The effect of a cervical testing campaign on incarcerated females- a repeated cross-sectional study in Norwegian prisons.

BACKGROUND

Incarcerated women face significantly elevated cervical cancer risks compared to the general population due to higher human papillomavirus (HPV) prevalence, limited healthcare access, and socio-demographic vulnerabilities. Despite elevated risk, female inmates are substantially less likely to receive cervical screening. No studies examining cervical screening among incarcerated populations in Nordic countries have been identified.

OBJECTIVE

To examine risk factors for cervical abnormalities, screening experiences, HPV vaccination status, barriers to screening participation, and symptoms among incarcerated women in Norway before and after a cervical screening campaign.

METHODS

A repeated cross-sectional study was conducted in all three Norwegian prisons with women's wards using a researcher-developed questionnaire. Data were collected at baseline (January/February 2025, n = 77) and post-campaign (May/June 2025, n = 97). The campaign included informational materials, prison visits, and educational sessions. The questionnaire assessed demographics, risk factors, screening history, vaccination status, participation barriers, and symptoms. Data were analyzed using descriptive statistics and chi-square tests.

RESULTS

Most respondents were aged 25-44 years, serving sentences under six months. High prevalence of risk factors was observed: tobacco/snus use (61.0%/53.9% at baseline) and multiple sexual partners (38.2% reported ≥ 5 partners). While 68.8% had prior cervical screening, only 19.6% received screening during incarceration. HPV vaccination rates were low (16.9%). Primary barriers included insufficient information (22.7% baseline, 33.8% post-campaign), fear of pain, previous trauma, and healthcare mistrust. Approximately one-third reported symptoms potentially indicating cervical abnormalities, most commonly persistent lower back pain (52% baseline, 65.6% post-campaign) and pelvic pain (36% baseline, 40.6% post-campaign). No statistically significant differences were observed between baseline and post-campaign responses.

CONCLUSIONS

Incarcerated Norwegian women exhibit multiple cervical cancer risk factors yet face substantial screening barriers during imprisonment. The campaign demonstrated limited impact on screening uptake, suggesting comprehensive sustained interventions are needed. Future strategies should address structural barriers, ensure adequate follow-up care, and explore self-sampling approaches to reduce health disparities in this vulnerable population.