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Cervical Cancer Screening and Follow-Up Practices in U.S. Prisons

  • Alexa N. Kanbergs
    Correspondence
    Address correspondence to: Alexa N. Kanbergs, MD-sCM, MS, Department of Obstetrics, Gynecology, and Reproductive Biology, 75 Francis Street, ASB 1-3, Brigham and Women's Hospital, Boston MA 02115
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Mackenzie W. Sullivan
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Morgan Maner
    Affiliations
    Center for Health Equity Research, Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Lauren Brinkley-Rubinstein
    Affiliations
    Center for Health Equity Research, Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Annekathryn Goodman
    Affiliations
    Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Michelle Davis
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Sarah Feldman
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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      Introduction

      The objective of this study is to better understand cervical cancer screening and follow-up practices in U.S. prisons.

      Methods

      A 29-question survey examining cervical cancer screening practices, education, and facility/patient characteristics was disseminated to state-prison medical directors.

      Results

      A total of 70% (35/50) of state medical directors completed the survey between August 2021 and January 2022. All prison systems provided cervical cancer screening both at intake and specified intervals. A total of 36% provided colposcopy on site, and 9% performed excisional procedures on site. A total of 11 states identified 1‒5 cases of cervical cancer within the last year. Frequently cited challenges included a perceived lack of patient interest, delays in community referral, and lack of follow-up of abnormal results after release.

      Conclusions

      This study found relatively high rates of screening with a perceived lack of patient interest as the most reported barrier. Follow-up care was also often affected by reported lack of patient interest, delays in community referral for diagnostic procedures, and patient release before follow-up. There is room for further optimization of screening and surveillance among incarcerated women by understanding and addressing systems-based challenges. By understanding patient barriers to primary screening, expanding access to onsite testing and community referral for abnormal results, and streamlining post-release follow-up, disparities in care among incarcerated women can be reduced.
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