'Orange is the new Blue': the start of organised colorectal cancer screening in a Milan penitentiary

Abstract

Abstract Issue According to the United Nations basic principles for the treatment of prisoners, they “shall have access to the health services available in the country without discrimination on the grounds of their legal situation”. In Italy this principle is executed by national legislation allocating responsibility for inmates' health directly to the National Health Service. In the Metropolitan City of Milan this duty is fulfilled by the Agency for Health Protection (ATS) that guarantees medical assistance in its penitentiaries. Description of the problem In Italy, cancer screening activities are considered essential levels of assistance i.e. guaranteed to all citizens. In fact, organised colorectal cancer (CRC) screening is offered by ATS, free of charge, to males and females, aged 50 to 74, in the form of a fecal immunochemical test every 2 years. Unfortunately, CRC screening uptake remains low among fragile patients, such as jail inmates, who are hard-to-reach by standard organised screening efforts. In 2019 the ATS Preventive Medicine Screening Unit began a small pilot organised CRC screening program, specific for inmates, starting in one of the city's main penitentiaries: Casa di Reclusione Milano Bollate, comprising 1200 inmates, and recently appointed nationwide referral center for elderly inmates. Results Inmates represent a large scarcely screened population that, following implementation of an organised tailored CRC screening program, showed high willingness to participate. Organised cancer screening programs may thus be necessary to guarantee maximum uptake among prisoners. Lessons Tailoring the organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service, and hopefully others in the future. Key messages Tailoring an organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service Organised screening programs could achieve extensive coverage and enhance equity of access in this hard-to-reach fragile population.