NHS Cervical Screening Programme Research Articles

Factors associated with failed ‘test of cure’ in the NHS Cervical Screening Programme: A retrospective cohort study

ObjectiveTo determine predictive factors associated with failed ‘test of cure’ (TOC) in the NHS Cervical Screening Programme (NHSCSP). MethodsRetrospective cohort study of all patients treated by large loop excision of transformation zone (LLETZ) between 1st April 2014 and 1st April 2019. Those with no documented HPV genotype on referral, no TOC outcome, those having a hysterectomy, chemotherapy and/or radiotherapy were excluded from final analysis. ResultsPatients referred with a singular HPV genotype of HPV 16, HPV 18, or HPV Other types (HPV O) were significantly more likely to pass TOC than those referred with multiple HPV genotypes (p < 0.0001). Those with HPV genotypes including HPV O were significantly more likely to fail TOC as compared to those with genotypes of solely HPV 16 and/or 18 (p < 0.0001).Patients aged ≥51 years were significantly more likely to fail TOC when compared to all other age groups (p < 0.0001). ConclusionAge >51 yrs. and infection with multiple hr-HPV types were predictors of post treatment hr-HPV persistence. Knowledge of HPV genotype both at referral, and following treatment, could allow a more individualised, and patient-centred, approach to both the management and follow up of CIN. HPV genotype should be reported as standard on all cervical screening sample results. The term HPV O should not be utilised and instead actual HPV genotype should be reported. This would enable us to optimise not only future research but would also allow future monitoring of the efficacy of vaccination programmes.

A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake

Objective.Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3–5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up.Methods.14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks.Results.Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06).Conclusion.The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.

A qualitative exploration of women's perspectives and acceptability of including new cancer awareness information in all-clear breast or cervical screening results.

ObjectiveThis study explored women's perspectives on the acceptability of including new cancer information with an all‐clear breast or cervical screening result letter (using ovarian cancer as a case study).MethodsIn 2016, six focus group discussions were conducted with women aged 25–70 years old, eligible for invitation to the NHS breast or cervical screening programme and resident in England. The focus groups lasted 60–90 min and were held in community venues. Data were analysed using thematic analysis.ResultsThirty‐eight women aged 25–67 years old participated in the focus groups. Data analysis yielded six descriptive themes: general cancer awareness, taking advantage of a ‘teachable moment’, a double‐edge sword, barriers to accepting and using new cancer information, motivators for accepting and using new cancer information and wider strategies to increase cancer awareness in women. Women welcomed the inclusion of new cancer information in all‐clear screening results but highlighted pertinent lessons to be considered to maximise the usefulness of the approach.ConclusionWhile women perceived this approach as acceptable, it is pertinent to note the potential of the new cancer information to stimulate anxiety and potentially widen inequalities by excluding non‐attenders at screening programmes. Specific complementary and tailored approaches are necessary to mitigate these limitations.

304 To Raise Awareness About the NHS Cervical Screening Programme and to Reduce the Number of Did-Not-Attend (DNAs) Cervical Screening Appointments Among Women Aged 25–35 Years Through a Collaborative Reward System with Local Businesses

Abstract Introduction Cervical screening is offered free under NHS Cervical Screening Programme since 1988. However, compliance is dwindling in the last decade, especially among women aged 25–35 years who had the least awareness. NHS Digital suggests overall coverage be 72 percent with 1.2 million Did-Not-Attend appointments. Method This project proposes financial and non-financial incentives can propel people to adopt healthier lifestyles. Project advocates CSR with local businesses, especially MSEs such as local gyms, local pharmacies, boutiques, salons, restaurants, and takeaways usually frequented by women aged 25–35 years. The project proposes, firstly, participating businesses will display ‘we support cervical screening program’ on their on-site and online portals. Secondly, they will provide exclusive offers (cash rewards, hampers, vouchers, priority services, free home deliveries, and personalised picture cards signed by staff) to women attending their cervical screening appointments. Thirdly, in their adverts, they would promote the cervical screening programme in a respectable manner to prevent the embarrassment of cervical swab and body-shaming. Fourthly, the businesses will ensure flexible staff working hours to attend the cervical screening to eradicate work-related practical barriers. Conclusions Cervical screening program is the best prevention against cervical cancer and can potentially reduce mortality by cervical cancer by up to 70 percent. If NHSCSP coverage reaches 84%, £10million can be saved per annum. Apart from early detection of cervical cancer and reducing Did-Not-Attend appointments by offering exclusive rewards for attending Cervical Screening to the participants.

