Would female inmates accept Papanicolaou smear screening if it was offered to them during their incarceration?

In February and March 1998 I conducted a survey about Papanicolaou smear screening at the Burnaby Correctional Centre for Women (BCCW). At the time of the nursing intake interview, the admitting nurse asked every inmate being admitted to participate. Inmates who agreed to participate completed an anonymous written survey. Of the 136 inmates asked to participate, 100 (74%) completed the survey.

Of the 100 respondents, 75 indicated that they would be willing to undergo a Pap test during their stay at the BCCW, if it was offered. More detailed results of the survey are presented in Table 1.

A bivariate analysis was used to compare the characteristics of the women who were willing to undergo a Pap test with those of the women who would refuse such screening. An inmate's ethnic background was the only factor associated with her willingness to undergo a Pap test (p = 0.027). There was no relation between an inmate's willingness to undergo a Pap test and age, educational level, length of sentence, understanding of the test, prior history of an abnormal Pap test result or prior history of colposcopy.

One limitation of the study was that I did not ascertain the characteristics of the inmates who declined to participate. However, the characteristics (age, education, length of sentence and ethnic background) of survey participants were the same as those of all other BCCW inmates during 1998 (p > 0.1).

That 75% of surveyed inmates were willing to undergo Pap smear screening during their incarceration is surprising in light of the results of a 1995 study at the same institution, which documented that only 15% of BCCW inmates had undergone Pap smear screening while they were incarcerated.1 Two factors contribute to this situation. First, because most sentences of less than 2 years at this institution are for drug-related crimes, the health care staff (myself included) deal with inmates' urgent medical needs, primarily related to their injection drug use,[2, 3] at the expense of their elective, preventive medical needs. Second, approximately 70% of BCCW inmates in 1998 were on remand (awaiting sentencing); for these inmates, the stay is usually less than 2 weeks. In reality, prison is a "revolving door" for women with shorter sentences. For the survey reported here, 71 of the 100 respondents were on remand. Of these, 53 (75%) stated that they would be willing to undergo a Pap test during their stay at BCCW.

Follow-up of Pap smear results is challenging. This is especially true for inmates who are on remand. Upon release from prison, women often return to poor housing, chaotic lifestyles and injection drug use,4 making it difficult for them to access medical treatment in their communities. The BC Cancer Agency now treats BCCW cytology smears as urgent, with a turnaround of a few days, to enable inmates to receive Pap smear results before their release; waiting time for colposcopy appointments has similarly been reduced.1 Community street nurses and family physicians do some follow-up. Many inmates reoffend; their Pap smear results and colposcopic appointments await them upon their return to prison. An intervention study has been designed to improve screening and follow-up in this population.

Female inmates receive Pap smear screening less frequently than women in the general population and are at increased risk for cervical dysplasia.[1, 5] We can reduce the occurrence of invasive cervical cancer in Canada by targeting those groups least likely to present for screening.6 This study demonstrates that female inmates, in BC at least, want to undergo Pap tests while they are incarcerated.

I thank the inmates of the Burnaby Correctional Centre for Women who participated in the Pap test survey and the nurses who assisted with the project.

This project was facilitated by funding from the Lloyd Jones Collins Foundation Clinical Faculty Scholar Award, Department of Family Practice, University of British Columbia.

Competing interests: None declared.