Objectives In Ireland, in April 2018, a free smear test was offered to women who wished to avail of this outside the screening programme. Physicians can also refer for colposcopy if concerned regarding a clinically suspicious cervix or a clinical history.This audit investigated the impact this had on referrals for a clinical indication and subsequent cancer diagnosis.

Methods A retrospective review of referrals for a clinical indication from October 2017 – February 2019 was conducted. Referral data and outcomes was recorded from the mediscan system. Data was analysed using Microsoft Excel.

Results Following the introduction of a free smear, the waiting time for non-urgent colposcopy rose from 4 weeks to 12–20 weeks. The referrals for a ‘clinical suspicion’ rose from 79 in the first six months (10/10/17 – 1/3/18) to 705 in the preceding six months. The number of referrals from GPs rose from 58% (n=46) to 83% (n=590). The total number of cancers diagnosed following a clinical suspicious indication was eight (0.93). Two cases of cancer were diagnosed in the first six months (2.53%), six were diagnosed in the preceding six months (0.85%). Six cases of subsequently diagnosed cancer were referred and seen as urgent (75%). Two cancers were diagnosed following a non-urgent referral. The majority of referrals had a normal colposcopy (n = 29 36.5%, 418 59.29%).

Conclusions Despite extra demand on the colposcopy department, the majority of subsequently diagnosed cancers were referred as urgent and seen promptly. The majority of clinically suspicious cervix resulted in a reassuring colposcopy.