Cervical cancer screening access for women who experience imprisonment in Ontario, Canada

Importance — Women who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence.

Objectives — To determine cervical cancer screening rates for women in provincial prison in Ontario and to compare these data with data for the general population.

Design, Setting, and Participants — This retrospective cohort study used correctional and health administrative data from January 1, 2006, to December 31, 2013. Participants included Ontario women aged 21 to 69 years during the follow-up period with no history of cervical cancer or hysterectomy. Analyses were conducted between July 2017 and September 2018.

Exposures — Women released from Ontario provincial prison in 2010 and admitted after 2008 were considered exposed, and women in the general population of Ontario were considered unexposed.

Main Outcomes and Measures — Whether women were overdue for cervical cancer screening at the time of admission to prison or on July 1, 2010, for the general population, defined as not having been screened in the previous 3 years, and whether women who were overdue were still overdue after 3 years.

Results — There were 4553 women in the prison group and 3 647 936 women in the general population group. The median (interquartile range) age was 36 (29-43) years in the prison group and 43 (34-53) years in the general population.Women in the prison group had 2.20 times (95%CI, 2.08-2.33) the odds of being overdue for cervical cancer screening compared with women in the general population after adjusting for neighborhood income quintile, at 53.9% (95%CI, 51.8%-56.1%) compared with 32.9% (95%CI, 32.8%-33.0%) (P < .001). Women in the prison group also had twice the odds of still being overdue at 3 years, with an odds ratio of 1.87 (95%CI, 1.76-1.99) after adjusting for neighborhood income quintile, and rates of still being overdue of 36.2% (95%CI, 34.5%-38.0%) compared with 21.9% (95%CI, 21.8%-21.9%) (P < .001).

Conclusions and Relevance — Women who experience imprisonment have worse cervical cancer screening access than women in the general population. Work should be done to promote cervical cancer screening awareness and to improve access to acceptable screening in prison and in the community after prison release.