Researchers Win NCI Grant to Reduce Cervical Cancer in Minorities

Researchers and physicians at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine continue to break new ground in research that benefits the medically underserved. The National Cancer Institute of the National Institutes of Health has awarded more than $4.2 million in funding to a five-year Miller School project aimed at reducing the excess rate of cervical cancer among minority women.

Led by Olveen Carrasquillo, M.D., M.P.H., associate professor of medicine and chief of the Division of General Medicine, and Erin Kobetz, Ph.D., M.P.H., assistant professor of epidemiology and public health, the goal of the South Florida Center for Reducing Cancer Disparities (SUCCESS) is to eliminate cervical cancer health disparities in the South Florida community through increased cervical cancer screening.

While there have been significant reductions in cervical cancer incidence and death, primarily due to widespread use of the Pap smear, the numbers for blacks and Hispanics are not as encouraging. “When you see pockets of women who aren’t getting treated,” says Kobetz, “that’s an indicator that there is a failure of the larger health care system to provide equitable opportunities for disease prevention.”

Nationally, African-Americans and Hispanics are twice as likely to contract cervical cancer and twice as likely to die from the disease as non-Hispanic whites. Haitians in the Miami metropolitan area face an even higher incidence of disease.

The team will study 600 women in three geographical areas with distinct racial/ethnic groups in Miami-Dade County: Little Haiti, composed primarily of Caribbean blacks; Hialeah, with a large number of Caribbean Hispanics; and West Perrine, which has a mix of Haitians, Hispanics and African-Americans.

The researchers will examine three different methods of cervical cancer screening to determine which of them most encourages women to engage in adequate, regular screening. One group will receive standard outreach interventions. A second group will be given a comprehensive home-based intervention led by a community health worker, and a third will use a home-based HPV self-sampling device along with the guidance of a community health worker.

As director of the Disparities and Community Outreach Core Resource at Sylvester, Kobetz has developed methods of community-based participatory research to better understand and address health disparities. She’ll use that model and experience as SUCCESS partners with the Center for Haitian Studies and the Health Choice Network, a network of federally qualified health centers that will play an integral role in reaching out to the target communities.

Much of the project, Kobetz explains, involves working with the neighborhood partners to effectively marry academic research and resources with community needs and customs. Eventually, they hope to change the landscape of the community to support cancer screenings and education.

Part of that long-term work involves formally training junior faculty and community workers to become proficient in dealing with health disparities. That arm will be led by Kobetz and Lee Sanders, M.D., M.P.H., associate professor of pediatrics. Carrasquillo says the goal is to build a cadre of investigators who will continue this research within the community and the University. “We hope that by addressing these disparities and building competence in the community, we also build a mentality of addressing education and awareness in other cancers.”

One particularly vulnerable group will be the focus of the pilot project: HIV-positive Haitian women. They have an increased risk of developing and dying of cervical cancer because their immune system is compromised. Sonjia Kenya, Ed.D., assistant professor of family medicine and community health and director of health disparities programs at the Jay Weiss Center for Social Medicine and Health Equity, will develop a community health worker program to provide culturally relevant education to this group of women. She hopes to determine if educational intervention leads to changes in knowledge, screening behaviors and appropriate follow-up care.

Kenya will work to train people who are viewed as “natural helpers” in the community, those who take a lead role in assisting residents and linking them to services. She’ll educate the lay people on specific screening criteria while taking advantage of their natural skills in approaching women in the neighborhoods.

Carrasquillo says using that link between science and the patients underscores the entire team project. “Working together with our community partners we hope to reduce and ultimately eliminate the unequal burden of cancer among minority women.”

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