Cancer screening rates low among unhoused population

Cancer screening rates among the unhoused are low, according to research published March 4 in the American Journal of Surgery.

A team led by medical student Talal Al-Assil from Western Michigan University in Kalamazoo found that while there is a high willingness to undergo screening in this population, screening rates are low for breast cancer, colorectal, and cervical cancers, as well as Hepatitis C.

“Enhancing the unhoused/homeless community’s access to cancer screenings is crucial,” the Al-Assil team wrote.

Cancer incidence and mortality are higher among the homeless and unhoused. Cancer death rates in the unhoused population reached 471 per 100,000 in a 2005 report published by the New York City Departments of Health and Mental Hygiene and Homeless Services. To compare, individuals who are housed had a cancer death rate of 247 per 100,000.

Al-Assil and colleagues noted that research on cancer prevalence and screening practices within this population is “alarmingly limited.”

The researchers investigated cancer screening rates and barriers to screening among the homeless and unhoused, focusing on two shelters in Kalamazoo, MI. They sent questionnaires to assess screening rates and system-level screening barriers. The study included questionnaire data from 143 participants, and the team focused on screening for Hepatitis C, lung cancer, breast cancer, colon cancer, and cervical cancer.

The rates of screening uptake were lowest for breast cancer at 44.4%, the investigators reported (in 2021, the national breast cancer screening rate was 75.9%). Yet 73% of the women who responded to the survey who had not undergone screening mammography in the past year expressed interest in receiving a mammogram, the team further reported. Colorectal cancer had the second lowest screening uptake at 45%, followed by Hepatitis C at 55.2%, and cervical cancer at 78.8%.

The researchers did not assess lung cancer screening status due to the recent update of screening guidelines and the timing of their study. They did note, however, that 77% of participants reported being active smokers.

The team also found the following factors to be the most common barriers to screening: lack of transportation (21.8%), lack of access to or awareness of screenings (20.5%), and low prioritization of health compared to other insecurities faced while being homeless (17.9%).

Finally, only 6.3% of participants reported lack of insurance as a barrier. The researchers highlighted that this finding challenges “the common assumption that affordability of healthcare is a significant obstacle to screening access in unhoused individuals.”

The study authors further noted that patient navigators and mobile screening services like mobile mammography could aid health initiatives for the homeless and unhoused.

“Future initiatives should focus on improving patient education and counseling while addressing logistical barriers, such as the need for additional appointments and transportation challenges,” they concluded.

The full study can be accessed here.