Abstract
BackgroundCervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor. We studied cervical cytology screening with surgical biopsy follow-up in women prisoners and compared the findings to those in the general population.MethodsWe reviewed 1024 conventional cervical smears, 73 cervical biopsies and 2 loop electrosurgical excision procedure (LEEP) specimens referred to us from the Correctional Center in Columbus, Ohio during a 12-month period. The results were compared to 40,993 Pap smears from the general population for the same 12-month period.ResultsHigh grade squamous intraepithelial lesion (HGSIL) was diagnosed in 1.3% of the cervical smears from the inmate population versus 0.6% in the general population (p < 0.01). The unsatisfactory rate was 1.6% compared to 0.3% in the general population (p < 0.01). Among the study population, follow-up tissue diagnosis was obtained in 24.3% of the abnormal cytology results (ASCUS, LGSIL, and HGSIL). Of the HGSIL Pap smears, 61.5% had a subsequent tissue diagnosis. Thirty-nine biopsies (52% of the all inmate biopsies and LEEP) showed CIN II/III (cervical intraepithelial neoplasia II/III). Eight of these thirty-nine follow-up biopsies diagnosed as CIN II/III had a previous cervical cytology diagnosis of ASCUS. The average age for HGSIL was 30.5 years (S.D. = 5.7) and for low grade squamous intraepithelial lesion (LGSIL) was 27.2 years (S.D. = 6.1).ConclusionA significantly higher prevalence of HGSIL cervical cytology and unsatisfactory smears was encountered in female inmates, with tissue follow-up performed in less than two thirds of the patients with HGSIL. These results are in keeping with data available in the literature suggesting that the inmate population is high-risk and may be subject to less screening and tissue follow-up than the general population. Clinicians should proceed with urgency to improve screening and follow-up with treatment. The inmate population should be targeted for HPV vaccination promptly after FDA approval.
Highlights
Cervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor
The Papanicolaou-stained conventional cervico-vaginal smears were classified according to the Bethesda system (1988): within normal limits (WNL), atypical squamous cells of uncertain significance (ASCUS), atypical glandular cells of unknown significance (AGUS), low grade squamous intraepithelial lesion (LGSIL), high grade squamous intraepithelial lesion (HGSIL), carcinoma, and unsatisfactory for evaluation.[9]
HGSIL was diagnosed in 1.3% of the cervical smears from the inmate population versus 0.6% in the general population (p < 0.01)
Summary
Cervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor. We studied cervical cytology screening with surgical biopsy follow-up in women prisoners and compared the findings to those in the general population. Cervical carcinoma remains the second leading cause of cancer death in women worldwide. Women inmates represent a socially disadvantaged group with high-risk behavior and low participation in the Pap smear screening programs, they have a higher propensity for developing cervical carcinoma than the general population. [4,5,6,7,8] Prevalence rates as high as 10% for carcinoma in situ, 16% for syphilis, and 5% for gonorrhea have been reported in detainees.[4,5] We studied the results of cervical screening in female prisoners, in addition to cytology specimen adequacy, and biopsy/loop electrosurgical procedure specimens (LEEP) follow-up Women inmates represent a socially disadvantaged group with high-risk behavior and low participation in the Pap smear screening programs, they have a higher propensity for developing cervical carcinoma than the general population. [4,5,6,7,8] Prevalence rates as high as 10% for carcinoma in situ, 16% for syphilis, and 5% for gonorrhea have been reported in detainees.[4,5] We studied the results of cervical screening in female prisoners, in addition to cytology specimen adequacy, and biopsy/loop electrosurgical procedure specimens (LEEP) follow-up
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