Prevalence of Epithelial Cell Abnormalities and Risk behaviors for Cervical Cancer Among female Prisoners in Chiang Mai women Correctional Institute

Abstract

           Background: CA Cervix is the most common cancer among women worldwide. The incidence in Northern Thailand has been reported as double of the general population. Present studies have already documented the risk factors for this disease and many countries have developed clinical guidelines recommending periodic screening through pelvic examination and PAP smears in women with risk factors. Unfortunately, prisoners are one of the marginalized populations in our society with low access to health care before, during and after imprisonment. Objective: Document the prevalence of CA cervix in female prisoners in order to provide adequate care and support for those with diseases and to plan for appropriate reduce programs to reduce risk behavior in those without disease. Methods: A retrospective cross sectional survey conducted during 2007-2008. 302 volunteered to answer a self-administered questionnaire of their risk behavior. The volunteer then received pelvic examinations and PAP smears were done. Pathology results were reported by an experience pathologist from a University hospital. Results: The sample only accounts for 21.6% of all prisoners. About 70% of the women in this survey were 35 years or older. 99% of the samples taken yielded satisfactory specimens. The prevalence of abnormal epithelial cell abnormality was 3.3%. Most common abnormalities were ASCUS and ASCH found in 2.3% of the population followed by HSIL and LSIL at 0.7% and 0.3% respectively. In term of risk behaviors for CA cervix, the study found that 2/3 had a history of contracting a STDs and smoking. Half did not use condoms regularly. Almost half were sexually active early, were on oral contraceptive pills and had never underwent a pelvic examination and screening for CA cervix. 1/3 has more than 4 partners and has reported more than 4 pregnancies. Conclusion: Although the sample in this study is only a small part of the population, it shows a much higher prevalence of abnormal epithelial cell abnormalities than the normal population. Promoting CA screening in this high risk population can not be overlooked and integrated as part of routine prison health service systems.