Cervical Dysplasia and Treatments Barrier in Jail: A Study in Marseille's Detention Center—Les Baumettes, France

Abstract

Introduction: The main objective was to estimate the prevalence of cervical dysplasia among incarcerated women. The secondary objective was to identify obstacles to the possible management of a cervical dysplasia in detention by assessing their knowledge of screening for cervical cancer (CC), the existence of vaccination, and the management of precancerous lesions. Materials and Methods: The first part of the study was descriptive and retrospective, studying pap-smear results in women's correctional facility at the Baumettes prison center (PC) in Marseille, France. The second part of the study was qualitative and prospective and took place at the Baumettes PC. Voluntary and French-speaking inmates aged 25–65 years answered an short-form 12 quality-of-life questionnaire and a more targeted questionnaire on CC screening and cervical dysplasia treatments. Results: In total, 201 pap-smear tests were assessed, 135 were normal (66.8%) and 33 unsatisfactory (16.3%). There were 33 abnormal pap-smear tests (16%). The patients were 38.9 years (±9.5 years), had 4.05 pregnancies (±2.7), and 2.29 children (±1.85). Seventy-five percent were smokers. Psychiatric disorders were found in 52.2% inmates. In the second part of the study, among the 35 inmates questioned, the SF-12 questionnaire's analysis shows that the physical health component score was on average 43.6 and the mental health component score (MCS) was 36.5. Analysis demonstrated that the uncertainty of the exact day of hospitalization is an obstacle to treatment for 15 patients presenting significantly a lower MCS score ( p = 0.047). Conclusion: Prevalence of pathological pap-smear tests is higher within a prison population, screening is accepted and the inmates are receptive to information about CC prevention, delivered during individual interviews. Mental health's management and care system's reorganization in detention are essentials factors for care acceptance.

Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review

“…Eight studies described both screening and management interventions [ 37 – 44 ]. Numerous chronic non-communicable conditions are represented in the included literature, encompassing diabetes ( n = 11) [ 45 , 49 – 51 , 53 , 55 , 56 , 59 , 60 , 63 , 67 ], gynaecological diseases ( n = 10) [ 26 , 27 , 29 – 33 , 38 , 43 , 70 ], cardiovascular disease (CVD) ( n = 6) [ 34 , 37 , 42 , 61 , 62 , 83 ], chronic kidney disease (CKD) ( n = 5) [ 35 , 52 , 66 , 72 , 73 ], dermatological conditions ( n = 4) [ 64 , 74 , 78 , 75 ], ophthalmological conditions ( n = 3) [ 57 , 58 , 77 ], respiratory illnesses ( n = 3) [ 48 , 54 , 68 ], oral cancer ( n = 1) [ 25 ], and colorectal cancer ( n = 1) [ 28 ]. Approximately one third of studies ( n = 22) covered several diseases and/or general long-term prisoner health [ 36 , 39 – 41 , 44 , 46 , 47 , 65 , 69 , 71 , 76 , 79 – 82 , 84 – 89 ].…”

“…Approximately one third of studies ( n = 22) covered several diseases and/or general long-term prisoner health [ 36 , 39 – 41 , 44 , 46 , 47 , 65 , 69 , 71 , 76 , 79 – 82 , 84 – 89 ]. A minority of research focused on specific populations with prison, including women ( n = 12) [ 26 , 27 , 29 – 33 , 38 , 42 , 43 , 51 , 70 ], older adults ( n = 8) [ 39 – 41 , 44 , 87 – 89 ], and people of Aboriginal Australian ethnicity ( n = 1) [ 35 ].…”

“…[ 25 ] Oral precancerous lesions were found in 6·4% of people in Indian prisons, exceeding the national prevalence of 0·4% [ 25 ] Similarly, high rates of CKD were detected amongst Aboriginal people in prison with 25.1% of screenings being positive [ 35 ], whereas rates of cardiovascular disease amongst the prison population undergoing NHS healthchecks were comparable with general communities [ 34 ]. Rates of reported cervical screening abnormalities in prisons varied from 3% to 16.4% [ 26 , 27 , 38 ]. In a study of colorectal cancer screening over two years, 13.5% and 21.3% of completed FITs screened positive each year [ 28 ].…”

“…Six studies assessed people’s experiences and perceptions of screening interventions in prison [ 26 , 27 , 30 , 32 , 33 , 36 ]. Williams et al found that awareness of NHS healthcheck results was variable but generally poor within prison.…”

“…One study found that women with lower education levels and fewer than five aliases were more likely to be re-screened for cervical cancer [ 32 ]. DeLuget et al and Giuseppe et al demonstrated that only 48% and 36.4% of female prisoners, respectively, were aware of the link between cervical cancer and human papillomavirus infection; [ 27 , 29 ] this knowledge was associated with improved adherence with cervical cancer screening [ 29 ].…”