Breast cancer screening for persons experiencing homelessness

Primary care providers (PCPs) care for their patients in part by helping them to follow cancer screening guidelines, including screening mammography. However, completing screening and follow-up due to abnormal results can be difficult for PCPs caring for patients with barriers to care, such as persons experiencing homelessness (PEH). The large population of PEH in the US have many unmet healthcare needs, high cancer prevalence and mortality, and therefore a need for cancer screening interventions. Hence we created and evaluated a specialized breast cancer screening program for PEH.

Following national screening guidelines, participants with breasts were eligible if they were at least 40 years old or 35-39 years old with a first-degree family history of positive diagnosis of breast cancer and had not completed a mammogram in the last 12 months. The study utilized convenience sampling and did not seek a sample representative of the population to maximize services to individuals identified by community organizations. The multi-method evaluation included analysis of participant surveys and data from the electronic health record with descriptive statistics, as well as reflexive thematic analysis of patient navigation notes (records of communications between patients and navigators).

In a large Midwestern city in 2023-2024, 124 participants completed mammograms and surveys, among whom 107 participants (86.3%) received normal results and 17 participants (13.7%) received abnormal results and needed additional testing. The seventeen participants who received abnormal results received extensive support from patient navigators; navigators called these participants three to nineteen times, on average calling participants five times. Survey results demonstrated positive attitudes toward preventative health and healthcare providers. Qualitative analysis of patient navigation notes revealed three major themes: (1) relationship building; (2) persistent communications; and (3) collaboration.

Primary care practices may improve healthcare for PEH by identifying their housing insecure patients and being deliberate in the strategies used to keep these individuals engaged in completing cancer screening. Creating relationships to serve PEH throughout a cancer screening journey, with multiple and multi-modal forms of communication, while collaborating with community organizations are effective strategies for PCPs to use to meet the needs of this hard-to-reach population.

Clinicaltrials.gov #: NCT04348123; Registration date April 13, 2020.