title: Reduction in colposcopy workload and associated clinical activity following human papillomavirus (HPV) catch-up vaccination programme in Scotland: an ecological study.
abstract: OBJECTIVE
  To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP).
  
  
  METHODS
  Population-based observational study using nationally collected data.
  
  
  METHODS
  Scottish colposcopy clinics.
  
  
  METHODS
  All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008 and 2014.
  
  
  METHODS
  Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) were 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.
  
  
  METHODS
  Referral criteria, positive predictive value of colposcopy, default rates, and rates of cervical biopsies and treatments.
  
  
  RESULTS
  A total of 7372 women referred for colposcopy at age 20 or 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 = 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 < 0.0001) and no treatment (2008/9, 74.9%; 2013/14, 91.8%; linear trend P < 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 human papillomavirus (HPV) catch-up immunisation programme. Referral criteria and the service provision of colposcopy needs to be planned carefully, taking account of the increasing number of women who have been immunised against HPV that will be entering cervical screening programmes worldwide.
  
  
  CONCLUSIONS
  Colposcopy referral criteria and service planning need attention following HPV immunisation programme.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Cruickshank
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Cotton
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kavanagh
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.|Health Protection Scotland, Glasgow, UK.
authors.forename: C
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK.
authors.forename: K
authors.initials: K
authors.lastname: Cuschieri
authors.affiliation: Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK.
authors.forename: H
authors.initials: H
authors.lastname: Cubie
authors.affiliation: Department of Pathology, University of Edinburgh, Edinburgh, UK.
authors.forename: T
authors.initials: T
authors.lastname: Palmer
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: K G
authors.initials: KG
authors.lastname: Pollock
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000639:trends*; D005260:Female; D006801:Humans; D016015:Logistic Models; D030361:Papillomavirus Infections / Q000150:complications / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D000078337:Procedures and Techniques Utilization / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends; D012606:Scotland; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000821:virology; D016526:Workload / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical screening; HPV; HPV vaccine; colposcopy; immunisation; loop excision