Their socioeconomic and health profile make caring for women in prison more resource intensive than caring for men as identified in an earlier post. In addition to their background, women also have gender-specific health conditions that require additional attention. One such category of medical need is reproductive cancers. Incarceration is both an opportunity to screen for these high risk conditions and an opportunity to education women about their signs and symptoms. Consider ways to incorporate cancer screening and health education into regular patient encounters such as sick call and chronic care clinic visits. Include questions about cancer screening practices during the initial and annual physical assessment process.
Recommendations for breast cancer screening and self-evaluations have changed over the years. The following guidelines are from the American College of Obstetricians and Gynecologists (ACOG):
- Women aged 40 years and older should be offered screening mammography annually
- Clinical breast examination should be performed annually for women aged 40 years and older
- For women aged 20–39 years, clinical breast examinations are recommended every 1–3 years
- Breast self-awareness should be encouraged and can include breast self-examination. Women should report any changes in their breasts to their health care providers.
The National Library of Medicine has help for teaching breast self-examination. This patient information that can be printed for use with patients.
Cervical cancer screening recommendations have changed, as well. In the past, Pap smears were an annual event but new research has led to an age-guided determination of cervical cancer screening timing. The CDC has available a table comparing American Cancer Society (ACS), American College of Obstetricians and Gynecologists (ACOG) and the US Prevention Service Taskforce recommendations. Here are some commonly held standards:
- Cervical cancer screening begins at age 21
- Screening should be every 3 years for women age 21-65
- Unless there is a history of cervical cancer, screening can stop at age 65
- Women who have had a hysterectomy do not need screened unless the cervix remains
- These guidelines also include women who have been immunized against HPV
Be reminded that a Pap test only screens for cervical cancer so patients need to know that ovarian, uterine, vaginal and vulvar cancers are not covered with this screen. The CDC has a handy guide to reproductive cancer symptoms that might be helpful for use with patient education efforts.
Our patient population needs gentle encouragement to submit to a pelvic exam and cervical cancer screening. Significant history of emotional and physical abuse can make this experience traumatizing. A pelvic exam is frequently refused in the correctional setting.
Ovarian cancer is difficult to detect early and therefore remains a top cause of mortality among reproductive cancers. Patient education regarding ovarian cancer should include the four early warning signs of ovarian cancer:
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Sudden urge to urinate or frequent urination
Reproductive cancers like breast, cervical, and ovarian cancer are a concern for female patients. Our patient population often lacks prior healthcare management and self-care skills. Incarceration is an opportunity to improve the health of our women patients and the public health of our country.
How do you screen for and teach about reproductive cancers in your setting? Share your thoughts in the comments section of this post.
To read more about the unique aspects of women’s health care in the correctional setting see Chapter 9 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.
Photo Credit: Sebastian Kaulitzki