1. Prison Abnormalities Dr J H F Smith Royal Hallamshire Hospital, Sheffield East Pennine Cytology Training Centre NEYH Cervical Screening Symposium 2013

2. Rise in number of women in prison versus prisoners as a whole

3. Women entering prison under sentence, length of sentence, 2010

4. Women in prison Number of women in prison trebled in the past 20 years Currently about 4000 female prisoners in England and Wales Shift away from non-custodial penalties to short prison sentences Most convictions for acquisitive crime such as theft

5. Women in prison 13 women's prisons in England; one in Scotland Wide mix of prisoners Female offenders often held further away from their families that men

6. Women in prison At least one third of women prisoners are lone parents Multiple health and social needs 25% have spent time in local authority care as a child 50% have suffered domestic violence 33% have experienced sexual abuse

7. Women in prison High-risk of self harm and suicide –80% of women in prison have a mental disorder –33% attempted suicide before imprisonment –16% self harm whilst in prison Poor self-reported health –Below average contact with community health services before imprisonment –Long-standing drug and alcohol problems –High incidence of HIV, Hep C and STD

8. Management of female prisoners with abnormal cervical cytology Smear result (%) HMP Holloway Local general practice Normal86.793.8 Mild dyskaryosis 8.04.4 Moderate dyskaryosis 3.10.9 Severe dyskaryosis 1.80.8 ? Invasive squamous ca 0.40.1 ? Glandular neoplasia 0.040.1 Downey et al BMJ 1994; 308: 1412 Prevalence of CIN 2+ in the prison population 53.1/1000 versus 18.5/1000 in general practice Prison population significantly younger (median 27 (range 17-58) years) than the general practice population (median 33.5 (range 17-58) years)

9. British Columbia Women prisoners 11 times more likely to have high grade smear abnormality compared with age-match general population 47% women prisoners had received at least one smear in the past three years compared with 87% of the general population Only half of women participating in a prison screening intervention programme were rescreened in the subsequent three years Martin. Can J Pub Health 1998; 89: 382

11. Prisons in NEYH HMP New Hall HMP Low Newton –Closed prison. Category A("escape would be highly dangerous"), Restricted Status ("escape would present a serious risk") and Closed Conditions ("too high a risk for open conditions") prisoners. Adults and young offenders. HMP Askham Grange –Open prison. Open Conditions (”prisoners who can reasonably be trusted in open conditions). Adults and young offenders

12. Screening in Prisons in NEYH HMP Low Newton –Reception screening where NHS number smart code obtained and GP summary requested –Date of last smear test? If not known obtained from Durham Screening Office but Open Exeter restricted to the Durham area –Visiting colposcopy and GUM service –Hospital appointments limited to one per half day

13. Screening in Prisons in NEYH HMP Askham Grange –Reception screening where NHS number and smart code obtained and GP summary requested –Date of last smear test? No access to Open Exeter –Often have prison service health record –Prisoners can attend hospital appointments unescorted

14. Laboratory and prison cervical sample abnormal rates by year Prison/Laboratory 2010/112011/12 HMP New Hall 13.8%14.9% Mid Yorkshire Hospitals NHS Trust 6.9%6.4% HMP Low Newton 18.2%19.1% University Hospital of North Durham 9.0%9.3% HMP Askham Grange 7.8%5.7% York Teaching Hospital NHS Foundation Trust 5.4%5.5%

15. Breakdown of cervical sample results by prison 2011/12 Result HMP New Hall HMP Low Newton HMP Askham Grange Inadequate0.6%0.0%1.9% Negative84.5%80.9%92.5% Low grade 9.9%12.1%3.8% High grade 5.0%7.0%1.9%

16. % Age Distribution of Prison Populations

17. Future action I To review cervical screening practice at HMP New Hall Further analysis of abnormal rates, compare data from open and closed prisons including HMP Styal To compare abnormality rates with breast and bowel screening

18. Future action II To explore failsafe if prisons don’t have access to Open Exeter To explore whether there is a link between high abnormal rates and other sexual health issues. To identify whether the prisons have data on DNA rates and the reasons

19. Any Questions?

20. Overall Winner 2010 Achieving Excellence in Learning, Teaching & Development Contact Us: Training Centre ManagerAdministration Team Nick Dudding Kathryn Hawke & Chloe Avery (44) 114 2712538(44) 113 2466330 nick.dudding@sth.nhs.ukkathryn.hawke@nhs.net nick.dudding@sth.nhs.ukkathryn.hawke@nhs.net chloe.avery@nhs.net www.cytologytraining.co.uk East Pennine Cytology Training Centre