Maximising the acceptability of extended time intervals between screens in the NHS Cervical Screening Programme: An online experimental study.

ObjectiveThe NHS Cervical Screening Programme plans to increase the screening interval from 3 to 5 years for women aged 25–49 who test negative for human papillomavirus (HPV). This exploratory cross-sectional online survey tested the impact of different levels of information about the proposed change on acceptability of a longer interval.MethodsWomen aged 18–45 (n = 585) were individually randomised to one of three information exposure groups differing in the level of information provided about the screening interval change: (1) basic information; (2) basic information with additional detail about timeline of HPV infection; (3) as (2) but with the addition of a diagram. Acceptability of the change (favourable and unfavourable attitudes) was assessed post-exposure alongside HPV timeline beliefs. We used ANOVA and regression analyses to test for between-group differences.ResultsWomen in Group 3 had higher scores on the favourable attitudes sub-scale compared with Group 1. Women in Groups 2 and 3 had more accurate timeline beliefs than those in Group 1. There were no between-group differences in unfavourable attitudes. After adjusting for demographic factors, a higher favourable attitudes score was independently predicted by being in Group 3 compared to Group 1, more accurate HPV timeline beliefs, and previous irregular or non-attendance at screening.ConclusionsOverall, acceptability of an increased screening interval was moderate, but providing women with information about the safety and rationale for this change may improve acceptability. In particular, communicating the long timeline from HPV exposure to cervical cancer may reassure women about the safety of the proposed changes.

Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February–October 2015 were eligible. 3133 women aged 24–29 (Study 1) were randomized (1, 1) to ‘no SMS’ (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30–64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09–1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03–1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02–1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.

Awareness and knowledge of human papilloma virus in UK women aged 25 years and over: Results from a cross-sectional internet-based survey.

The expanding use of human papilloma virus (HPV) testing within cervical screening requires an evaluation of public understanding of HPV. This study aimed to explore HPV awareness and knowledge using a previously psychometrically validated measure in a sample of UK women aged 25years and over. An anonymous web-based cross-sectional survey design was used, and responses were recorded for 246 women (mean age=37.59, SD=9.20). Findings indicated limits to women's understanding of HPV, its transmission, treatment and link with cancer. The mean HPV knowledge score was 9.35 (4.43), and the mean HPV testing score was 3.34 (1.91). Multivariate analyses revealed that information seeking following cervical screening and being a student is associated with higher HPV knowledge and that having a positive HPV test result and having university education is associated with higher HPV testing knowledge. These results highlight that there is a lack of knowledge and misunderstanding relating to HPV and its link with cancer in adult women in the UK. The findings suggest that public health HPV information campaigns are urgently needed, especially with a drop in UK cervical screening attendance rates, and with the upcoming change to HPV primary testing within the UK NHS cervical screening programme.

Improving laboratory workflow through automated pre-processing of SurePath specimens for human papillomavirus testing with the Abbott RealTime assay.

Cervical specimens collected in liquid-based cytology (LBC) are used for cervical screening in the UK. The Abbott RealTime high-risk human papillomavirus (hrHPV) assay for the detection of 14 hrHPV types is approved by the English NHS Cervical Screening Programme (NHSCSP). As per manufacturer's instructions, pre-analytic processing of LBC involves a manual vortex and liquid transfer into a secondary tube. In high-throughput settings, hands-on time for pre-processing is considerable and poses the potential for human error. Implementation of hrHPV primary screening planned for 2019 accompanied by centralisation of services is a major change for the NHSCSP, increasing the demand for availability of automated pre-analytics. This study evaluated a custom-configured work-table setup of the Tecan Freedom EVO designed to automate pre-processing of BD SurePath LBC prior to HPV testing on the Abbott m2000. Automatically and manual pre-processed specimen results were compared (primary screening population n=307; triage population n=169). Excellent agreement of overall hrHPV results (98.1%; k: 0.95) was observed. On average, it takes approximately 1.5minutes hands-on-time per sample to process manually compared to 45minutes to aliquot 48 samples using the Freedom EVO 150. The Tecan worktable configuration designed to automate and control pre-analytics required for preparing SurePath LBC samples for HPV testing using Abbott RealTime resulted in assay performance comparable to that following the manufacturer validated manual process. It significantly reduces hands-on-time and allows for complete specimen identification tracking and documentation of process control.

