Cancer Screening and Diagnosis in Correctional Settings (2026)

Cancer in correctional facilities

Although cancer deaths are rare in jail, where the average length of incarceration is short, cancer is a leading cause of death in prison and is rising as prison populations age.^3,4 Compared with individuals who have never been incarcerated at the time of cancer diagnosis, individuals who are diagnosed with cancer in jail or prison are much more likely to die from their cancer.^5,6 Although this is attributable to many factors, one contributor to higher cancer mortality is later stage of diagnosis.^7-9

Cancer screening

Six cancers – breast, cervical, colorectal, liver, lung, and prostate – have screening tests to enable early detection of cancer. These screenable cancers account for approximately 50% of all cancers diagnosed in prison.⁸ Notably, although evidence for increased risk of cancer among incarcerated compared with nonincarcerated individuals is mixed, elevated risks of developing cervical, liver, and lung cancers are well documented, likely related to high prevalence of risk factors such as HPV infection, smoking history, alcohol use, and viral hepatitis,^5,8 and, in the case of cervical cancer, low rates of screening and treatment for premalignant lesions. Cancer screening enables early detection of cancers, which leads to earlier stage at diagnosis, increased likelihood of cure, and improved cancer survival. Some cancer screening interventions (e.g., colonoscopy, Pap smears) can also prevent the subsequent development of cancer by identifying and removing precancerous precursors. Additionally, because early-stage cancer costs less to treat than late-stage cancer, increased screening is associated with lower health care spending.^10,11 Thus, cancer screening can lead to better patient outcomes with lower overall spending.

As of publication of this statement, USPSTF guidelines recommend screening for breast, cervical, colorectal, and lung cancer for all individuals within specified age ranges (in the case of lung cancer, with a specified smoking history, as well).¹ Additionally, USPSTF guidelines encourage patients and clinicians to discuss on an individual basis whether prostate cancer screening is appropriate.

Incarcerated individuals have 3 to 7 times higher rates of liver cancer than the general population.^8,12 USPSTF guidelines do not have recommendations about liver cancer screening, as such screening is appropriate only for those with diagnoses that increase their risk of liver cancer. However, AASLD has published guidelines recommending screening for patients with cirrhosis and certain patients with prolonged hepatitis B infection.² Accordingly, these individuals should be screened for liver cancer, aligned with AASLD screening criteria.

Screening guidelines are updated frequently, so health care professionals working in correctional facilities need to ensure that their facility screening practices align with current guidelines.

Although cancer screening should be offered to all eligible individuals, it may not be feasible or desirable for individuals who are anticipated to be incarcerated for a short period of time (days or weeks) to avoid care fragmentation upon release to the community. Cancer screening in prisons should be guideline driven, risk stratified, and equity focused, with emphasis on catch-up care and continuity. Thus, NCCHC recommends that cancer screening be offered to all eligible individuals whose length of incarceration is anticipated to be at least several months. This would allow for appropriate diagnostic follow-up for those who screen positive as well as linkage to treatment.

Unfortunately, cancer screening rates in U.S. correctional facilities may be low. Public data on cancer screening in jails and prisons is scant, and a literature review found few studies, and these had significant data limitations.¹³ This review suggests that cervical cancer screening rates in correctional facilities may be comparable to the general population, but that screening rates for other cancers is likely low. Notably, the review found no studies evaluating lung or liver cancer screening rates in correctional facilities, and a subsequent study found that correctional facilities were less likely to offer screening for lung and liver cancer than for other cancers, despite higher incidence of these cancers among incarcerated individuals.¹⁴ In 2025, a federal report on colorectal cancer screening in federal prisons showed that less than half of prison residents were up to date on colorectal cancer screening.¹⁵ In contrast, cancer screening rates in California prisons are on par with or better than national screening rates in the general population, demonstrating that high screening rates are possible under certain conditions, including intentional policies to increase screening.^16,17

Barriers to cancer screening and strategies to overcome them

There are numerous barriers to cancer screening in correctional facilities that likely vary across contexts. Common barriers include the logistics of conducting off-site screening tests (e.g., CT scans for lung cancer screening, colonoscopies), the lack of public health infrastructure to identify which individuals are eligible for and have received screening as well as appropriate interval for the next screening, clinician shortages that require prioritization of acute care over preventive care, lack of clinician familiarity with frequently changing screening guidelines, and inadequate patient privacy for screening procedures or specimen collection (e.g., for stool-based colorectal cancer screening).^14,15,18

Many evidence-informed strategies to improve cancer screening have been used in community settings. Some of these strategies may be applicable or could be tailored to correctional settings. Successful strategies include patient-directed interventions such as navigation (trained personnel assist individuals with the screening process), education (e.g., videos, flyers, printed materials), reminders (via mail, email, or text), and direct provision of screening supplies (e.g., fecal immunohistochemical test kits for colorectal cancer screening).^19-23 Successful clinician-facing interventions include education, reminders, and feedback on screening completion and gaps (“audit and feedback”). Interventions that combine multiple components are more effective than single-component interventions, as are interventions tailored to specific cultural contexts.

