By Kiara Ford
In our series on the financial side of breast cancer, we have already examined the breast cancer to poverty pipeline, and the economic toll a breast cancer diagnosis carries with it. But missing from this conversation is the question: what happens if you are already experiencing poverty when you are diagnosed with breast cancer? More specifically, how would someone experiencing homelessness be able to detect, treat, and recover from breast cancer?
Continue reading to learn more about how homelessness can complicate breast cancer screening, diagnosis, and treatment.
Homelessness: Breaking the Stigma
Before answering this question, let’s define what it means to be a person experiencing homelessness. There are numerous toxic narratives attached to the word “homeless,” but it is important to remember that many of the prejudices are based on stereotypes and are not representative of the population. We must avoid making generalizations about people experiencing homelessness, because the circumstances that lead to homelessness can vary so greatly.
The Social Security Administration defines a person experiencing homelessness as “an individual with no permanent living arrangement, i.e., no fixed place of residence.” This could be a family staying in transitional housing, a person fleeing domestic violence, or someone struggling with unemployment. The circumstances that lead to homelessness are most often complex and unique to the individual, so sweeping statements about the entire homeless population can be harmful. What can be said, however, is that most people experiencing homelessness will have to navigate financial hardship, limited resources, and instability.
Breast Cancer Screening Barriers
These difficulties are contributing factors into why unhoused people with breast cancer are almost twice as likely to die as those with consistent housing. One of the greatest barriers is access to preventative care and early detection. For women at average risk, mammograms are recommended over the age of 40 every other year, in the hopes that the cancer can be found and treated as early as possible. One 2014 study found that only 59% of unhoused women surveyed had had a mammogram in the past two years, and that 53% of those who had had one did not know the results.
The Toll of Delayed Cancer Detection and Treatment
This lack of regular screening makes it more likely that cancer will be diagnosed later, which is compounded further by the fact that people experiencing homelessness may be forced to delay treatment. Doctors typically recommend starting treatment soon after diagnosis in order to improve survival odds, but the barriers created by homelessness can make this impossible. One study from Boston Medical Center found that 90% of patients in the sample deferred care by at least 30 days, and the average time between diagnosis and treatment was 98 days. The most common reasons given for these delays were comorbidities and mental illness interfering with treatment, having no place to recover after surgery, and inability to cover the cost of care.
Cancer Care is Prohibitively Expensive
Covering the cost of care is one of the greatest barriers to healthcare in America, especially for those without insurance. Research has shown that around 60% of people experiencing homelessness are not insured. Although many of this group would be eligible for coverage under Medicare or Medicaid, acquiring the necessary documentation and filling out the forms without an address can prove challenging. This leaves uninsured, unhoused people with limited options.
There are safety net hospitals, which receive federal funding to provide service to any patient in need, regardless of ability to pay. There are also medical respite facilities, which provide accommodation for individuals experiencing homelessness who are too sick to stay in a shelter or on the street, but not sick enough to be admitted to the hospital. While both these services provide vital care, they can also be difficult to locate and are not always accessible to people who may need them.
Homelessness is a complex issue and it cannot be solved overnight, especially with a breast cancer diagnosis further complicating the situation. What we can do is meet people where they are, withhold judgments, and invest in screening programs such as mobile mammograms for lower income individuals.
Read more about safety net hospitals: https://healthcareconsumernavigatorcenter.com/consumer-information-navigator/section-4/safety-net-hospitals-resource-healthcare-consumers/
On the Podcast: Breast Cancer Conversations
Breast Cancer and the Law: Resources for Patients and Caregivers
About the Author:
Kiara Ford is a graduate of Emerson College, where she majored in communication studies and minored in health and society. She is a certified community health worker and has worked extensively in disability advocacy. She is passionate about health equity, and hopes to raise awareness and increase understanding of patients’ rights through her work.
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