Cancer screening among jail inmates

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Many cancer victims can significantly improve the prognosis of the diagnosis with early detection and treatment. Two cancer types that have had improvement in survival rates due to disease screening are breast cancer and cervical cancer. Screening test for breast cancer include breast self-examination (BSE), clinical breast examination (CBE) and mammography. The screening test for cervical cancer is the Papanicolaou (Pap) test. The National Cancer Institute (NCI) released a series of statements of benefit and harm for the above screening tests based on research. In the case of BSE, the NCI asserts that it does not reduce breast cancer mortality and formal instruction and encouragement to perform leads to more breast biopsies and to the diagnosis of more benign breast lesions. In the case of CBE, screening reduces breast cancer mortality. For Mammography performed in women aged 40 to 70 years, breast cancer mortality decreases. The benefit is higher for older women, in part because their breast cancer risk is higher. With the Pap test, regular screening of appropriate women reduces mortality from cervical cancer. In any screening examination, false-positives result in further testing which can carry inherent risks and false negatives may provide false reassurances resulting in a delay in cancer diagnosis. A study conducted at the University of San Francisco reviewed cancer screening of these conditions among jail inmates. The study reviewed the sociodemographic profile of incarcerated persons and suggested they might be at higher risk for the development of certain cancers and for poor outcomes from those cancers. One item the study sought to examine was whether these inmates had received age-appropriate screening. Findings revealed no significant difference in cervical cancer screening between these inmates and other non-incarcerated individuals, however, the women who reported having a Pap test while in jail or prison were significantly more likely to be up to date on cervical cancer screening than women who had never had a Pap test while incarcerated. This suggests that correctional systems may be a principal provider of this preventive test for many female inmates. The researchers report that study results in regards to breast cancer screening was limited by a small number of women in older age groups. Their limited findings suggest, however, that women in the study group were less likely to be up to date on mammography than California women. They also reported that knowledge about breast cancer screening could be improved as most women eligible for screening identified breast examinations rather than mammography as a mean of screening, despite the fact that the CBE and BSE are of less certain benefit than mammography. There is no national registry for tracking disease prevalence and risk factors among incarcerated persons and they are excluded from national health surveys. The results of the cited study were from data obtained by self-report, which are likely to overestimate frequency. A cancer screening registry or statewide computerized medical records in jails would give more significance to this data and may show or confirm that the jail may be an appropriate setting for this type of cancer screening.

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