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Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysis
  1. Nadia Escobar1,
  2. Emma Plugge2
  1. 1 Department of Transmissible Diseases, Ministry of Health, Santiago, Chile
  2. 2 Health and Justice, Public Health England, Reading, UK
  1. Correspondence to Dr Nadia Escobar, Ministry of Health, Santiago 8320070, Chile; nadia.escobar{at}


Background and objectives Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population.

Methods We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group.

Findings A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes.

Conclusion Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended.

PROSPERO registration number CRD42014009690.

  • cancer: cervix
  • cancer epidemiology
  • health inequalities
  • public health
  • prevention

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  • Contributors NE and EP conceived of the study. NE undertook the search. Both authors read all papers and extracted data and quality assessed included studies. Both undertook meta-analyses. NE wrote the first draft and both authors have revised it subsequently.

  • Funding This work was undertaken when NE was an MSc student at the University of Oxford. EP was employed by the University of Oxford at that time.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.