Changes in cancer screening rates by housing status, race, and ethnicity following a multi-component implementation strategy at an urban Federally Qualified Health Center, 2023-2025

Background: To evaluate changes in cancer screening rates among patients experiencing homelessness compared with the general patient population-stratified by race and ethnicity-following implementation of a multi‑component screening strategy at an urban FQHC. Methods: Through a national HRSA initiative linking FQHCs with NCI‑designated cancer centers, we implemented peer navigation addressing social determinants of health (SDOH), community outreach, point‑of‑care text messaging, and a multi‑ethnic public health campaign (“Cancer Screening for Life”). Electronic health record and administrative data supported a pre-post descriptive analysis of up‑to‑date breast (female), cervical (female), and colorectal cancer (all adults) screening rates. Outcomes were compared by housing status, race, and ethnicity. Results: Screening trends varied by cancer type and population: • Breast cancer: Among patients experiencing homelessness, screening increased from 31.2% (567/1,816) to 35.6% (690/1,938) (+4.4 pp). In the general population, the number screened rose (8,681 → 9,163), but the rate declined from 66.8% to 65.4% (−1.4 pp) after guideline changes lowering the starting age from 50 to 40. • Cervical cancer: Screening remained stable among patients experiencing homelessness (32.0% → 31.3%; −0.7 pp) and the general population (59.3% → 60.0%; +0.7 pp). • Colorectal cancer: Screening declined among patients experiencing homelessness (29.6% → 23.2%; −6.5 pp) and the general population (52.4% → 49.0%; −3.4 pp) after eligibility expanded from age 50 to 45. Across cancer types, Hispanic/Latino patients had the highest cervical and colorectal uptake, while American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, and Unreported groups consistently had lower rates. Conclusions and Implications: The multi‑component strategy increased breast cancer screening among patients experiencing homelessness and modestly improved cervical screening in the general population. Colorectal declines likely reflect expanded eligibility rather than reduced screening activity. Persistent disparities-especially among American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, and Unreported groups-and competing socioeconomic burdens highlight the need for interventions addressing SDOH. Strengthening screening implementation will require sustained peer navigation, SDOH‑informed support, digital outreach, and culturally tailored messaging. In California's high‑cost environment, policies should incorporate family‑centered supports, financial and housing stability resources, and routine stratification by housing status, race, and ethnicity to advance equity and improve screening uptake.