Online Program

Colorectal cancer screening in the population of two NYC homeless shelter based clinics

Wednesday, November 6, 2013

Blanca Sckell, MD, MPH, Community Medicine Program, Lutheran Family Health Centers, Brooklyn, NY
Victoria Garland, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Andrea Jakubowski, Medicine, Mount Sinai, New York, NY
Ramin Asgary, MD, MPH, Dept of Medicine, New York University, New York, NY
Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths among adults, but screening rates remain below national average for minorities and low income populations, who suffer higher rates of CRC mortality. There is a dearth of research on CRC screening in the homeless population. Methods: We assessed colon cancer screening practices at two New York City homeless shelter-based community health centers. In accordance with USPSTF recommendations, patients over age 50 were evaluated for fecal occult blood test (FOBT), flexible sigmoidoscopy plus FOBT and colonoscopy. Socio-demographics and barriers to screening were evaluated. Rates between homeless and non-homeless patients were compared. Descriptive, univariate and multivariate analysis were performed. Results: 446 charts were reviewed; 76% were male, the majority was African American and Hispanic and 61 percent were homeless (mean of 2.4 years). 19% of homeless patients were up-to-date for CRC screenings versus 41% of non-homeless (p<0.05). There was no difference between genders. Homeless patients were less likely to receive preventive care counseling from their providers and had a higher rate of declining screening when discussed (p<0.05). Conclusion: The significant lower rate of CRC screening in the homeless population is worrisome. Traditional risk factors, inability to obtain follow-up care and low rates of active provider counseling are important barriers. Proposed interventions include: increasing face-to-face counseling by providers at any clinical encounter to decrease missed opportunities; targeted training for providers; and increasing access to targeted screening strategies using patient navigators to improve CRC screening.

Learning Areas:

Clinical medicine applied in public health
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Assess rates of colon cancer screening and compliance with USPSTF guidelines in a New York City homeless population. Identify barriers to cancer screenings in the homeless population. List Strategies to improve screening for colon cancer among the homeless population.

Keyword(s): Cancer Screening, Homeless Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have designed, performed and analyzed this study and drafted the abstarct. I serve as the medical director of the homeless shelter network clinics in NYC and have been working with this population for many years. I have extensive background in researching and providing service to vulnerable and marginalized populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.