When is it appropriate for a woman not to have a cervical smear despite being in eligible age group

Withdrawal of a woman from the NHS cervical screening programme will result in stoppage of all invitations being sent to a woman and permanent removal of her name from the prior notification list (PNL) (1).

Following are the categories in which women may be 'ceased' from the programme:

• informed choice
  • some women may request to remove her name from the screening register in the following circumstances:
    • women who have never had sex with a man - the risk of developing cervical cancer is very low in a woman who is not sexually active (1,5)
    • women with a physical disability which will make sample taking a difficult task
    • circumcised women
    • women with a learning disability
    • terminally ill women (2)
  • the health care professional should make sure that prior to ceasing from the programme the woman has received sufficient and accurate information, that she has expressed the desire through a written request (Consent to Cervical Screening)
    
    
• age
  • women 65 years or older with three consecutive negative cytology results (3)
  • women over 65 years who have failed to respond to persistent invitation (1)
    
    
• women who have had radiotherapy for cervical cancer
  
  
• women with 'absence of cervix'
  • women with a total hysterectomy
  • male to female transsexuals
  • congenital absence of cervix (1)

The lead colposcopist may recommend withdrawal from the programme in

• women with severe cervical stenosis usually due to previous surgery with a history of high grade CIN, cervical glandular intraepithelial neoplasia (cGIN) or unexplained high grade cytology in whom neither cervical dilatation nor hysterectomy is appropriate
• if the women agrees to withdraw she can be ceased from the programme and if she declines to withdraw, cervical screening should be continued (3)

Reference:

• 1. NHS Cancer Screening Programmes 2004. Ceasing women from the NHS cervical screening programme
• 2. NHS Cancer Screening Programmes 2006. Taking samples for cervical screening. A resource pack for trainers
• 3. NHS Cancer Screening Programmes 2010. Colposcopy and programme management. Guidelines for the NHS cervical screening programme 2nd edition.