Cancer in an incarcerated population

Abstract

The challenge posed to prison health systems in the U.S. by an immense incarcerated population is significant. However, the patterns of presentation and associated mortality of cancer among the incarcerated population is unknown. An historical cohort of cancers diagnosed among inmates of the Texas Department of Criminal Justice over the course of 20 years who were followed at the University of Texas Medical Branch in Galveston, Texas was identified. There were 1807 inmates who were diagnosed with cancer. Two cohorts were chosen for comparison: a random sample of 179,757 patients from the Surveillance, Epidemiology, and End Results (SEER) registry, and an age-matched, gender-matched, race-matched SEER population comprised of 6124 patients (MSEER). Disease sites and associated mortality of the inmate cancer patients were determined and compared with SEER cohorts. A marked rise in cancer diagnoses among inmates paralleled the rise in the inmate population. The leading cancers were lung carcinoma, non-Hodgkin lymphoma (NHL), and carcinomas of the oral cavity and pharynx. Among women, cervical carcinoma was the most common. Lung carcinoma, NHL, and hepatic carcinoma accounted for more cancer deaths among inmates than in the SEER cohort (P < 0.0001 for all comparisons). Lung carcinoma, hepatic carcinoma, and NHL were significantly more common in the inmate cohort than in the MSEER cohort (P < 0.001 for all comparisons). The median survival was inferior in the inmate cohort (21 mos) compared with the SEER cohort (55 mos) and the MSEER cohort (54 mos) (P < 0.0001 for both comparisons). Cancers with unique epidemiology and high associated mortality have emerged among the incarcerated. This has significant implications for prison health systems.