Newly qualified health visitor: Routine cervical screening

The NHS cervical screening programme is a key part of the prevention of cervical cancer, but misconceptions persist among new mothers and uptake is declining year on year, says Jessica Bewick

Does ethnicity and culture affect the non-compliancy of cervical cancer screening?”

Background: Globally, an estimated 528,000 women develop cervical cancer (CC) each year, 266,000 of whom die from the disease. CC is the fourth most-common cancer in women worldwide and fourteenth in the UK, where 3,200 cases are diagnosed each year. In England CC is more common among White females and more common among women in deprived areas. In 1989, the NHS Cervical Screening Programme (NHSCSP) developed a screening programme aimed at identifying women who may be at risk of developing CC. However, incidence rates for CC are projected to rise by 43% in the UK between 2014 and 2035, to 17 cases per 100,000 females by 2035, which suggests that there are ongoing barriers that may be preventing women from attending cervical cancer screening (CCS). The primary goal of this extended literature review, it to examine these barriers, with particular emphasis on the extent to which they are shaped by ethnicity. Methodology: The research question and selection of relevant keywords were formulated using the PICO(S) framework. Six databases were used to search for relevant literature. Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and SCOPUS provided literature specific to the nursing and allied health perspectives while PsycINFO and Applied Social Sciences Index and Abstract (ASSIA) were used to find studies focused on sociological and psychological aspects of the research question. The use of the Cochrane database provided previous research papers relevant to the topic. All papers were screened for eligibility against the inclusion and exclusion criteria and critically appraised, and quality assessed using the Joanna Briggs Institute (JBI) checklist for systematic reviews, with reference to the Boland, Cherry & Dickson3 theories of methodology. Results: Thematic analysis of the eight studies was carried out in line with the process outlined by Braun & Clark4 to identify recurring themes and barriers to CCS access: (1) Psychological and emotional barriers (2) Financial barriers (3) Perceptions and previous experiences. Discussion: The barriers are applicable to women from all ethnicities, to varying degrees. However, females from marginalized, educationally deprived or underserved groups are less likely to attend CCS screening due to the barriers identified. This has immense implications for CC policy and practice.

The evolution of the NHS cervical screening programme

The NHS Cervical Screening Programme continues to make improvements in response to scientific research and technical advances. This article details the history of change in the programme and the latest significant advances, including human papillomavirus primary screening and the opportunities this will provide for cervical screening in the future. It provides further information about the challenges the programme faces and how sample takers are being supported in the delivery of the changes.

Determinants of a GP visit and cervical cancer screening examination in Great Britain.

ObjectiveIn the UK, women are requested to attend a cervical cancer test every 3 years as part of the NHS Cervical Screening Programme. This analysis compares the determinants of a cervical cancer screening examination with the determinants of a GP visit in the same year and investigates if cervical cancer screening participation is more likely for women who visit their GP.MethodsA recursive probit model was used to analyse the determinants of GP visits and cervical cancer screening examinations. GP visits were considered to be endogenous in the cervical cancer screening examination. The analysed sample consisted of 52,551 observations from 8,386 women of the British Household Panel Survey.ResultsThe analysis showed that a higher education level and a worsening self-perceived health status increased the probability of a GP visit, whereas smoking decreased the probability of a GP visit. GP visits enhanced the uptake of a cervical cancer screening examination in the same period. The only variables which had the same positive effect on both dependent variables were higher education and living with a partner. The probability of a cervical cancer screening examination increased also with previous cervical cancer screening examinations and being in the recommended age groups. All other variables had different results for the uptake of a GP visit or a cervical cancer screening examination.ConclusionsMost of the determinants of visiting a GP and cervical cancer screening examination differ from each other and a GP visit enhances the uptake of a smear test.

Psychological Impact of Primary Screening (PIPS) for HPV: a protocol for a cross-sectional evaluation within the NHS cervical screening programme

IntroductionThe NHS Cervical Screening Programme is now using human papillomavirus (HPV) testing as the primary test in six sentinel sites in England, with the intention of rolling this out across...

