Dr. Olveen Carrasquillo Explores a Self-Administered Home Kit to Test Haitian Women for Cervical Cancer
In Miami’s little Haiti, the enclave with the highest concentration of Haitians in the United States, the number of Haitian women diagnosed with cervical cancer—38 per 100,000—is four times the number of all other women diagnosed with cervical cancer in the state of Florida.
“Those are alarming numbers,” says NCI/CRCHD grantee Olveen Carrasquillo, M.D., M.P.H., an Associate Professor of Medicine and Chief of the Division of General Internal Medicine at the University of Miami's Miller School of Medicine. He is also affiliated with the South Florida Center for Reduction of Cancer Disparities, a comprehensive NCI initiative aimed at reducing cervical cancer disparities through community-based participatory research (CBPR). Carrasquillo works alongside fellow NCI/CRCHD grantee, Dr. Erin Kobetz, a pioneer in cervical cancer research in Haitians, whose formative research led to the large-scale project the two are currently leading.
Cervical cancer has been linked to the human papillomavirus (HPV), the most common sexually transmitted infection. There are more than 40 HPV types that can infect the genital, mouth, and throat areas of males and females. Most people who become infected with HPV are unaware they are infected, so it is critical to get screened regularly. Screening tests can find early signs of disease, meaning problems can be treated early, before they ever turn into cancer.
Carrasquillo and Kobetz are testing the use of a new screening method that could revolutionize the way Haitian woman and other hard-to-reach populations are screened for cervical cancer. It’s a simple and painless pap smear kit that uses a cotton swab similar to a large Q-tip. Women can use the kit by themselves to test for HPV in the privacy of their own homes without the presence of a physician, and then mail the swabbed material to the clinic for testing. Follow-up depends on the results of the screening. With the availability of this home-based screening intervention, Carrasquillo hopes the numbers of cervical cancer cases will decline in Little Haiti.
With help from community health workers, the five-year study is aiming to recruit 600 women, aged 30-65, who have never had a Pap test, from Haitian, Hispanic and African American communities in Little Haiti, Hialeah, and West Perrine in Miami-Dade County. Hispanics and African Americans are among the cohort studied because they, too, have a disproportionately higher incidence of cervical cancer (twice as high as white women). To date, Carrasquillo and Kobetz have assessed 2,602 women for the study. Of those, 515 were eligible, and less than 5% declined to participate. So far, the randomized sample comprises 51% Hispanics, 39% Haitians, and 11% African Americans, and over half are uninsured. In Little Haiti, nearly half (48%) have been found to be HPV-positive and at high risk versus 18% in the other two communities.
In Little Haiti, most of the women live in extreme poverty and have no medical insurance coverage. The poverty rate in the neighborhood is 30%—almost double that of the entire Miami-Dade County. A combination of barriers that includes inability to pay the doctor or lab, cultural modesty around taking their clothes off in front of a stranger when seeking medical treatment, and language challenges has contributed to the disproportionate incidence of cervical cancer among Haitian women.
In addition to this study, Carrasquillo has been a principal investigator on more than a dozen government and foundation research and training grants in the areas of minority health, health disparities, CBPR, and access to care. His research has been published in a variety of journals including the New England Journal of Medicine, Journal of the American Medical Association, and American Journal of Public Health. Carrasquillo is co-founder and Vice-president of Latinos for National Health Insurance. In 2012, he received the Society of General Internal Medicine’s prestigious Herbert W. Nickens Award for his exceptional commitment to improving minority health.
Born in Puerto Rico and raised in the Bronx, Carrasquillo graduated summa cum laude from the Sophie Davis School of Bio-Medical Education at New York’s City College in 1989, and subsequently obtained his M.D. from the New York University School of Medicine in 1991. He completed a three-year internal medicine residency at Columbia-Presbyterian Medical Center and went on to complete Harvard's two-year General Medicine Fellowship. He also obtained an M.P.H. from the Harvard School of Public Health.