Cervical Cancer Elimination in Scotland Expert Group Final Report

9. Cervical Screening Subgroup

Background

The Scottish Cervical Screening Programme

Cervical screening commenced in Scotland in the 1960s but it was not until 1988 that an organised, formal, national cervical screening programme was established. As shown in Figure 4, it has developed over time to ensure that it remains underpinned by the best scientific evidence, as recommended by the UK National Screening Committee (UK NSC).

• 1960s - Cervical screening introduced in Scotland
• 1988 - Establishment of formal population-based screening programme
• 2016 - Change in age-range and frequency
• 2020 - Primary HPV screening and 5 Year intervals (if HPV negative) introduced

All women and people with a cervix aged between 25 and 64 years of age are offered primary HPV testing every five years, with more frequent screening for those found to have HPV and/or a history of cell changes. The Scottish Cervical Call-Recall System (SCCRS) is a Scotland-wide, population-register based computer system that supports the programme from end to end; issuing paper invitation letters, recording sample taking, laboratory analysis, generating results letters and referring patients to colposcopy if required.

Screening is primarily delivered within GP practices by practice nurses, and samples are analysed in two nationally commissioned laboratories. Colposcopy services are delivered by the 14 territorial Health Boards. The Cervical Screening Programme Board is a national group that facilitates programme-level leadership, direction, governance, oversight and assurance. It has a formal workplan. Screening Oversight and Assurance Scotland (SOAS), part of NHS National Services Scotland (NSS), provides national coordination and oversees all elements of the six national screening programmes, reporting to the Scottish Government. Strong links exist with the other UK nations and the Republic of Ireland, and regular eight nations meetings take place (Scotland, Ireland, England, Wales, Northern Ireland, Jersey, Guernsey and Isle of Man) to share learning and good practice.

PHS provides data and analytical support to the cervical screening programme, as well as developing participant and professional information materials (see Figure 5). Paper information leaflets in English language format are sent with screening invitations; alternative languages and formats are available on request electronically.

The Scottish Equity in Screening Strategy

The Scottish Equity in Screening Strategy^[24] was published in 2023 and sets out a vision to achieve equity in all six national screening programmes. It focuses on the following areas:

• communications, engagement, and learning
• access
• data collection and monitoring
• research and evaluation
• overarching issues

Many of the strategy’s actions overlap with the recommendations in this report and are already in the process of being implemented. These will be highlighted below.

Current/Future Developments in Cervical Screening

In June 2025 the UK NSC made a permissive recommendation for HPV self-sampling to be added to the cervical screening programme for use by the under-screened population. Within Scotland, this is being implemented on a phased basis, beginning in a small number of GP practices serving areas of high deprivation. Whilst self-sampling activity will commence in March 2026, full roll-out across the whole country is limited by IT development requirements and procurement regulations so will take at least 2-3 years to complete. The HPV Self-Sampling Implementation Group will oversee this process and report to the National Screening Oversight Board, whilst providing regular updates to the Cervical Screening Programme Board.

There is currently insufficient evidence to recommend that self-sampling should be used routinely as a primary screening test for all individuals eligible for screening (i.e. not just the under-screened population), therefore the UK NSC and the National Institute for Health and Care Research (NIHR) are working together to commission an in-service evaluation to fill the evidence gaps.

The UK NSC has also commissioned an academic institution to model optimal screening intervals for fully HPV vaccinated individuals. It is expected that the number of cervical screens required in this group will reduce significantly in the future.

Recommendations

The group’s findings and recommendations are summarised below:

Identification of eligible cohort

• ensure CHI register is optimally maintained to identify population eligible for screening
• ensure that programme exclusions are based on strict criteria that are managed with robust processes^[25]

Screening invitations

• move from paper-based to digital communications^[26]
• provide invitations in an accessible format for all

Information provision

• provide information in an accessible format to all
• raise awareness of the concept of cervical cancer elimination

Appointment making

• supplement existing sample taking appointment booking processes with online booking
• encourage extended hours screening clinics

Sample taking

• make NES sample taking training material available to all sample takers and not just practice nurses (action completed August 2025)
• encourage and facilitate more opportunistic screening, e.g. in sexual health, addiction and homelessness services
• streamline IT processes to facilitate opportunistic screening
• provide specialist screening service for those requiring additional support
• implement HPV self-sampling in line with UK NSC guidance

Laboratory testing and reporting

• ensure laboratory processes and equipment continue to meet recommended standards
• report and issue results timeously

Monitoring of effectiveness

• aim to reduce the gap between screening coverage in the most and least deprived groups
• collect protected characteristic and additional requirements data and other data associated with being under-screened to allow more inequalities analysis
• evaluate programme management pathways
• develop National Invasive Cervical Cancer Audit (NICA) report

Other

• develop more formal links between screening and vaccination services to allow shared learning and to facilitate innovative approaches to increasing vaccination and screening coverage

Conclusion

Scotland has a well organised and high quality national cervical screening programme. However, coverage across the population as a whole is suboptimal and in addition, significant inequalities exist in the programme’s coverage. These must be addressed to allow Scotland to eliminate cervical cancer across all under screened groups. Substantial optimisation work is already underway via the Scottish Cervical Screening Programme work plan and the Scottish Equity in Screening Strategy. These actions, combined with the CCE screening subgroup’s additional recommendations will set Scotland on the path to a timely and equitable cervical cancer elimination.