PWE-052 Low uptake of cervical screening in immunosuppressed patients with inflammatory bowel disease at a district general hospital

Introduction ECCO guidelines strongly recommend regular cervical screening for women with inflammatory bowel disease (IBD), especially if treated with immunomodulators. We wanted to investigate if our immunosuppressed female IBD patients were being screened in accordance with the NHS Cervical Screening Programme (CSP) and identify if they were at increased risk of cytological abnormalities. Method We searched our database for patients commenced on azathioprine, mercaptopurine, methotrexate, infliximab or adalimumab from June 2005 to October 2013. We excluded patients who were on these drugs for less than one year, were not of cervical screening age (25–64) or had had a hysterectomy. Information provided from general practitioners, local cytology department and Open Exeter (CSP database) were used to identify women participating in CSP and if they showed any abnormalities. Results 153 patients met the criteria to participate in the CSP. 115 (75%) were up-to-date compared to a national participation rate of 78.3%. 25 (16%) had participated in the CSP but were not up-to-date at the time of report. 9 (6%) had not participated in the CSP and 4 (3%) actively declined participation. Date from the 2013 National CSP demonstrates that 5.3% of those screened displayed low grade abnormalities and 1.2% had high grade abnormalities. Of our 153 patients 13 (8.5%) had cytological abnormalities. 5 (3%) patients had abnormalities before immunosuppressive therapy with 1 (0.7%) patient showing high grade abnormality (moderate dyskaryosis with CIN1 confirmed) which subsequently remained negative whilst on immunosuppression. Our results identified 7 (4.6%) patients with low grade abnormal cytology results after commencing immunomodulators (3; borderline nuclear changes in squamous cells, 2; mild dyskaryosis, 2; low grade dyskaryosis and high risk HPV detected). Only 1 (0.7%) patient had high grade dyskaryosis during immunosuppression but their follow up cytology was negative. Conclusion IBD patients are at increased risk of cytology abnormalities which is concerning since our CSP participation is below the national average. However data from our unit suggests that commencing immunosuppression therapy did not increase that risk any further. This data underlines that IBD specialists need to educate and encourage patients to participate in the CSP programme. Disclosure of interest K. Wade Conflict with: Abbvie sponsorship to attend ECCO, H. Johnson: None Declared, H. Dewhurst: None Declared, S. Weaver Conflict with: been on advisory board for MSD and Abbvie but not for past 12 months, S. McLaughlin Conflict with: Abbvie sponsorship to attend DDW, Abbvie Advisory board, Ferring sponsorship to attend ECCO.

Colposcopy attendance and deprivation: A retrospective analysis of 27,193 women in the NHS Cervical Screening Programme.

Background:Attendance for cervical screening is socially graded, but little is known about patterns of attendance for colposcopy following an abnormal screening result.Methods:Logistic regression was used to regress colposcopy attendance status for 27 193 women against age and area-level deprivation, adjusting for ethnicity.Results:Colposcopy attendance was high at 8 weeks (89%) and 4 months post-referral (94%) but women living in the most deprived areas were significantly less likely to attend.Conclusions:The high overall attendance rates at colposcopy are encouraging but lower attendance among women in the most income-deprived areas indicates that even when these women attend primary cervical screening, they remain at higher risk of missing out on the benefits of the programme.

High-risk HPV platforms and test of cure: should specific HPV platforms more suited to screening in a 'test of cure' scenario be recommended?

When the Sheffield screening laboratory changed the high-risk human papillomavirus (hrHPV) platforms from hybrid capture 2(®) (HC2; Digene Ltd) and to cobas 4800(®) (Roche) an unexpected and substantial increase in the number of cytology-negative/hrHPV-positive test-of-cure (ToC) samples after large loop excision of the transformation zone (LLETZ) was noted. We explore the potential reasons for these increased rates and discuss the implications this may have on the English NHS cervical screening programme (CSP). A retrospective cohort study with interval analysis between June 2007 and June 2012. ToC was performed on 1530 women with HC2 and 396 with cobas 4800: 95.1% and 92.4% of women had negative cytology at ToC in the HC2 and cobas4800 testing period, respectively. Of these 13.9% and 27.8% tested positive for hrHPV in the HC2 and cobas 4800 group, respectively (P=<0.0001). No clinically significant increase in the number of cases of cervical intraepithelial neolpasia (CIN) was detected by the cobas4800 test in spite of doubling the number of cytology-negative/hrHPV-positive ToC samples. As far as we are aware, this is the first study reporting potential differences between different HPV platforms currently available in the English programme. The immediate impact of this increase in rates of hrHPV detection with cobas4800 is an increased number of colposcopy referrals to our service. The NHSCSP needs to assess whether this increase is acceptable and, if not, whether specific HPV platforms more suited to screening in a ToC scenario should be recommended.

