In a study reported in The Lancet Oncology, Lüchtenborg et al found that the incidence of cancer increased in the prison population in England between 1998 and 2017; those with cancer were less likely to receive curative treatment and had poorer overall survival vs patients with cancer in the general English population.
Study Details
The population-based, matched cohort study used data from the National Cancer Registration and Analysis Service in England to identify primary invasive cancers diagnosed in adults in the prison and general populations over a 20-year period from January 1998 to December 2017. Prison patients were matched 1:5 with general population patients for 5-year age group, gender, diagnosis year, cancer site, and disease stage.
Key Findings
A total of 2,015 incident cancers among 1,964 adults (1,556 men and 459 women) in English prisons were identified during the 20-year period through the end of December 2017. The age-standardized incidence rate for cancer among men in prison was initially lower vs men in the general population but increased to a similar level by the end of the study period. In 1998, age-standardized incidence rates were 119.33 vs 746.97 per 100,000 person-years; in 2017, they were 856.85 vs 788.59 per 100,000 person-years. Age-standardized incidence rate was not calculated for women in prison, who had a low incidence rate of invasive cancers.
Over the 20-year study period, the incidence of invasive cancer among men in prison increased, with an incidence rate ratio per year of 1.05 (95% confidence interval [CI] = 1.04–1.06). The age-standardized incidence rate ratio (ASIRR) for the 20-year period was significantly lower in men in prison vs men in the general population (ASIRR = 0.76, 95% CI = 0.73–0.80) and nonsignificantly lower in women in prison vs women in the general population (ASIRR = 0.83, 95% CI = 0.68–1.00).
Among all patients with cancer, for the period of January 2012 through December 2017, curative treatment was received by 274 (32.3%) of 847 prison patients vs 1,728 (41.5%) of 4,165 general population patients (adjusted odds ratio [OR] = 0.72, 95% CI = 0.60–0.85).
For the period of January 2012 through December 2017, cancer diagnosis in prison was associated with poorer overall survival; there were 347 deaths during 2,021.9 person-years in the prison cohort vs 1,626 deaths during 10,944.2 person-years in the general population (adjusted hazard ratio = 1.16, 95% CI = 1.03–1.30). The overall survival outcome was in part explained by the difference in receipt of curative treatment and adjustment for medical route of diagnosis.
The investigators concluded, “Cancer incidence increased in people in prisons in England between 1998 and 2017, with patients in prison [being] less likely to receive curative treatments and having lower overall survival than the general population. The association with survival was partly explained by accounting for differences in receipt of curative treatment and adjustment for diagnosis route. Improved routine cancer surveillance is needed to inform prison cancer policies and decrease inequalities for this under-researched population.”
Elizabeth A. Davies, PhD, of the Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King’s College London, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the UK National Institute for Health and Care Research and others. For full disclosures of the study authors, visit thelancet.com.
