Screening for cervical cancer in imprisoned women in Brazil

Abstract

Context and objectiveIncarcerated women are more vulnerable to developing cervical cancer than women in general; therefore, screening and intervention programs must be included in their healthcare provision. We therefore aimed to investigate the state of cervical cancer screening for imprisoned women in Mato Grosso do Sul, and to analyze the interventions geared toward the control of cervical cancer.Materials and methodsThis was a cross-sectional study with analysis of primary and secondary data. Interviews were held with 510 women in seven prisons in the Brazilian state of Mato Grosso do Sul. The data for 352 medical records were analyzed statistically with the significance level set at 5%. Associations were assessed by the chi-squared test, adjusted by the Bonferroni correction.ResultsMost female prisoners had limited education, used tobacco, and had key risk factors for the development of cervical cancer. Half of the women interviewed (n = 255) stated that they had received a Papanicolaou (Pap) test in prison, but 134 (52.5%) of these did not know the result. Of those who had not received a Pap test, 149 (58.4%) stated that this was because of a lack of opportunity. There was no information regarding the provision of Pap tests or subsequent treatment in the medical records of 211 (59.9%) women. No protocols were in place for the provision of Pap tests in prison. There were statistical differences between prisons in terms of test frequency, the information provided to women, and how information was recorded in medical records.ConclusionThe screening of cervical cancer in prisons is neither systematic nor regular, and the results are not communicated to women in a significant number of cases. It is necessary to organize health services within the prison environment, ensuring that tests are done and that there is investigation for human papillomavirus. This could increase the diagnosis of cervical cancer at less advanced stages of the disease.

Behind bars: the burden of being a woman in Brazilian prisons

“…In several studies, women aged 40 and older in prison demonstrated a risk of developing cervical cancer 4 to 5 times higher compared to the general population [ 37 , 38 ]. Such vulnerability intensifies when early sexual debut occurred, the individuals are smokers, and they have prolonged use of oral contraceptives [ 39 ].…”

Cervical Cancer Screening Access for Women Who Experience Imprisonment in Ontario, Canada

“…In several studies, women in prison have indicated that they would be willing to access Papanicolaou testing in prison, 37 , 38 , 39 and in a study in Brazil, a majority of women had accessed testing in prison and a majority of those who had not accessed testing in prison specified that lack of opportunity was the reason why they didn’t access testing in prison. 33 Barriers to testing for women in prison may include a lack of access to acceptable health care in prison 14 , 18 , 23 and on release, 40 and a lack of knowledge regarding what a Papanicolaou test is and why this testing is done. 21 , 41 Another issue may be that given the high prevalence of comorbidity in this population, 21 the attention of patients and health care professionals is focused on specific conditions at the cost of other health conditions and preventive care.…”

Effectiveness of a Kansas City, Jail-Based Intervention to Improve Cervical Health Literacy and Screening, One-Year Post-Intervention

“…Interventions delivered in jails or prisons to increase Pap screenings are rare 9 ; most research on cervical cancer prevention with incarcerated women measures cervical cancer, abnormal Pap prevalence, Pap screening and follow-up rates, and factors associated with those variables. 2,7,10 Studies show rates of screening for incarcerated women are comparable to non-justice-involved women's rates. [11][12][13] Our participants' preintervention rates (72%) were atypical: nearly 10 percentage points lower than the local average (80.1%).…”