The future of cervical screening in the UK

Full implementation of liquid-based cervical cytology (LBC) coupled with changes in the screening age range and frequency have resulted in an annual workload reduction equivalent to 10 average-sized cytology laboratories. This and increased productivity of LBC have resulted in a growing mismatch between laboratory capacity and workload, which is a strong driver for laboratory amalgamation and reconfiguration as recommended in the Carter reports. Other drivers for reconfiguration will come from human papillomavirus (HPV) testing for triage of low-grade abnormality and test of cure, automation and HPV vaccination. Automation will potentially play a significant role in the achievement of the Cancer Reform Strategy targets for the NHS Cervical Screening Programme (NHSCSP), but call into question the role of the cytology screener as currently utilized. Progressive HPV vaccination may well result in adoption of HPV genotyping as the primary screening modality with secondary triage to cytology, which would have a further major impact on laboratory staffing and configuration.