As of 2023, the United States (US) has 1.9 million incarcerated people, of which 172,700 are women. Cancer has surpassed heart disease as the leading cause of death in state prisons, and the most common cancers in this population have effective screening tools. Barriers to access to preventative healthcare include lack of insurance, homelessness, mental illness and substance use, which are common among incarcerated women. Incarcerated women have higher rates of high grade cervical dysplasia and more likely to be lost to follow-up than non-incarcerated women. The aim of this study is to characterize the population of incarcerated women seeking care at our institution for an abnormal pap smear, describe the care received, and determine the rate of follow-up after their initial treatment.

After IRB approval, a retrospective chart review between January 2021- June 2024 of incarcerated patients with cervical dysplasia was performed. Demographics, clinical and pathological characteristics, and treatment data were collected and analyzed. Descriptive statistics were utilized to summarize data.

In total, 188 patients met inclusion criteria. The average age was 36 years and 44% were Caucasian. Regarding medical history, 46% had a mental health disorder, 17% had a history of sexually transmitted infections, and 73% reported tobacco use prior to incarceration. Only 4% of patients reported vaccination against HPV prior to their visit, however the HPV vaccination series was initiated in 66% of patients. ASCUS was identified in 36% of pap smears, with HSIL in 24%, and 91% of all patients were HPV+. Of the 89% who underwent colposcopy, 42% had HSIL, 33% were benign. An excisional procedure was performed on 44% of patients. 78% of patients who had an excisional procedure had HSIL histology, 1% had AIS and 1% had carcinoma. The average time between pap smear and colposcopy was 3.4 months, and the average time between pap smear and excisional procedure was 5.4 months. In all, 68% of patients did not have the recommended follow up in clinic within 18 months of their last appointment. Of those released, 66% were lost to follow up.

Women who are incarcerated are of lower socioeconomic status than the general population, lack health insurance, are less likely to undergo screening, and less likely to be educated on the importance of HPV vaccination. After counseling in clinic, 66% of eligible patients were amenable to initiation of the HPV vaccine series, demonstrating the importance of education. Although the prison system often allows incarcerated women access to medical care, barriers to care remain that delay treatment, as evidenced by the length of time between pap smear, colposcopy, and excisional procedure. Our research highlights the many opportunities for improvement in the care of incarcerated women with cervical dysplasia, and further research is warranted.