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  • br The low rates of


    The low rates of colorectal and breast cancer screening in the corrections group are striking, in absolute terms and compared with the rates for the general population, and indicate a missed opportunity to prevent cancer in this population. Most people who were not screened accessed primary care during the study period. Given the high bur-den of comorbidity in this population,3,4 the attention of patients and healthcare providers during primary care encounters may be focused on specific conditions at the cost of other health conditions and preventive care.19 Espe-cially in the period after release from correctional facilities, people who experience imprisonment have many urgent needs20−22 and may access primary care to address these issues rather than for preventive care.
    These issues notwithstanding, if colorectal and breast cancer screening indicate primary care quality, this study reveals that primary care quality is suboptimal for the corrections population. Further, a substantial proportion of people in the corrections group did not access any pri-mary care in the 3 years before and 3 years after the index date, respectively, suggesting there may also be substantial barriers to access to primary care. As most people spent only a few days in provincial correctional facilities over the study period, these data mainly reflect the quality and accessibility of primary care in the com-munity rather than in correctional facilities.
    Community- and corrections-based clinical and public health services could collaborate to define and address health promotion and healthcare needs for this popula-tion, for example through health promotion focused on
    preventive care,23 Rottlerin with population-based screen-ing programs24,25 and community-based primary care,26 and education of healthcare providers about the need for preventive care for people who experience imprisonment.
    This population-based study found relatively low levels of participation in colorectal and breast cancer screening among people who experience imprisonment, despite substantial use of primary care. To enhance population-based strategies to prevent cancer, efforts should be made in screening initiatives to include people who experience imprisonment, and to include correctional settings as a place to promote health and provide or link with programs and care.
    This study was supported by the Institute for Clinical Evalua-tive Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in
    this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
    We acknowledge the contributions of the Ontario Ministry of Community Safety and Correctional Services, which supported the study. We appreciate the work of Mr. Michael Kirk, Superin-tendent in the Program Effectiveness, Statistics and Applied Research Division, who prepared the dataset on people released from provincial correctional facilities in 2010.
    Regarding author contributions, Fiona Kouyoumdjian con-ceived of the study. All authors contributed to the project design. Kinwah Fung and Fiona Kouyoumdjian conducted anal-yses. Fiona Kouyoumdjian and Andres McConnon wrote the ini-tial draft of the manuscript and all authors revised the manuscript and approved the final draft.
    No financial disclosures were reported by the authors of this paper.
    1. Walmsley R. World Prison Population List. 11th ed. London: King’s College London International Centre for Prison Studies; 2016.
    6. Health Quality Ontario. Primary Care Indicators. Portals/0/Documents/home/cqa-05-primary-care-indicators.pdf. Pub-lished 2012. Accessed November 26, 2018.
    12. Chong N. IARC Technical Reports No. 32: Automated Data Collec-
    tion in Cancer Registration: Computerized record linkage in cancer registries. International Agency for Research on Cancer. Lyon, France: WHO; 1998.
    13. Canadian Task Force on Preventive Health Care. Breast Cancer (2011): Summary of recommendations for clinicians and policy-makers. https:// Published 2011. Accessed December 7, 2017.
    14. RECORD Group. RECORD (Reporting of studies conducted using observational routinely-collected data). Published 2017. Accessed January 18, 2018.
    15. Cancer Care Ontario. Ontario Cancer Screening Performance Report. Published 2016. Accessed December 3, 2018.