Breast Cancer Screening Among Homeless Women of New York City Shelter-Based Clinics

Background: Millions of Americans experience homelessness annually. Data on breast cancer screening among homeless women is extremely limited. Methods: We performed a retrospective study evaluating 100 female patients 50 to 74years old with at least three visits to two major New York City shelter-based clinics between 2010 and 2012 to evaluate and compare rates and predictors of mammograms in homeless and low-income domicile patients. Results: Of those we included, 44% were homeless with majority Black and Hispanic. Mean age was 59.28 (±5.84) years. The majority were insured, with 44% smokers and 87% with chronic illnesses. Rates of mammogram within past 2 years were 59% in homeless and 57.1% in low-income domicile patients; 53% did not know the results of their mammogram. Homeless and domicile patients received equal provider counseling. Homeless women were more likely to be uninsured (. p<.01). Domicile patients were more likely to have a chronic illness (. p<.01). A history of mental illness or substance abuse was not different between the two groups. In logistic regression, provider counseling predicted mammogram (odds ratio, 31.69; 95% CI, 3.76-266.8); race, insurance status, housing status, and history of mental illness or substance abuse did not. Conclusion: The overall low rate of mammogram in this population compared with the national average is alarming. We suggest trained patient navigators to address social barriers and tailored patient education and counseling at any clinical encounter to address misconceptions, along with broader structural approaches to address homelessness.