Cervical cancer screening program based on HPV testing and conventional Papanicolaou cytology for jail inmates


Background: To assess the validity of Human Papillomavirus (HPV) testing in a group of women at high risk for developing cervical cancer, a screening intervention was applied to a population of jail inmates in Rome, Italy. This cross-sectional study provided also new insights on the risk factors and on the HPV genotype distribution. Methods: We have invited 350 inmates to the preliminary stage of the screening program and 98 inmates decided to participate to the study and filled out a questionnaire for the history of attendance to previous cervical screening and for the known risk factors for cervical malignancies. HPV DNA test, conventional Pap smear and HPV genotyping were performed. Results: The percentage of women with High Risk (HR) HPV positivity were 19.3%. The inmates with LSIL/ HSIL status showed a significantly higher pre- valence of HR-HPV positivity (100% vs. 16.3%; p < 0.001) and of multiple HPV types (60% vs. 1.2%; p < 0.001) compared to women with normal/ASCUS Pap smear. HPV16 was the predominant genotype in either single or multiple infections. Conclusions: The results indicated that HPV DNA-based approach is a strategy useful for incarcerated women which do not have the opportunity or the social and cultural environment to receive preventive care.

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Fabiano, V. , Mariani, L. , Giovagnoli, M. , Raffa, S. , Vincenzoni, C. , Michetti, F. , Bevere, F. and French, D. (2010) Cervical cancer screening program based on HPV testing and conventional Papanicolaou cytology for jail inmates. Health, 2, 1027-1032. doi: 10.4236/health.2010.29151.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Proca, D.M., Rofagha, S. and Keyhani-Rofagha, S. (2006) High grade squamous intraepithelial lesion in inmates from Ohio: Cervical screening and biopsy follow-up. CytoJournal, 3(10), 15.
[2] Binswanger, I.A., White, M.C., Pérez-Stable, E.J., Goldenson, J. and Tulsky, J.P. (2005) Cancer screening among jail inmates: Frequency, knowledge and willingness. American Journal of Public Health, 95(10), 1781-1787.
[3] Magee, C.G., Hult, J.R., Turalba, R. and McMillan, S. (2005) Preventive care for women in prison: A qualitative community health assessment of the Papanicolaou test and follow-up treatment at a California state women’s prison. American Journal of Public Health, 95(10), 1712- 1717.
[4] Martin, R.E., Hislop, T.G., Moravan, V., Grams, G.D. and Calam, B. (2008) Three-year follow-up study of women who participated in a cervical cancer screening intervention while in prison. Canadian Journal of Public Health, 99(44), 262-266.
[5] Martin, R.E., Hislop, T.G., Grams, G., Calam, E., Jones, E. and Moravan, V. (2004) Evaluation of a cervical cancer screening intervention for prison inmates. Canadian Journal of Public Health, 95(4), 285-289.
[6] Benard, V.B., Johnson, C.J., Thompson, T.D., et al. (2008) Examining the association between socioeconomic status and potential human human papillomavirus associated cancer. Cancer, 113(Suppl. 10), 2910-2918.
[7] Appleby, P., Beral, V., Berrington de González, A., et al. (2007) Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet, 370(9599), 1609-1621.
[8] Burd, E.M. (2003) Human papillomavirus and cervical cancer. Clinical Microbiology Reviews, 16(1), 1-17.
[9] Kapeu, A.S., Luostarinen, T., Jellum, E., et al. (2008) Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within nordic biobanks. American Journal of Epidemiology, 169(4), 480- 488.
[10] Winer, R.L., Hughes, J.P., Feng, Q., O’Reilly, et al. (2006) Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25), 2645-2654.
[11] Kiaer, S.K., Breugelmans, G., Munk, C., Junge, J., Watson, M. and Iftner, T. (2008) Population-based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark. International Journal of Cancer, 123 (8), 1864-1870.
[12] Ronco, G., Giorgi-Rossi, P., Carozzi, F., et al. (2008) Results at recruitment from a randomized controlled trial comparing human papillomavirus testing alone with conventional cytology as the primary cervical cancer screening test. Journal of the National Cancer Institute, 100(7), 492-501.
[13] Hibbitts, S., Jones, J., Powell, N., Dallimore, N., et al. (2008) Human papillomavirus prevalence in women attending routine cervical screening in South Wales, UK: A cross-sectional study. British Journal of Cancer, 99(11), 1929-1933.
[14] Burchell, A.N., Winer, R.L., de Sanjosè, S., Franco, E.L. (2006) Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine, 24(S3), 52-61.
[15] Ronco, G., Giorgi-Rossi, P., Carozzi, F., et al. (2010) New Technologies for Cervical Cancer screening (NTCC) Working Group. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: A randomised controlled trial. Lancet Oncology, 11(3), 249-257.
[16] Cuzick, J., Clavel, C., Petry, K.U., et al. (2006) Overview od European and North American studies on HPV testing in primary cervical cancer screening. International Journal of Cancer, 119(5), 1095-1101.
[17] Smith, J.S., Lindsay, L., Hoots, B., et al. (2007) Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. International Journal of Cancer, 121(3), 621- 632.
[18] Woodman, C.B.J., Collins, S., Rollason, T.P., et al. (2003) Human papillomavirus type 18 and rapidly progressing cervical intraepithelial neoplasia. Lancet, 361(9351), 40- 43.
[19] Bosch, F.X., Burchell, A.N., Schiffman, M., et al. (2008) Epidemiology and natural history of human papilloma- virus infections and type-specific implications in cervical neoplasia. Vaccine, 26(S10), K1-K16.
[20] Zhao, C. and Austin, R.M. (2009) High-risk human papi- llomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results. Journal of Lower Genital Tract Disease, 13(2), 79-84.
[21] Mendez, F., Munoz, N., Posso, H., et al. (2005) Cervical coinfection with human papillomavirus types and possible implicaqtions for the prevention of cervical cancer by HPV vaccines. Journal of Infectious Diseases, 192(7), 1158-1165.
[22] Clifford, G.M., Gallus, S., Herrero, R., et al. (2005) Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: A pooled analysis. Lancet, 366(9490), 991-998.
[23] Clifford, G.M., Rana, R.K., Franceschi, S., Smith, J.S., Gough, G. and Pimenta, J.M. (2005) Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer. Cancer Epidemiology Biomarkers & Prevention, 14(5), 1157-1164.
[24] Prandi, S., Beccati, D., de Aloysio, G, et al. (2006) Applicability of the Bethesda system 2001 to a public health setting. Cancer, 108(5), 271-276.
[25] Paavonen, J., Naud, P., Salmerón, J., et al. (2009) Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): Final analysis of a double-blind, randomised study in young women. Lancet, 274(9686), 301-314.

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