title: Breast cancer screening among homeless women of New York City shelter-based clinics.
abstract: BACKGROUND
  Millions of Americans experience homelessness annually. Data on breast cancer screening among homeless women is extremely limited.
  
  
  METHODS
  We performed a retrospective study evaluating 100 female patients 50 to 74 years old with at least three visits to two major New York City shelter-based clinics between 2010 and 2012 to evaluate and compare rates and predictors of mammograms in homeless and low-income domicile patients.
  
  
  RESULTS
  Of those we included, 44% were homeless with majority Black and Hispanic. Mean age was 59.28 (±5.84) years. The majority were insured, with 44% smokers and 87% with chronic illnesses. Rates of mammogram within past 2 years were 59% in homeless and 57.1% in low-income domicile patients; 53% did not know the results of their mammogram. Homeless and domicile patients received equal provider counseling. Homeless women were more likely to be uninsured (p < .01). Domicile patients were more likely to have a chronic illness (p < .01). A history of mental illness or substance abuse was not different between the two groups. In logistic regression, provider counseling predicted mammogram (odds ratio, 31.69; 95% CI, 3.76-266.8); race, insurance status, housing status, and history of mental illness or substance abuse did not.
  
  
  CONCLUSIONS
  The overall low rate of mammogram in this population compared with the national average is alarming. We suggest trained patient navigators to address social barriers and tailored patient education and counseling at any clinical encounter to address misconceptions, along with broader structural approaches to address homelessness.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: ramin.asgary@caa.columbia.edu.
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.affiliation: Department of Community Medicine, Lutheran Family Health Centers, New York, New York.
authors.forename: Victoria
authors.initials: V
authors.lastname: Garland
authors.affiliation: Department of Community Medicine, Lutheran Family Health Centers, New York, New York.
authors.forename: Blanca
authors.initials: B
authors.lastname: Sckell
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014504:Urban Health