Two recently published studies underscore the importance of cancer screening among incarcerated populations.
In one study, higher county-level jail and state-level prison incarceration rates in the United States were associated with higher county- and state-level cancer mortality rates, especially for liver and lung cancers.1
Jingxuan Zhao, MPH
Jingxuan Zhao, MPH, a senior scientist in health services research at the American Cancer Society (ACS) and other researchers on the study analyzed incarceration data from 1995 to 2018 sourced from national jail and prison data at the county and state levels, respectively, and categorized them into quartiles. County- and state-level mortality rates with invasive cancer as the underlying cause of death were obtained from the National Vital Statistics System, and the findings were published in the Journal of the National Cancer Institute.1
Analyses of 50 states, 3062 US counties, and Washington, DC, revealed that higher county-level jail incarceration rates were associated with higher cancer mortality rates—compared with the lowest incarceration rates. Compared with quartile 1 (Q1, which had the lowest incarceration rate), Q2, Q3, and Q4 (which had the highest incarceration rate) had 1.3%, 2.3%, and 3.9% higher cancer mortality rates, respectively. Similarly, the researchers concluded that higher state-level prison incarceration rates were associated with higher cancer mortality rates. The magnitude of the associations of county-level jail and state-level prison incarceration and cancer mortality were similar for people identified as White or Black, as well as men and women.
“Our findings from this study suggest that programs to address adverse health effects of mass incarceration are warranted, particularly for populations that suffer from inequities in cancer care and outcomes and are disproportionately incarcerated in the United States,” Zhao said in a press release.2 “Populations in areas with high incarceration rates may have limited access to cancer prevention, early detection, and treatment. Furthermore, incarceration may disrupt local economies and labor markets and increase strain on social service systems. Multilevel efforts to address these challenges may help decrease cancer disparities at the community level.”
In another study led by Zhao and presented at the 2024 American Society of Clinical Oncology (ASCO) Quality Care Symposium in San Francisco, researchers identified individuals aged ≥50 years currently living with a partner who responded to the 2014-2020 Health and Retirement Study and examined their access to cancer screening.2
The researchers defined incarceration history by answers to the question: “Have you ever been an inmate in a jail, prison, juvenile detention center, or other correctional facility?” People were categorized into 3 groups: (1) without individual or partner incarceration history, (2) with individual incarceration history only, and (3) with partner incarceration history only. People with both individual and partner incarceration history were excluded due to a small sample size. Researchers used multivariate logistic regression models to compare receipt of any breast, cervical, and colorectal cancer screenings ≤2 years among screening-eligible people with individual or partner incarceration history with people who did not have an incarceration history, stratifying by sex and controlling for key sociodemographic characteristics.
Results of the study showed that “0.9% and 11.8% of females and males reported individual incarceration history, respectively; 11.1% and 1.0% reported partner incarceration history, respectively. Compared to females without individual or partner incarceration history, women with partner incarceration history were less likely to receive breast cancer screening (prevalence ratio (PR): 0.7, 95% CI: .5-.9); women with individual incarceration history were less likely to receive colorectal cancer screening (PR: 0.7, 95% CI: .5-.9). Compared to males without individual or partner incarceration history, men with partner incarceration history were less likely to receive colorectal cancer screening (PR: 0.5, 95% CI: .4-.7).”3
Researchers emphasized programs to improve access to care and cancer screening among people with incarceration history and their partners are warranted.
“Having comprehensive health insurance is a critical factor for survivorship against cancer,” said Lisa A. Lacasse, president of ACS CAN, in a press release.2 “Medicaid is an important source of health insurance for people who would not otherwise have access to care, including those who are transitioning back to their communities following incarceration. We urge lawmakers in the 10 states that have not expanded Medicaid to do so to improve health outcomes and reduce the burden of cancer.”
References
- Zhao J, Kajeepeta S, Manz CR, et al. County-level jail and state-level prison incarceration and cancer mortality in the United States. J Natl Cancer Inst. Published online September 17, 2024. https://doi.org/10.1093/jnci/djae189
- American Cancer Society. New study finds higher county-level jail and state-level prison incarceration rates associated with higher county- and state-level cancer mortality rates. Published September 17, 2024. Accessed October 17, 2024. https://pressroom.cancer.org/study-incarceration-rates-cancer
- Zhao J, Han X, Nogueira LM, et al. Associations of individual and partner incarceration history and receipt of cancer screening in the US. JCO Oncol Pract. 2024;20(suppl 10):Abstract 50. https://doi.org/10.1200/OP.2024.20.10_suppl.50