Cancer Screening, Diagnosis, and Survival in California Prisons

Importance: Cancer is the leading cause of death in prison. Limited literature suggests cancer screening rates in prison are low, but population-level screening data in prisons are scarce.

Objective

To determine screening rates for 5 cancer types, identify individual and incarceration characteristics associated with receipt of screening, and characterize outcomes for screen-detectable cancers in California prisons. Design, setting, and participants: This cohort study included individuals incarcerated in California state prisons who were eligible for breast, cervical, colorectal, liver, or lung cancer screening between January 1, 2014, and June 30, 2023. Incarceration data were linked to state cancer registry data from 2014 to 2021 to identify screen-detectable cancers diagnosed in the study population. Analyses were conducted between August 2024 and July 2025. Exposures: Receipt of screening within 3 months before a cancer diagnosis. Main outcomes and measures: Receipt of cancer screening; screening rates; and cancer diagnosis, stage, and survival were calculated. Multivariable models evaluated characteristics associated with screening receipt and associations between screening receipt and stage at diagnosis and survival, with adjustment for demographic and incarceration characteristics.