Nonetheless, correctional facilities are unique care environments that require a pragmatic approach to improve cancer screening. Although data supporting interventions to improve cancer screening specifically in correctional facilities is much more limited than data for interventions in the community setting, the correctional health community has described several strategies to overcome barriers:²⁴

1. Bringing screening tests into correctional facilities whenever possible, such as by using mobile mammography vans
2. In recognition that many incarcerated individuals have suffered sexual trauma, using recently approved self-administered HPV testing to reduce need for clinician-administered invasive pelvic exams^25,26
3. For screening that must be conducted off-site, planning screening drives that coordinate bulk screening to reduce staffing and transportation barriers (e.g., lung cancer screening caravans²⁷)
4. Creating screening templates within electronic health records, especially to track smoking history to enable identification of patients eligible for lung cancer screening or to track other factors that affect eligibility for or modality of screening (e.g., family history, comorbidities that dictate the need for colonoscopy rather than stool-based colorectal cancer screening)
5. Educating clinicians on updates to screening guidelines
6. Educating patients on cancer screening recommendations so they can advocate for themselves
7. Creating enforceable metrics that hold prisons and/or correctional health vendors accountable for cancer screening

Moreover, as is commonly done in the community through measures such as the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS) measures,²⁸ progress on cancer screening completion rates should be measured using population dashboards, with target screening rate thresholds matched to screening rates achieved in the community.²⁹ If screening rates fall below the thresholds, quality improvement initiatives should identify barriers to screening and consider implementing appropriate strategies to overcome them. Departments of corrections and correctional health vendors alike may use contractual negotiations to agree on target screening rate thresholds, incentives for meeting such thresholds, and resources necessary to achieve these targets, ensuring alignment of care delivery and resource availability. Ideally, screening rates would be published regularly on publicly accessible websites (such as one used in California¹⁷) to ensure transparency and accountability.

Cancer diagnosis and linkage to care

Cancer screening is just the first step in the care continuum. For patients with positive screening tests, timely diagnostic confirmation, new cancer diagnosis workup, oncology evaluation, and treatment initiation improves cancer outcomes.^30,31

After a positive screening test, most individuals require confirmatory testing. Correctional health staff should be educated on appropriate follow-up after positive screening tests, as these are often managed in primary care (e.g., a colonoscopy after a positive stool-based test). Population health efforts (e.g., dashboards, clinician performance indicators) can be used to track individuals with positive tests undergoing further workup to ensure timely follow-up.

After a diagnosis of cancer is made or when it is strongly suspected, incorporating multidisciplinary care teams is important. Referral to oncology or other appropriate specialists should be expedited. To the extent to which specialists are willing to engage prior to formal consultation, early oncology involvement may enable correctional facilities to obtain necessary new cancer workup (e.g., appropriate imaging) prior to an in-person consultation, facilitating time to treatment. In the nonincarcerated population, the median time from diagnosis to treatment initiation is 26 days, and delays as short as an additional 4 weeks to treatment initiation are associated with worse stage at diagnosis and survival.^30,31 To facilitate treatment within 4 weeks of diagnosis, correctional facilities should attempt to have initial oncology or other appropriate specialist consultation within 2 weeks of a diagnosis.

Throughout screening and diagnostic processes, it is important to communicate the goals, processes, risks, and benefits of screening and further workup to patients, particularly as many incarcerated people have limited health literacy or access to health information. When tests are positive, the ordering clinician should explain the results and next steps rather than defer to a downstream clinician to disclose a possible cancer diagnosis. Clear communication improves patient comprehension and may increase adherence to diagnosis and treatment plans.

Patients may be released from correctional facilities in the midst of cancer screening, workup, treatment, or posttreatment surveillance. Correctional facilities should provide these patients with referrals to community-based care, support to link to appropriate follow-up care (e.g., Medicaid enrollment, assistance making appointments timed after release), and health records necessary to resume community-based care without delay.

Cancer diagnosis outside of screening tests

Half of cancers diagnosed among incarcerated individuals do not have screening tests, and even patients who undergo cancer screening can develop cancer between screening intervals. Notably, individuals diagnosed with cancer during incarceration have a median age in the mid-50s, approximately 10 years younger than the median individual diagnosed in the general population.^8,32 Thus, correctional health staff should be vigilant for signs or symptoms of cancer even in younger patients and should further work up patient self-report of such signs or symptoms, when clinically appropriate. Although there is no comprehensive list, the American Cancer Society provides a list of symptoms that could represent cancer, such as unexplained weight loss, new palpable masses, and hematochezia.³³ The presence of these symptoms may also reflect noncancerous conditions; if clinicians have a concern for cancer, they should initiate a diagnostic workup and, if a diagnosis is confirmed, ensure timely linkage to appropriate specialty care.

July 31, 2026 – Adopted by the National Commission on Correctional Health Care Governance Board