Evaluation of a Cervical Cancer Screening Intervention for Prison Inmates

Abstract

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.

Résumé

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.

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Correspondence to Dr. Ruth Elwood Martin MD, FCFP.

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Acknowledgements: This work was supported by a research grant from the British Columbia Medical Services Foundation. We thank the inmates and staff at Burnaby Correctional Centre for Women for their constructive input in developing the intervention; the Corrections Branch of the Ministry of Public Safety and Solicitor General for allowing us to conduct this study; the Cervical Cancer Screening Program at the BC Cancer Agency for providing the needed information for the linkage and evaluation; and E. Baptiste for preparing the manuscript.

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Martin, R.E., Hislop, T.G., Grams, G.D. et al. Evaluation of a Cervical Cancer Screening Intervention for Prison Inmates. Can J Public Health 95, 285–289 (2004). https://doi.org/10.1007/BF03405133

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