Across the world, imprisoned women have higher rates of cervical cancer and the human papillomavirus (HPV) infection that can lead to cancer, according to a research review.

Screening and treatment could address these problems in an especially vulnerable population of women, the authors conclude in the Journal of Epidemiology & Community Health.

“This relevant health issue affects underprivileged populations in a disproportionate manner,” study co-author Nadia Escobar Salinas of the Ministry of Health in Santiago, Chile, told Reuters Health.

Cervical cancer is the fourth most common cancer in women worldwide. About 570,000 cases are diagnosed annually across the world, according to the World Health Organization. The highest rates are in Latin America, Southeast Asia and sub-Saharan Africa. Most deaths occur in low-income and middle-income countries.

“People in prisons are deprived of their freedom as part of a criminal conviction, but that should not mean they are also deprived of their right to health and preventive interventions,” Escobar Salinas said by email.

She and Emma Plugge of Public Health England in Reading, UK, reviewed 35 previous studies of HPV infection and cervical cancer in imprisoned women published between 1968 and 2017. The studies involved more than 53,000 imprisoned women in the U.S., Canada, UK, Spain, Italy, Brazil, Mexico, Peru, Taiwan and Russia.

In nine of the studies, HPV infection rates among imprisoned women ranged from 10% to 55%, with the lowest percentages in Brazil and Italy and the highest in Taiwan and Spain. The worldwide prevalence of HPV among women with normal cervical cells is about 11%, the study team notes.

Similarly, precancerous cervix lesions that are typically caused by HPV infection were diagnosed in up to 22% of imprisoned women, with the highest rates in the U.S., Spain and Brazil, according to 23 studies included in the review. In 20 of these studies, imprisoned women had double the rate of lesions compared with women in their own countries.

Invasive cervical cancer was assessed in seven studies, with prevalence among imprisoned women ranging from 0.1% to 1.2% in the U.S., UK and Canada. This is 100 times the rate of women in the general population, the authors note. Screening programs in England, for instance, report a 0.001% prevalence and worldwide estimates are around 0.016%.

The data also highlight worldwide health inequities, the study team writes. Most studies came from high-income countries with the smallest burden of cervical cancer, yet the ranges were still significant. Research in Africa and Southeast Asia would show even higher rates, they note.

“What surprised me the most was the lack of information about women’s health in prisons worldwide, specifically in low- and middle-income countries,” Escobar Salinas said. “We didn’t limit the search by region or continent, and after a wide search, we realized most of the available studies that came up were from high-income countries.”

Nonetheless, cervical cancer is currently preventable, the authors write, and cervical lesions usually show up years before invasive cancer occurs, so a screening program could help with early detection.

“These women who are incarcerated tend to have more health problems but less access to healthcare in the community,” said Kate Dolan of the University of New South Wales in Sydney, Australia, who wasn’t involved in the study.

The United Nations and World Health Organization say healthcare should be the same for prisoners as for the surrounding community, Dolan added.

“It is the poor and vulnerable who go to prison,” she said by email. “Prison provides a brief time when preventive healthcare can be undertaken.”

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