In the United States, the aging incarcerated population is confronting a significant health crisis: cancer. Approximately 15% of incarcerated adults, or about 175,000 individuals, are now 55 years or older. As these numbers rise, cancer has emerged as a leading health threat within prisons. Despite its growing prevalence, outcomes for cancer patients who are or have been incarcerated are notably poorer compared to those without incarceration histories.
A recent study by Yale researchers sheds light on the quality of cancer care received by individuals diagnosed during or shortly after incarceration. The study, published in the journal JAMA Network Open, reveals that these individuals are less likely to receive prompt, guideline-recommended cancer treatments. This gap in care could help explain the higher cancer-related mortality rates observed in this population.
Understanding the Study’s Findings
“Incarceration is associated with higher cancer-related mortality,” stated Cary Gross, a professor of medicine and epidemiology at Yale School of Medicine and senior author of the study. “Because people who are incarcerated have a constitutional right to care, it is particularly important to understand the cancer care that patients are receiving.”
The study highlights that most specialized cancer care for incarcerated individuals occurs outside correctional health care settings. According to Ilana Richman, an assistant professor at Yale School of Medicine and one of the study’s first authors, “It’s important that clinicians and health systems providing care to incarcerated individuals recognize and address barriers to high-quality, timely care.”
The Complexities of Outsourcing Cancer Care
Outsourcing specialized oncologic care can have mixed effects on the quality of treatment. On one hand, patients might receive care at comprehensive cancer centers, which typically have access to advanced treatments and demonstrate better outcomes. On the other hand, logistical challenges such as scheduling appointments and arranging transportation can hinder timely care delivery. Additionally, the limited budgets of government-financed carceral health care can restrict contracts with external facilities, further impacting care quality.
The Study’s Methodology and Results
The Yale researchers evaluated cancer care quality using data from the Connecticut Tumor Registry and the Connecticut Department of Correction. They identified individuals diagnosed with invasive cancer in Connecticut from 2005 to 2016, analyzing a sample of 690 individuals between March 2024 and January 2025. The study compared cancer care quality among three groups: those diagnosed while incarcerated, those diagnosed within 12 months post-release, and those never incarcerated.
Key indicators of care quality included the time to initiate treatment—such as surgery, chemotherapy, and radiation therapy—and whether treatment began within 60 days of diagnosis. The findings revealed that individuals diagnosed during incarceration were less likely to start treatment within 60 days or receive recommended care. Similarly, those diagnosed shortly after release faced delays compared to individuals without incarceration histories.
“Many of our community members know someone who has a history of criminal justice involvement,” Gross noted. “This is a good opportunity to not only advocate for improving the health of these individuals but also to consider the health impact of mass incarceration.”
Implications and Future Directions
The study suggests that gaps in cancer care quality may contribute to the disparities in outcomes observed among formerly incarcerated individuals. The research team is conducting interviews with individuals diagnosed with cancer during incarceration to gather insights into their experiences.
Cary Gross, founder and director of Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, emphasized the importance of removing barriers to accessing cancer treatment advancements. “As we strive to develop new cancer screening tests or treatments, it’s also critical to ensure that we are removing barriers to accessing these breakthroughs,” he said.
Other contributors to the study include Lisa Puglisi, Rajni Mehta, Emily Wang, Jenerius Aminawung, and M.D. student Jason Weinstein. The study was supported by a grant from the National Institutes of Health.
The findings underscore the need for systemic changes in how cancer care is delivered to incarcerated populations, highlighting the broader implications of health disparities within the criminal justice system.
