Health authority cervical screening recall policies and time since last smear: a retrospective cohort analysis in the north west of England

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Abstract
Objectives: To evaluate the impact of health authority cervical screening programmes upon the actual screening interval for women attending as a result of routine recall and to assess the impact of general practice recall policies on attendance for smears. Setting: Nine health authorities constituting the Lancashire and Greater Manchester zones of the North West region of the National Health Service. Methods: Information was obtained on the invitation and recall policies of each health authority. A retrospective analysis of information held on cervical screening databases ("Exeter" computer systems) was performed. The proportions of smears, classified by a screening interval of "unscheduled", "on-time", or "overdue", in the different health authority recall programmes were compared. General practices in one health authority (operating five-yearly recall) were contacted to determine their current practice screening policy. Results: Women who were invited as part of a three-yearly recall programme were more likely to attend for smears at intervals of 3-5 years than those on a five-yearly recall programme (68% vs 47%). Those health authorities operating three-yearly recall that issued recall invitations to women more than four weeks before the date the smear was due had higher rates of "unscheduled" smears. In the one health authority (operating a five-yearly recall programme) in which we determined general practice screening policy, 62% of the general practitioners (GPs) were operating their own three-yearly recall policy; these GPs had a higher proportion of the women who attended for smears "on-time" (51%) than did those who relied on the heath authority five-yearly recall procedure (44%). Conclusions: Despite the cervical screening programme being a national programme, there is scope at a local level for considerable variation in the interpretation of national guidance. This variation effects the extent to which programmes comply with the requirement to screen all women at an interval of 3-5 years.

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