title: Cervical Cancer Screening Among Homeless Women of New York City Shelters.
abstract: Introduction Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US. Methods We enrolled 297 homeless women 21-65 years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test). Results Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9 % were smokers and 41.7 % were homeless more than a year. Despite a 76.5 % proportion of self-reported Pap test within the past 3 years, 65 % of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p < 0.01) and relationship between HPV and an abnormal Pap test (p < 0.01). Conclusions Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.
authors.affiliation: Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA. ramin.asgary@caa.columbia.edu.|Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA. ramin.asgary@caa.columbia.edu.
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.affiliation: Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA.
authors.forename: Analena
authors.initials: A
authors.lastname: Alcabes
authors.affiliation: Department of OBGYN, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Feldman
authors.affiliation: Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Garland
authors.affiliation: New York University School of Medicine, 227 E30th Street, New York, NY, 10016, USA.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Naderi
authors.affiliation: Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA.
authors.forename: Blanca
authors.initials: B
authors.lastname: Sckell
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D065006:Papanicolaou Test / Q000523:psychology / Q000706:statistics & numerical data*; D030361:Papillomavirus Infections / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Cancer disparities; Cervical cancer; Homeless; Screening