Tuesday 4th February 2020 is World Cancer Day, a day of increasing importance to people imprisoned across the world. We know people in prison have high rates of tobacco smoking and alcohol use, important risk factors for cancer. They are also less likely to take sufficient physical activity and eat a healthy diet. Added to this, the global prison population is ageing, so it’s likely that many more imprisoned people will be affected by cancer in the coming years.
This month, a senior cancer epidemiologist in the UK, Dr Elizabeth Davies, writes about how she became interested in understanding the epidemiology of cancer in prisons in England.
Why should we study cancer in prison populations?
As a cancer epidemiologist, working in prison health research feels like unfamiliar terrain. While a junior doctor during the 1990s, I had occasionally noticed patients visiting hospitals handcuffed to prison officers or chained to their beds. Later, on a deafening and disorientating visit to one London prison, I saw health professionals working in extraordinarily difficult conditions with patients suffering from severe mental health problems. At the time I was focussing on cancer research. No studies had considered cancer in English prisons, but the population was a young one, and cancer is more common in older rather than younger people. Now, the situation has changed radically. The prison population has grown and is ageing, making cancer diagnoses more common. At the same time cancer treatment has advanced dramatically. Can we be sure that patients in prison are receiving the same cancer care as others?
I was first asked the question ‘how many people are diagnosed with cancer in London prisons?’ when I was Medical Director of the Thames Cancer Registry, a cancer data collection service covering South East England. A Cancer Macmillan Support initiative from 2007-2012 had found nurses in the capital concerned about the care patients in prison were receiving. At the registry we suddenly realised we could search the cancer database for patients diagnosed from prison postcodes. So, with nursing colleagues, we published the first study of cancer in the London prison population. Data for 1986-2005 showed on average only 31 patients diagnosed in each five-year period. Lung cancer was most common in men and early cancers of the cervix in women. Although no patients had died in prison, further work was clearly needed. I sent our paper to people who might have influence on NHS policy, but eventually I realised that a more detailed national study was needed.
It took a while to build the team to gain funding for the study. Public Health England first showed interest by supporting me as an epidemiologist at King’s College London. There I was approached by colleagues from University College Hospitals also concerned about cancer care. Colleagues at the Mental Health Foundation, University of Surrey, The Ministry of Justice, and NHS England Commissioning all became involved. People who have experience of cancer care in prison working with Revolving Doors Agency are now playing a key role. As a team we are now half-way through a ‘mixed methods’ study. We are sifting through national cancer databases in Public Health England to identify patients in prison and comparing their diagnoses and outcomes with patients in the general population. At the same time, we are carrying out qualitive interviews with patients to understand their experiences of diagnosis and treatment, and with prison officers and health professionals in prisons and the NHS to understand the challenges of providing care. So far, we’ve been surprised and pleased by the early interest in the study. Our real challenge, however, will be to translate our findings into recommendations that can inform policy and care.
Dr Elizabeth Davies is Clinical Reader in Cancer and Public Health, Cancer Epidemiology, Population and Global Health, at King's College London. She is an academic public health physician with research interests in cancer inequalities, patient experience, supportive and palliative care and medical humanities. If you are interested in conducting epidemiological studies relating to cancer in prisons in your country and would like to discuss further with Elizabeth, please email her at firstname.lastname@example.org