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The incidence of cervical cancer in women with postcoital bleeding and abnormal appearance of the cervix referred through the two-week wait pathway: A retrospective cohort study.
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  • Brittany* Jasper,
  • Emma* Thorley,
  • Filipe Martins,
  • Krishnayan Haldar
Brittany* Jasper
Sunshine Coast University Hospital

Corresponding Author:[email protected]

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Emma* Thorley
London North West Healthcare NHS Trust
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Filipe Martins
Addenbrooke's Hospital
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Krishnayan Haldar
Addenbrooke's Hospital
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Abstract

Objectives: To determine the incidence of cervical cancer in women referred through the two-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix and calculate the associated costs. Design: A retrospective cohort study. Setting: United Kingdom. Population: 604 women with postcoital bleeding and abnormal appearance of the cervix seen in two-week-wait colposcopy clinics over five years. Methods: Women were identified from a departmental database. Clinical and demographic data was collected. Categorical data was analysed with Chi-squared or Fisher’s exact tests and predictive values were calculated. Cost analysis was performed using Care Commissioning Group tariffs and national statistics on the cervical screening programme. Main outcome measure: Histopathological diagnosis of cervical cancer. Results: Of the 604 women referred, 1·16% were diagnosed with cervical cancer. None of the women who were up-to-date with cervical screening were diagnosed with cervical cancer, whilst 6·67% of women out-of-date with cervical screening were diagnosed with cervical cancer (p<0·001). The positive predictive value for diagnosing cervical cancer was 1·70% for postcoital bleeding [95% CI 0·64–3·7] and 0·31% for abnormal appearance of the cervix [95% CI 0·0008–1·7]. At Cambridge University Hospitals, the cost of two-week-wait colposcopy for these referral indications was £23,829·20 annually. In England, the cost of colposcopy for urgent clinical indications of cervical abnormalities was £2,657,176·00 annually. Conclusions: The incidence of cervical cancer in women referred through the two-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix is low. These referrals carry substantial cost despite low predictive values and national guidelines should be refined.