Cancer Incidence and Survival Among Ever-Incarcerated Patients in California and Massachusetts
6 affiliations
- 1Traversal Health, Nashville, Tennessee
- 2Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- 3Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- 4Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill
- 5Harvard Medical School, Boston, Massachusetts
- 6Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Abstract
Importance: Cancer is the leading cause of death in US prisons. Few studies have compared cancer incidence and survival for currently and formerly incarcerated populations with those for the general population.
Objective: To ascertain the association of prison incarceration with cancer outcomes, and to inform potential public health interventions.
Design, Setting, and Participants: This cohort study used state cancer registry data on patients with cancer diagnosed in California and Massachusetts between January 1, 2010, and December 31, 2019. Identifiers of persons incarcerated in California and Massachusetts state prisons during this study period were linked to cancer registry data to identify incarceration status at diagnosis. Data analysis was performed between March 2023 and August 2025.
Exposures: Current, former, or never incarceration status at diagnosis.
Main Outcomes and Measures: Cancer incidence, which was calculated as standardized incidence ratios (SIRs) relative to never-incarcerated patients. Stage at diagnosis and survival outcomes were characterized. The association between incarceration status and diagnosis stage and survival were assessed using regression models adjusted for demographic characteristics, year of diagnosis, cancer type, and state of residence.
Results: The study included 2 171 336 cancers, among which 2 165 540 (99.7%) were diagnosed in never-incarcerated, 3305 (0.2%) in currently incarcerated, and 2491 (0.1%) in formerly incarcerated patients. The median (IQR) age at diagnosis was 66 (56-75) years, 57 (49-64) years, and 55 (46-62) years, respectively. Overall, patients included 1 141 745 males (52.6%). Compared with never-incarcerated patients, currently incarcerated patients were more likely to have cervical (SIR, 3.57; 95% CI, 2.26-5.35) and liver cancers (SIR, 3.10; 95% CI, 2.79-3.43). In Massachusetts, currently incarcerated patients (odds ratio [OR], 1.62; 95% CI, 1.07-2.46) and all formerly incarcerated patients (OR, 1.19; 95% CI, 1.02-1.38) had a higher likelihood of advanced-stage diagnoses of screen-detectable cancers. Five-year survival was 62.4% for all never-incarcerated patients, 54.4% for currently incarcerated patients in California, 36.4% for currently incarcerated patients in Massachusetts, and 51.8% for all formerly incarcerated patients. Compared with never-incarcerated patients, formerly incarcerated patients had worse adjusted survival (hazard ratio [HR], 1.71; 95% CI, 1.61-1.82), while currently incarcerated patients had worse survival that varied by state (California: HR, 1.41 [95% CI, 1.33-1.49]; Massachusetts: HR, 2.18 [95% CI, 1.85-2.56]).
Conclusions and Relevance: In this cohort study of Massachusetts and California cancer registry data, currently and formerly incarcerated patients with cancer had inferior survival. The distinctive epidemiologic pattern of cancer incidence and mortality in incarcerated populations identifies strategic targets for cancer control.
Related
- Incidence of Osteoradionecrosis and Dental Implant Survival in Patients With Irradiated Head and Neck Malignancies: A Systematic Review and Meta-Analysis
- Cancer Screening, Diagnosis, and Survival in California Prisons
- Incidence, treatment, and survival of synchronous peritoneal metastases in breast cancer
- Proteinuria with extended VEGF inhibitor therapy in RAS-mutant metastatic colorectal cancer: incidence, interruptions, and exploratory survival analysis.
- Systemic and organ-specific proteomic aging clocks as predictors of cancer incidence and survival: insights from the Finnish Twin Cohort
BibTeX
@article{manz2026cancer,
title = {{Cancer Incidence and Survival Among Ever-Incarcerated Patients in California and Massachusetts}},
author = {Christopher R. Manz and Angela C. Tramontano and Samira L. Dias and Emma Voligny and Christopher D. Baggett and Alexi A. Wright and Deborah Schrag},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39346},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855827},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cancer Incidence and Survival Among Ever-Incarcerated Patients in California and Massachusetts
AU - Christopher R. Manz
AU - Angela C. Tramontano
AU - Samira L. Dias
AU - Emma Voligny
AU - Christopher D. Baggett
AU - Alexi A. Wright
AU - Deborah Schrag
PY - 2026
DA - 2026/10/26
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.39346
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855827
AB - Importance: Cancer is the leading cause of death in US prisons. Few studies have compared cancer incidence and survival for currently and formerly incarcerated populations with those for the general population. Objective: To ascertain the association of prison incarceration with cancer outcomes, and to inform potential public health interventions. Design, Setting, and Participants: This cohort study used state cancer registry data on patients with cancer diagnosed in California and Massachusetts between January 1, 2010, and December 31, 2019. Identifiers of persons incarcerated in California and Massachusetts state prisons during this study period were linked to cancer registry data to identify incarceration status at diagnosis. Data analysis was performed between March 2023 and August 2025. Exposures: Current, former, or never incarceration status at diagnosis. Main Outcomes and Measures: Cancer incidence, which was calculated as standardized incidence ratios (SIRs) relative to never-incarcerated patients. Stage at diagnosis and survival outcomes were characterized. The association between incarceration status and diagnosis stage and survival were assessed using regression models adjusted for demographic characteristics, year of diagnosis, cancer type, and state of residence. Results: The study included 2 171 336 cancers, among which 2 165 540 (99.7%) were diagnosed in never-incarcerated, 3305 (0.2%) in currently incarcerated, and 2491 (0.1%) in formerly incarcerated patients. The median (IQR) age at diagnosis was 66 (56-75) years, 57 (49-64) years, and 55 (46-62) years, respectively. Overall, patients included 1 141 745 males (52.6%). Compared with never-incarcerated patients, currently incarcerated patients were more likely to have cervical (SIR, 3.57; 95% CI, 2.26-5.35) and liver cancers (SIR, 3.10; 95% CI, 2.79-3.43). In Massachusetts, currently incarcerated patients (odds ratio [OR], 1.62; 95% CI, 1.07-2.46) and all formerly incarcerated patients (OR, 1.19; 95% CI, 1.02-1.38) had a higher likelihood of advanced-stage diagnoses of screen-detectable cancers. Five-year survival was 62.4% for all never-incarcerated patients, 54.4% for currently incarcerated patients in California, 36.4% for currently incarcerated patients in Massachusetts, and 51.8% for all formerly incarcerated patients. Compared with never-incarcerated patients, formerly incarcerated patients had worse adjusted survival (hazard ratio [HR], 1.71; 95% CI, 1.61-1.82), while currently incarcerated patients had worse survival that varied by state (California: HR, 1.41 [95% CI, 1.33-1.49]; Massachusetts: HR, 2.18 [95% CI, 1.85-2.56]). Conclusions and Relevance: In this cohort study of Massachusetts and California cancer registry data, currently and formerly incarcerated patients with cancer had inferior survival. The distinctive epidemiologic pattern of cancer incidence and mortality in incarcerated populations identifies strategic targets for cancer control.
SN - 2574-3805
ER -