Reduction in colposcopy workload and associated clinical activity following HPV catch-up vaccination programme in Scotland: an ecological study

TY - JOUR

T1 - Reduction in colposcopy workload and associated clinical activity following HPV catch-up vaccination programme in Scotland

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

AU - Cruickshank, M E

AU - Pan, J.

AU - Cotton, SC

AU - Kavanagh, K

AU - Robertson, C

AU - Cuschieri, K

AU - Cubie, H

AU - Palmer, T

AU - Pollock, KG

N1 - This is the peer reviewed version of the following article: Cruickshank, M. E., Pan, J., Cotton, S. C., Kavanagh, K., Robertson, C., Cuschieri, K., ... Pollock, K. G. (2017). Reduction in colposcopy workload and associated clinical activity following HPV catch-up vaccination programme in Scotland: an ecological study. BJOG: An International Journal of Obstetrics and Gynaecology, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving

PY - 2017/1/11

Y1 - 2017/1/11

N2 - Objective: To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP). Design: Population-based observational study using nationally collected data. Setting: Scottish colposcopy clinics. Sample: All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008-2014. Methods: Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) was extracted, including: referral criteria, referral cervical cytology, colposcopic findings, clinical procedures and histology results. Analysis was restricted to those referred to colposcopy at age 20 or 21 years. Main outcome measures: Referral criteria, positive predictive value of colposcopy, default rates and rates of cervical biopsies and treatments. Results: 7372 women referred for colposcopy at age 20/ 21 years were identified. There was a downward trend in the proportion of those referred with abnormal cytology (2008/9: 91.0%, 2013/14: 90.3%, linear trend p value = 0.03). Women were less likely to have diagnostic or therapeutic interventions. The proportion with no biopsy (2008/9: 19.5%, 2013/14: 26.9%, linear trend p value < 0.0001) and no treatment (2008/9: 74.9%, 2013/14: 91.8%, linear trend p value < 0.0001) increased over the period of observation. Conclusions: A reduction in clinical activity related to abnormal screening referrals is likely to be associated with the HPV catch-up immunisation programme. Referral criteria and service provision of colposcopy needs to be planned carefully taking account of the increasing number of HPV- immunised women that will be entering cervical screening programmes worldwide.

AB - Objective: To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP). Design: Population-based observational study using nationally collected data. Setting: Scottish colposcopy clinics. Sample: All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008-2014. Methods: Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) was extracted, including: referral criteria, referral cervical cytology, colposcopic findings, clinical procedures and histology results. Analysis was restricted to those referred to colposcopy at age 20 or 21 years. Main outcome measures: Referral criteria, positive predictive value of colposcopy, default rates and rates of cervical biopsies and treatments. Results: 7372 women referred for colposcopy at age 20/ 21 years were identified. There was a downward trend in the proportion of those referred with abnormal cytology (2008/9: 91.0%, 2013/14: 90.3%, linear trend p value = 0.03). Women were less likely to have diagnostic or therapeutic interventions. The proportion with no biopsy (2008/9: 19.5%, 2013/14: 26.9%, linear trend p value < 0.0001) and no treatment (2008/9: 74.9%, 2013/14: 91.8%, linear trend p value < 0.0001) increased over the period of observation. Conclusions: A reduction in clinical activity related to abnormal screening referrals is likely to be associated with the HPV catch-up immunisation programme. Referral criteria and service provision of colposcopy needs to be planned carefully taking account of the increasing number of HPV- immunised women that will be entering cervical screening programmes worldwide.

KW - HPV

KW - HPV vaccination

KW - immunisation

KW - cervical screening

KW - colposcopy

KW - loop excision

KW - Scottish Cervical Screening Programme

KW - human papillomavirus

UR - http://obgyn.onlinelibrary.wiley.com/hub/journal/10.1111/(ISSN)1471-0528/

U2 - 10.1111/1471-0528.14562

DO - 10.1111/1471-0528.14562

M3 - Article

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -