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

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.