The status of cervical screening and breast cancer healthcare services among incarcerated women in Westville Correctional Facility KZN, South Africa

Abstract

Background: Incarcerated women represent a vulnerable population with severe health problems, including a heightened risk of cervical and breast cancer. The provision of comprehensive healthcare, including cancer prevention services, within prisons is a critical yet often neglected issue. Aim: This study investigated the status of cervical screening and breast cancer healthcare services among incarcerated women at Westville Correctional Facility in KwaZulu-Natal, South Africa. Methods: A mixed-methods approach was utilised, including a cross-sectional survey of 145 incarcerated women, a retrospective review of 1,639 Pap smear results from Westville Correctional Facility laboratory records (2013–2022) and in-depth interviews with healthcare workers (HCWs). Data analysis included descriptive statistics, chi square tests, and thematic analysis. Results: Retrospective data had a high HIV prevalence (54%). Despite this risk, cervical screening was low, with only 21.4% of women receiving a Pap smear during incarceration and 43.4% with no screening history. Breast cancer screening was virtually non-existent (1.4%). Knowledge regarding both cancers was low, with most of the incarcerated women unaware of risk factors, symptoms, and screening methods. Retrospective data revealed an erratic, campaign-based screening pattern, with a screening rate of less than 5% per year. Critically, 23.3% of women with a clinically healthy cervix had a cytological abnormality. A significant association between a healthy cervix and antiretroviral (ARV) treatment (X² (8) =61.907, p<0.001) was found. Findings from HCWs contextualised these results, revealing severe structural barriers including skeletal staffing, outdated equipment, and a protracted referral process that forces a reactive, crisis-driven care model. Furthermore, HCWs reported internalised stigma among offenders, something which actively suppresses health-seeking behaviour. Conclusion: An implementation gap exists in cancer prevention services, driven by non-systematic screening, critical health literacy deficits, and a carceral environment that erodes patient agency. The rate of occult cytological abnormalities underscores the inadequacy of visual inspection.