Colorectal and breast cancer screening status for people in Ontario provincial correctional facilities

Introduction — Primary care represents an opportunity to improve health for people who experience imprisonment, and screening for colorectal and breast cancer indicate primary care quality. The study objectives were to examine the proportion of people released from provincial correctional facilities who were overdue for colorectal or breast cancer screening on admission to the correctional facility and who were still overdue after 3 years, and to compare findings with data for the general population.

Methods — Administrative data were used to identify people eligible for colorectal and breast cancer screening who were released from provincial correctional facilities in 2010 (N=3,803 and N=249, respectively) and in the general population (N=2,757,584 and N=1,099,942, respectively) in Ontario, Canada. Chi-square tests and log binomial regression models were used to compare the proportion of individuals overdue for screening on admission or on July 1, 2010 for the general population, and still overdue after 3 years. Analyses were conducted in 2017 and 2018.

Results — Compared with the general population, people in the corrections group were 1.53 times (95% CI=1.50, 1.55) more likely to be overdue for colorectal cancer screening: 77.1% (95% CI=74.3, 79.9) vs 50.5% (95% CI=50.5, 50.6), and 2.25 times (95% CI=2.06, 2.46) more likely to be overdue for breast cancer screening: 65.9% (95% CI=56.2, 76.8) vs 29.3% (95% CI=29.2, 29.4, both p<0.001). They were also more likely to still be overdue 3 years later: 62.6% (95% CI=60.1, 65.2) vs 33.6% (95% CI=33.5, 33.6) for colorectal cancer and 52.2% (95% CI=43.6, 62.0) vs 20.2% (95% CI=20.1, 20.3) for breast cancer (both p<0.001).

Conclusions — People who experience imprisonment are less likely than the general population to access colorectal and breast cancer screening. This suggests the need to strengthen primary care for this population. Specifically, efforts should be made to improve access to colorectal and breast cancer screening, through health promotion, program delivery, and linkage to community services while in correctional facilities.