severe /?Invasive?Glandular Laboratory samples Negative changes dyskaryosis dyskaryosis dyskaryosis carcinoma neoplasia Magden Park Laboratory 63,177 58,242 2,677 1, North Wales Service 46,010 43,138 1, Royal Gwent Hospital 36,273 33,769 1, S & W Wales Service 59,803 56,627 2, WALES 205, ,776 7,995 3, , Table 11b: Result (as percentage of total adequate samples)¹ by laboratory Severe Total dyskaryosis adequate Borderline Mild Moderate Severe /?Invasive?Glandular Laboratory samples Negative changes dyskaryosis dyskaryosis dyskaryosis carcinoma neoplasia Magden Park Laboratory % 4.2% 2.1% 0.5% 0.9% % North Wales Service % 3.7% 1.8% 0.3% 0.4% Royal Gwent Hospital % 3.8% 1.8% 0.6% 0.6% % S & W Wales Service % 3.7% 0.9% 0.3% 0.4% WALES % 3.9% 1.6% 0.4% 0.6% % ¹ Results of tests from GP and NHS Community & Sexual Health Clinics only Cervical Screening Wales, Information Team Page 23 Cervical Screening Programme, Wales: 2012/2013

26 Source: KC61, part B Figure 11a: Result of test ¹, by laboratory 10 High grade Mild Dysk 8 Borderline Negative Magden Park Laboratory North Wales Service Royal Gwent Hospital S & W Wales Service WALES 8% 7% Figure 11b: Low grade 2 and high grade 3 results as a percentage of adequate samples¹, by laboratory High grade Mild Dysk Borderline 6% 5% 4% 3% 2% 1% Magden Park Laboratory North Wales Service Royal Gwent Hospital S & W Wales Service WALES ¹ Results of tests examined from GP and NHS Community & Sexual Health Clinics only 2 'Low grade' results are 'borderline' or 'mild dyskaryosis' whilst 'High grade' results are 'moderate dyskaryosis' or wors 3 'High grade' includes results reported as 'moderate dyskaryosis', 'severe dyskaryosis', 'severe dyskaryosis/?invasive carcinoma', or '?glandular neoplasia' Cervical Screening Wales, Information Team Page 24 Cervical Screening Programme, Wales: 2012/2013