Canadian Journal of Public Health

, Volume 95, Issue 4, pp 285–289 | Cite as

Evaluation of a Cervical Cancer Screening Intervention for Prison Inmates

  • Ruth Elwood MartinEmail author
  • T. Gregory Hislop
  • Garry D. Grams
  • Betty Calam
  • Elaine Jones
  • Veronika Moravan


Background: Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics.

Method: Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined.

Results: A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period.

Conclusion: The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardest-to-reach group.


Contexte: Les femmes détenues, insuffisamment examinées, sont plus vulnérables au cancer du col utérin. Nous avons analysé l’incidence d’une intervention de dépistage par test de Papanicolaou effectuée par une infirmière, qui comprenait des séances d’information et des cliniques d’échantillonnage pour le test de Papanicolaou.

Méthode: Nous avons comparé les taux de dépistage par test de Papanicolaou chez 650 détenues du Centre correctionnel pour femmes de Burnaby avant et durant la période d’intervention de 20 semaines. Ces taux ont été déterminés en couplant les dossiers du Bureau des affaires correctionnelles sur les détenues et les dossiers des patientes du Programme de dépistage du cancer du col de l’utérus. Nous avons également analysé les associations entre les facteurs socio-démographiques et les taux de dépistage par test de Papanicolaou.

Résultats: La proportion de détenues examinées était plus élevée durant la période d’intervention (26,9 %) qu’avant l’intervention (21,0 %) (bien que cette différence ne soit pas significative: p=0,06). Les femmes détenues pendant un séjour de très courte durée avaient été examinées moins fréquemment au cours des deux années précédant l’intervention. Les détenues qui n’avaient pas terminé leurs études secondaires et celles incarcérées sur une plus longue période avaient de manière significative plus de chances de subir un test de Papanicolaou durant la période d’intervention qu’avant la période d’intervention.

Conclusion: L’intervention effectuée par une infirmière a donné lieu à une modeste amélioration de la proportion des détenues ayant subi un dépistage par test de Papanicolaou. Malheureusement, l’avantage de l’accès à une infirmière clinicienne ne s’étendait pas, le plus souvent, aux détenues non examinées ou insuffisamment examinées antérieurement. Il faudrait déployer plus d’efforts pour cibler le groupe des détenues le plus difficile à atteindre.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Band PR, Gallagher RP, Threlfall WJ, Hislop TG, Deschamps M, Smith J. Rate of death from cervical cancer among Native women in British Columbia. CMAJ 1992;147(12):1802–4.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Anderson G, Benedet JL, LeRiche JC, Matisic JP, Thompson JE. Invasive cancer of the cervix in British Columbia: A review of the demography and screening histories of 437 cases seen from 1985–1988. Obstet and Gynecol 1992;80(1):1–4.Google Scholar
  3. 3.
    Hislop TG, Clarke HF, Deschamps M, Joseph R, Band PR, Smith J, et al. Cervical cytology screening: How can we improve rates among First Nations women in urban British Columbia? Can Fam Phys 1996;42:1701–8.Google Scholar
  4. 4.
    Hislop TG, Deschamps M, Teh C, Jackson C, Tu S-P, Yasui Y, et al. Facilitators and barriers to cervical cancer screening among Chinese Canadian women. Can J Public Health 2003;94(1):68–73.PubMedGoogle Scholar
  5. 5.
    Calam B, Norgrove L, Brown D, Wilson MA. Pap screening clinics with Native women in Skidegate, Haida Gwaii: Need for innovation. Can Fam Phys 1999;45:355–60.Google Scholar
  6. 6.
    Karsai H, Coldman AJ, Gavin D, Brumelle S, Boyes DA, Anderson GH, et al. Cervical intra-epithelial neoplasia in female prisoners in British Columbia. CMAJ 1988;139:733–37.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Downey GP, Gabriel G, Deery ARS, Crow J, Walker PG. Management of female prisoners with abnormal cervical cytology. BMJ 1994;308:1412–13.CrossRefGoogle Scholar
  8. 8.
    Martin RE. A review of a prison cervical cancer screening program in British Columbia. Can J Public Health 1998;89(6):382–86.PubMedGoogle Scholar
  9. 9.
    Logrono R, Wong JY. Rates of abnormalities and infectious agents in cervical smears from female inmates in Texas: Comparison with private and university clinic patients. Texas Medicine 1999;95:60–63.PubMedGoogle Scholar
  10. 10.
    Martin RE. Would female inmates accept Papanicolaou smear screening if it was offered to them during their incarceration? CMAJ 2000;162:657–58.PubMedPubMedCentralGoogle Scholar
  11. 11.
    National Commission on Correctional Health Care. Standards for health services in prisons. Chicago: NCCHC, 1997.Google Scholar
  12. 12.
    Anno BJ. Prison Health Care: Guidelines for the Management of an Adequate Delivery System. Chicago, Illinois: National Commission on Correctional Health Care, 1991.Google Scholar
  13. 13.
    Bickell NA, Vermund SH, Holmes M, Safyer S, Burk RD. Human papillomavirus, gonorrhea, syphilis, and cervical dysplasia in jailed women. Am J Public Health 1991;81:1318–20.CrossRefGoogle Scholar
  14. 14.
    Young DS. Women’s perceptions of health care in prisons. Health Care Women Int 2000;21:219–34.CrossRefGoogle Scholar
  15. 15.
    Tucker J, Jones E, Martin RE, Hislop G, Berkowitz J, Grams G, Calam B. The Key Role of the Nurse Practitioner in Implementing a Cervical Cancer Screening Program in Prison. Unpublished data.Google Scholar
  16. 16.
    Automatch Generalized Record Linkage System -User’s Manual. Burtonsville, Maryland: Matchware Technologies Inc., 1996.Google Scholar
  17. 17.
    Annual report, Cervical Cancer Screening Program. BC Cancer Agency, 2001;19.Google Scholar

Copyright information

© The Canadian Public Health Association 2004

Authors and Affiliations

  • Ruth Elwood Martin
    • 1
    • 2
    Email author
  • T. Gregory Hislop
    • 3
    • 4
  • Garry D. Grams
    • 2
  • Betty Calam
    • 2
  • Elaine Jones
    • 5
  • Veronika Moravan
    • 6
  1. 1.Health Care, Burnaby Correctional Centre for WomenBurnabyCanada
  2. 2.Department of Family PracticeUniversity of British ColumbiaVancouverCanada
  3. 3.Department of Health Care and EpidemiologyUBCCanada
  4. 4.Cancer Control ResearchBC Cancer AgencyCanada
  5. 5.British Columbia Centre for Disease ControlCanada
  6. 6.Population and Preventive OncologyBC Cancer AgencyCanada

Personalised recommendations