Study raises questions about cancer screening in prisons
People incarcerated in Connecticut prisons are likely being under-screened and under-diagnosed for cancer, according to a new study from the Yale School of Medicine.
“Our main finding was that we saw a lower rate and lower proportion of early stage screen-detectable cancers like breast cancer, colorectal cancer, and prostate cancer among people who are incarcerated compared to the community,” said Dr. Ilana Richman, lead author and assistant professor at the Yale School of Medicine.
The study’s initial objective was to fill data gaps. Large national surveys that track cancer screening – data used by the Centers for Disease Control and Prevention to track screening rates – typically exclude the incarcerated population.
“It's a little bit of a black box,” Richman said. “So what we did is rather than look at cancer screening directly, we looked at patterns of cancer diagnosis. The idea was that when cancer screening is used successfully, it tends to diagnose cancers at an earlier stage rather than a later stage. That's how cancer screening works. And so we can compare the stage at diagnosis in two populations – people who are incarcerated compared to people in the community and ask, when was the cancer diagnosed? Was it diagnosed at an earlier stage or a later stage? And that gives us some insight into whether cancer screening may have been used at similar rates in the two populations.”
The researchers also saw a trend toward diagnosis of late-stage cancers in the post-incarceration period. Richman said the pattern suggested both less screening and detection of cancers during incarceration and a shift toward diagnosis once people are released from incarceration.
“One possible explanation is that those cancers are not being diagnosed during incarceration either because people don't report their symptoms or they do report them and they're not being diagnosed immediately,” she said. “But once people emerge from incarceration, those symptoms are investigated and lead to a cancer diagnosis.”
To formerly incarcerated people like Ray Boyd of New Haven, the findings come as no surprise.
“We all struggled to get medical attention [in prison],” he said. ”It’s not something the system cares about.”
Boyd said he was incarcerated for 10,810 days — he prefers referring to the time he served in days — and said he struggled to get care for an autoimmune disorder that he said he developed in prison, following a viral infection.
“It’s not easy to see the doctor,” Boyd said. People in prison first have to go through a correctional officer and a nurse. If they are deemed ill enough to be seen by a doctor, they have a co-pay of $3. “We made 75 cents a day and a lien will be put on your account [if you don’t have $3]; so some just don’t go see the doctor,” he said.
Responding to the findings
Richman said more barriers exist in delivering health care in correctional settings.
“You think about trying to do a colonoscopy on somebody who's incarcerated, it's really difficult,” she said. “Imagine doing the prep, drinking the solution to clean out the bowels, and then being transported to a facility to do it, every single one of those steps is really difficult.”
Now that the data is out, researchers plan to talk to incarcerated people to learn more about barriers to care in prison, she said. Boyd is part of a Yale pilot program offering cash assistance to formerly incarcerated people. Next, researchers hope to partner with the Department of Correction’s health care teams to implement wider cancer screening in state prisons.
The Connecticut Department of Correction did not immediately respond to Connecticut Public’s request for a comment.
The latest study builds upon research by Yale’s Dr. Lisa Puglisi, Dr. Emily Wang and Dr. Cary Gross, who in 2019found that people who had been incarcerated were far more likely to be diagnosed with certain cancers, including lung and cervical cancers.
In 2022, research from the Yale Cancer Center revealed a higher risk of cancer mortality in incarcerated and recently released adults.
In the new study, researchers saw lower rates of early stage cancers in incarcerated people similar to those with Medicaid or without insurance.
“It suggests that there are some common barriers to accessing screening among people who have Medicaid or who are uninsured, and people who are incarcerated,” Richman said.
Another way to put it, she said, is that some of the social determinants of health, like poverty, affect all three groups in similar ways.