Management of women with low grade cytology: how reassuring is a normal colposcopy examination?

To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up. Cohort study within a randomised controlled trial. NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham. Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination. Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified. Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy. The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative. For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

Psychosocial Impact of Alternative Management Policies for Low-Grade Cervical Abnormalities: Results from the TOMBOLA Randomised Controlled Trial

BackgroundLarge numbers of women who participate in cervical screening require follow-up for minor cytological abnormalities. Little is known about the psychological consequences of alternative management policies for these women. We compared, over 30-months, psychosocial outcomes of two policies: cytological surveillance (repeat cervical cytology tests in primary care) and a hospital-based colposcopy examination.MethodsWomen attending for a routine cytology test within the UK NHS Cervical Screening Programmes were eligible to participate. 3399 women, aged 20–59 years, with low-grade abnormal cytology, were randomised to cytological surveillance (six-monthly tests; n = 1703) or initial colposcopy with biopsies and/or subsequent treatment based on colposcopic and histological findings (n = 1696). At 12, 18, 24 and 30-months post-recruitment, women completed the Hospital Anxiety and Depression Scale (HADS). A subgroup (n = 2354) completed the Impact of Event Scale (IES) six weeks after the colposcopy episode or first surveillance cytology test. Primary outcomes were percentages over the entire follow-up period of significant depression (≥8) and significant anxiety (≥11; “30-month percentages”). Secondary outcomes were point prevalences of significant depression, significant anxiety and procedure-related distress (≥9). Outcomes were compared between arms by calculating fully-adjusted odds ratios (ORs) for initial colposcopy versus cytological surveillance.ResultsThere was no significant difference in 30-month percentages of significant depression (OR = 0.99, 95% CI 0.80–1.21) or anxiety (OR = 0.97, 95% CI 0.81–1.16) between arms. At the six-week assessment, anxiety and distress, but not depression, were significantly less common in the initial colposcopy arm (anxiety: 7.9% vs 13.4%; OR = 0.55, 95% CI 0.38–0.81; distress: 30.6% vs 39.3%, OR = 0.67 95% CI 0.54–0.84). Neither anxiety nor depression differed between arms at subsequent time-points.ConclusionsThere was no difference in the longer-term psychosocial impact of management policies based on cytological surveillance or initial colposcopy. Policy-makers, clinicians, and women themselves can be reassured that neither management policy has a significantly greater psychosocial cost.Trial RegistrationControlled-Trials.com ISRCTN 34841617

Cervical Cancer Screening Service Utilisation in UK

This study investigates empirically how past screening behaviour, individual and household characteristics affect the current uptake of cervical cancer screening in UK. For the conceptual framework, we use a modified Grossman model which is extended for non-economic factors. A dynamic version of a random effects panel probit model with initial conditions is estimated on the balanced sub-sample of the data. The analysis sample is restricted to women of age 16 and older and grouped into different age categories with respect to the NHS Cervical Screening Programme (NHSCSP). As dataset a balanced panel data of 857 women with 11,998 observations from the British Household Panel Study (BHPS) for the period from 1992 to 2008 is used for the analysis. Results suggest show that previous screening uptake, age, partner status, employment status and a previous GP visit have a significant influence on the likelihood of the uptake of cervical cancer screening.

The invasive cervical cancer review: psychological issues surrounding disclosure

An audit of the screening history of all new cervical cancer cases has been a requirement since April 2007. While NHS cervical screening programmes (NHSCSP) guidance requires that women diagnosed with cervical cancer are offered the findings of the audit, as yet there has been no research to investigate the psychological impact that meeting to discuss the findings might have on patients. This is in spite of the fact that cytological under-call may play a role in as many as 20% of cervical cancer cases. This review draws on the literature concerning breaking bad news, discussing cancer and disclosing medical errors, in order to gain insight into both the negative and positive consequences that may accompany a cervical screening review meeting. We conclude that while patients are likely to experience some distress at disclosure, there are also likely to be positive aspects, such as greater trust and improved perception of care.