Criminal Justice Involvement and Abnormal Cervical Cancer Screening Results Among Women in an Urban Safety Net Hospital

Abstract

Objective The aim of the study was to elucidate the risk factors underlying abnormal cytology-based cervical cancer screening (Pap testing) in justice-involved women (JIW) compared with non-JIW in an urban safety net hospital. Methods Retrospective chart review of women with a history of correctional involvement who received care at Grady Health System between 2010 and 2018 and had a Pap test was performed (n = 191). An age-matched cohort of women with no correctional involvement and had a Pap test at Grady served as the control (n = 394). Variables of interest were age, HIV, smoking, race, mental health history, and history of incarceration. Outcomes of interests were rate of abnormal Pap tests and follow-up. χ2 and logistic regression models evaluated associations between the variables of interest and outcomes. Results Rates of abnormal Pap tests were significantly higher in JIW (35.6%) than controls (18.5%, p < .0001). Compared with controls, JIW were significantly more likely to have high-grade cervical cytology (odds ratio [OR] = 3.89, p < .0005) and be lost to gynecologic follow-up (OR = 8.75, p < .0001) and a history of severe mental illness (29.5% vs 4.3%, p < .0001). Those with abnormal Pap tests were likely to be HIV-positive (OR = 20.7, p < .001) and have a history of incarceration (OR = 2.33, p < .001). Predictors of high-grade Pap test were smoking history (OR = 0.16, p = .014), HIV-positive (OR = 3.66, p = .025), and history of incarceration (OR = 3.96, p < .0005). Conclusions Justice-involved women represent a high-risk subpopulation with significantly increased rates of high-grade cytology and lost to follow-up. This underscores the need for attention to screening programs and follow-up interventions for JIW.

Commentary on New Guidance for Human Papillomavirus–Related Cancer Screening Among Sexual and Gender Minority Populations

“…This issue of the Journal of Lower Genital Tract Disease presents recommendations by Jodry et al 1 for human papillomavirus (HPV) screening specific to sexual and gender minority (SGM) individuals. These recommendations are organ based while recognizing that SGM populations have unique risk factors and barriers to cancer screening distinct from their heterosexual cisgender counterparts.…”

“…Despite the large and increasing size of the LGBTQ+ adult population, no formal screening guidelines exist for HPV-associated cancers in this community. The recommendations outlined by Jodry et al 1 clarify the risk of HPV in SGM subgroups, particularly the misconceptions that women who have sex with women and transgender men (TGM) are not at risk for cervical HPV. Furthermore, they recommend screening for anal cancer among men who have sex with men (MSM) and transgender women in the absence of national guidelines.…”

“…Furthermore, they recommend screening for anal cancer among men who have sex with men (MSM) and transgender women in the absence of national guidelines. See Table 1 in Jodry et al 1 for the full screening recommendations. Finally, the authors note that vaccination rates are lower among MSM and transgender women due to previous policies that included only individuals assigned female at birth and recommend HPV vaccination as a means of primary prevention for individuals of any gender up to the age of 45 years.…”

“…Approximately 14% of TGM have had a hysterectomy, and thus the majority of TGM are at risk for cervical cancer 6 . Furthermore, TGM who identify as gay or bisexual (MSM) may be at risk for anal HPV and are eligible for anal cancer screening under recommendations made by Jodry et al 1 …”

“…Providers should be aware of the need for gender-neutral examination garments and all-gender bathrooms to make patients feel welcomed 8 . The use of self-sampling should be made available to TGM for cervical cancer screening given the increased pain and discomfort experienced by many of these patients 1 …”