The Connecticut Department of Correction (DOC) has a long history of health care litigation filed by incarcerated people or their families, but a new colon cancer screening program from the agency is now attracting national attention as a positive step for prisoner health.
Dr. Maurizio Nichele, a colorectal surgeon at the DOC, is working with people in prisons across Connecticut to get them screened for colorectal cancer – all at no cost to them.
“Most people don't want to talk about colon cancer, they don't want to talk about their bowel movements,” Nichele says. “ My first goal is to get people comfortable talking about the issue, then I educate them on the importance of the program.”
Since its launch last year, Nichele says of the 300 people who took the Cologuard stool test, 30 underwent colonoscopies, and about a half of those were found to have pre-cancerous polyps.
“We’re the first program in the country to actually take this dilemma of getting people screened, by the horns,” he says.
The relatively low number of people diagnosed with precancerous polyps shouldn't be a deterrent to operating the program, said Dr. Ilana Richman of the Yale School of Medicine.
That’s because although colorectal cancer is among the most common cancers in the U.S., it is still relatively rare. For every 100,000 adults aged 50-54, 60 will be diagnosed with colorectal cancer in a year. And of the more than 12,000 incarcerated people in state prisons, only about 300 people have been screened since the Cologuard program was launched.
“We have to screen a large number of people to find one colorectal cancer,” Richman says. “That said, colorectal cancer screening is really important because it can find polyps. Polyps are much more common than colorectal cancer. And removing polyps during a colonoscopy can prevent the future development of colon cancer.”
Dr. Byron Kennedy, chief medical officer at the DOC, says the program is also solving the problem of getting incarcerated people to hospitals for invasive testing.
“When we send that patient out to a hospital, they're transported, and typically they have two custody officers that accompany those transports,” he says. “The biggest issue of that is really the limited number of slots that are available. And that's not just for our patient population, that's in the community.”
Nationally and in Connecticut, colonoscopy slots are limited with wait times growing.
Also, the preparation for a colonoscopy can be especially challenging.
In prisons, almost half of colonoscopy candidates ultimately can’t receive the invasive procedure because of preparation failures, which is a rate much higher than in the general population, according to Exact Sciences, the company that makes Cologuard.
A recent study in the New England Journal of Medicine, supported by Exact Sciences, found that the next-generation of Cologuard stool test showed higher sensitivity for colorectal cancer and advanced precancerous lesions than FIT, a competing product, but also showed lower specificity.
Other states are taking notice of what’s happening in Connecticut prisons.
Six other state agencies and correctional facilities nationally, including the Nebraska Department of Corrections, have since adapted the program.
“There has been a significant amount of interest based on the outcomes that have been demonstrated in Connecticut,” says Dr. Durado Brooks, deputy chief medical officer of the Screening Unit at Exact Sciences.
Cancer incidence rates depend on screening rates, and past research from Yale, co-authored by Richman, found cancer incidence is lower in incarcerated populations, but much higher in recently released individuals, potentially indicating lower screening in prisons.
And that’s a statistic that Ken Krayeske, attorney and a candidate for the DOC ombudsman position, says he sees everyday in the course of his work.
He’s been fighting alleged failures to screen cancer in state prisons for years and says the DOC’s new program is a positive step.
“I’m really grateful to see the results of that litigation in some of the changes – like this program,” he says.
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