Mobile clinic brings mammograms to unhoused women on Skid Row

Sharon Horton walked through the door of a sky-blue mobile clinic and onto a sidewalk on Skid Row. She wore a yellow knit hat, gold earrings and the relieved smile of a woman who has finally checked a mammogram off her to-do list.

It had been years since her last breast cancer screening procedure. This one, which took place in the City of Hope mobile cancer prevention and screening clinic, was quicker and simpler. The staff was nice. The machine that x-rayed her chest was more comfortable than the cold, hard contraption she remembered.

Relatively speaking, of course, it was still a mammogram.

“It’s like, OK, let me go already!” Horton, 68, said with a laugh.

The clinic was parked on South San Pedro Street, in front of Union Rescue Mission, the nonprofit shelter where Horton resides. Within a week, City of Hope, a cancer research hospital, would share the results with Horton and Dr. Mary Marfisee, director of family medical services at the mission. If the mammogram detected something concerning, they would develop a treatment plan from there.

Union Rescue Mission resident Naureen Sayani, 47, left, discusses her medical history with Adriana Galindo, a physician assistant, before having a mammogram last week.

(Kayla Bartkowski/Los Angeles Times)

“It’s very important to take care of your health and you need to get involved in whatever you can to make your life better,” said Horton, who is looking forward to an upcoming move to Section 8 housing.

Horton was one of the first patients in a new women’s health initiative from UCLA’s Homeless Healthcare Collaborative at Union Rescue Mission. Staffed by third-year UCLA School of Medicine students and led by Marfisee, an assistant clinical professor of family medicine at UCLA, the clinic treats Mission residents as well as unhoused people living in the surrounding neighborhood.

The new cancer screening project comes at a time of dire financial pressures on the county’s public health departments.

Citing rising costs and a $50 million reduction in revenue from federal, state and local grants and contracts, the Los Angeles County Department of Public Health on Feb. 27 terminated services at seven of 13 public clinics that provide vaccines, testing and treatment for sexually transmitted diseases and other services to county residents, both sheltered and unsheltered.

Although the Union Rescue Mission’s funding comes primarily from private sources and is less threatened by budget cuts, the 135-year-old shelter expects the need for services to increase, said its executive director, Mark Hood.

Even though homelessness has declined over the past two years in Los Angeles County, the homeless population in Skid Row – long considered the epicenter of the region’s homeless crisis – increased by 9% in 2024, the most recent year for which census data is available.

For many local women facing daily concerns about housing, food and personal safety, “their own health is not a priority,” Marfisee said.

Those whose problems have become too serious to ignore face enormous barriers to getting care. Marfisee remembers a patient who came to see her with a lump in her breast and without identification.

To get a mammogram, Marfisee said, the woman first had to obtain a birth certificate and then a state-issued identification card. Then she had to sign up for Medi-Cal. After that, clinic staff helped her find a primary care doctor who could order the imaging test.

Given barriers to preventative care, homeless women die from breast cancer at a rate nearly twice as high as women in safe housing, a 2019 study find. Marfisee’s own survey of mission residents found that nearly 90 percent were not up to date on recommended cancer screenings, such as mammograms and Pap tests, which detect early cervical cancer.

To fill this gap, Marfisee – a fierce patient advocate – contacted City of Hope. The Duarte-based research and treatment center unveiled its first mobile cancer screening clinic in March 2024, a van-sized mobile clinic on wheels that it deploys to food banks and health centers, as well as to businesses offering free mammograms as a corporate benefit.

“In true Dr. Mary fashion, she saw the vision,” said Jessica Thies, regional nursing director of the mobile screening program. After overcoming a few logistical hurdles, the mission and City of Hope set a date for the van’s first visit.

The next challenge was getting the message out to patients. Marfisee and her students toured the surrounding neighborhood, went bed to bed in the women’s dormitory and held two information sessions in December and January to answer patients’ questions.

During the sessions, the team explained the basics of determining who should have a mammogram (women aged 40 or older, those with a family history of breast cancer) and the procedure itself. (“Like a tortilla machine?” one woman asked skeptically after hearing a description of the mammography unit.)

The medical students were able to dispel rumors some women heard: the test does not damage breast tissue and X-rays do not increase the risk of cancer. Others questioned the value of a mammogram: What was the point of knowing they had cancer if they couldn’t get follow-up care?

On this last point, Marfisee is determined not to let patients slip through the cracks.

Thirteen patients underwent mammograms during the truck’s first visit Wednesday. Within a week, City of Hope will contact patients with their results and send them to Marfisee and her team. She’s already mentally planning the next steps if a patient finds themselves in a situation requiring a biopsy or further imaging: working with the mission’s case manager, asking for favors, arguing with whatever insurance the patient might have.

“It’ll be a good fight,” Marfisee said, as denizens of the adjacent cafeteria brought trays of sloppy joes and hamburgers to their lunch tables. “But we’ll just continue to ask for help and make it happen.”