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Housing Status and Cancer Screening in US Veterans.

Hannah Decker1,2, Laura Graham3, Ashley Titan4

  • 1Department of Surgery, UCSF, San Francisco, USA. Hannah.decker@ucsf.edu.

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|February 26, 2025
PubMed
Summary

Veterans experiencing homelessness had lower rates of colorectal and breast cancer screening compared to housed Veterans. However, the Veterans Health Administration (VA) system shows promise for delivering preventative care to this vulnerable population.

Keywords:
cancer screeninghealth equityhomelessnesshousingpreventive care

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Area of Science:

  • Oncology
  • Public Health
  • Health Services Research

Background:

  • Cancer significantly impacts individuals experiencing homelessness, often leading to late-stage diagnoses and poorer survival outcomes.
  • Homelessness is a critical social determinant of health affecting cancer care access and outcomes.

Purpose of the Study:

  • To compare colorectal and breast cancer screening incidence and timeliness between homeless and housed Veterans.
  • To evaluate the effectiveness of the Veterans Health Administration (VA) system in providing cancer screening to homeless Veterans.

Main Methods:

  • A retrospective, matched cohort study analyzed data from 2,580,640 Veterans (2011-2021) within the VA healthcare system.
  • Homeless Veterans were matched to three housed Veterans based on demographics and clinic visit details.
  • Conditional Poisson regression models assessed the association between housing status and screening outcomes, adjusting for covariates.

Main Results:

  • Homeless Veterans exhibited significantly lower adjusted incidence rate ratios (aIRR) for colorectal cancer screening (aIRR 0.84) and breast cancer screening (aIRR 0.87) compared to housed Veterans.
  • Following a positive screening test, homeless Veterans had a 12% lower aIRR of undergoing diagnostic colonoscopy.
  • The timeliness of biopsy procedures was comparable between homeless and housed Veterans.

Conclusions:

  • Veterans experiencing homelessness demonstrate lower cancer screening rates within the VA system compared to their housed counterparts.
  • Despite lower rates, screening prevalence in this group exceeds that of non-Veteran homeless populations.
  • The VA system's infrastructure offers valuable insights for improving preventative cancer care delivery for homeless individuals.