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Patients experiencing homelessness face a high burden of chronic disease, including colorectal cancer. Access to colonoscopy is limited by many structural barriers in this population. In an exemplar case, we describe the barriers encountered by a homeless patient with a history of colorectal cancer who was lost to follow up and presented 11 years later with a new primary colon cancer. We provide policy solutions to increase the use of primary and secondary screening, including essential private bathroom access for colonoscopy preparation in patients who had a positive screening or require surveillance after diagnosis and treatment. We believe that increasing early detection and treatment may be cost-effective and could reduce disparities in morbidity and mortality in homeless patients.