Erick Suárez

University of Puerto Rico, Medical Sciences Campus, San Juan, San Juan, Puerto Rico

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Publications (77)206.71 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This article describes the methodology of the first population-based study of human papillomavirus (HPV) infection among women aged 16-64 years residing in the San Juan Metropolitan Area of Puerto Rico (PR). The sample was identified through a complex sampling design of households. The sampling frame was selected in four stages, using census tracts maps from the Census Bureau. Women completed a face-to-face interview and a computer-assisted self-interview using the Audio CASI system, for the collection of demographic, clinical, and lifestyle variables, and sampling acceptability. Anal, cervical, and oral specimens were collected through self-collection methods for HPV DNA testing using a modified pool of MY09/MY11 consensus HPV L1 and human ß-globin amplification primers. Anthropometric measurements were taken using the Third National Health and Nutrition Examination Survey methodology. Blood samples were collected to create a bio-repository for future HPV-related studies. Fifty census tract blocks were randomly selected. We recruited 566 women, with a response rate of 83.4%. Response rates did not vary by age-group (p>0.05); although they varied by socioeconomic (SES) census block stratums (p<0.05), response rates were good (>75%) in all SES strata. All participants agreed to respond to the surveys and provide the requested anogenital and oral samples. Overall, more than 98% understood and more than 50% felt comfortable with the cervical, anal, and oral self-collection methods used. This article documents the feasibility of performing population-based studies for HPV surveillance in women in PR.
    Puerto Rico health sciences journal 09/2015; 34(3):117-27. · 0.67 Impact Factor
  • 07/2015; DOI:10.1007/s40615-015-0144-5
  • Cancer Research 05/2015; 75(9 Supplement):P5-06-05-P5-06-05. DOI:10.1158/1538-7445.SABCS14-P5-06-05 · 9.33 Impact Factor
  • Daisy González · Erick L. Suárez · Ana Patricia Ortiz
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    ABSTRACT: To assess the prevalence of cervical cancer screening through Papanicolaou (Pap) test utilization and its association with sexual behaviors among a population-based sample of Hispanic women in Puerto Rico (PR). This study was a secondary data analysis of the database of a cross-sectional study of HPV infection in PR (2010-2013; n = 554 women). Pap test utilization (past 3 years) was self-reported and sexual risky behavior was defined as an index that considered the following sexual behaviors: early age of sexual debut (≤16 years), 11 or more lifetime sexual partners, and 2 or more sexual partners in the last year. Multivariable logistic regression was used to estimate the magnitude of the association between sexual risk behavior and Pap test utilization, after adjusting for socioeconomic and lifestyles characteristics. The overall prevalence of Pap test utilization was 78.0%. Pap test screening varied with sexual behavior, with women with none or one risky sexual behavior having higher odds of Pap test utilization in the past 3 years (odds ratio [OR], 1.74; 95% CI, 1.03-2.93) compared with those with two or three risky sexual behaviors. This difference remained marginally significant (p < .10) after adjusting for age, educational attainment, smoking status and STI history (OR, 1.72; 95% CI, 0.96-3.08). The prevalence of cervical cancer screening in this population (78%) is still below Healthy People 2020 recommendations (93%). Also, women with risky sexual behaviors are less likely to have been screened. Efforts to promote cervical screening programs should focus on these high-risk women as a method for cervical cancer prevention and control. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
    Women s Health Issues 03/2015; 25(3). DOI:10.1016/j.whi.2015.01.002 · 1.61 Impact Factor
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    ABSTRACT: This study compared the incidence of lung cancer among Puerto Ricans (PRs) with that of Whites, Blacks, and Hispanics in the United States. We computed age-standardized rates of lung cancer during 1992-2010 and percentages of change over time. Standardized rate ratios (SRR) were estimated to assess racial/ethnic and gender differences. All men groups showed a significant decline in lung cancer over time but PRs observed the smallest change (-1.2 %). For both men and women, PRs had lower incidence rates compared to other racial/ethnic groups (SRR < 1; P < 0.05). Among all groups, men reported higher incidence rates than women but PRs showed the largest gender disparity (SRR = 2.29). This study showed that although PRs exhibited lower incidence rates of lung cancer, this subgroup of Hispanics faced an important burden of lung cancer, principally because PR men had the smallest decline over time and the largest gender difference among all groups.
    Journal of Immigrant and Minority Health 01/2015; 17(3). DOI:10.1007/s10903-014-0153-1 · 1.16 Impact Factor
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    ABSTRACT: Barrett's esophagus (BE) is the strongest risk factor of esophageal adenocarcinoma (EAC). A previous study found a lower incidence of EAC in Puerto Rico (PR) as compared to other racial/ethnic groups in the United States (US). Notwithstanding, BE epidemiology in PR is unknown. Study aims: i) to determine BE prevalence among individuals with gastroenterological pathology reports from three major anatomic pathology laboratories in PR and ii) to describe the association between dysplastic BE with age and gender. Clinic-based study examined data collected from three anatomic pathology laboratories encompassing the majority of gastroenterology practices in PR. Individuals with histology confirmed BE (January 2007-December 2011) were analyzed (n = 1,232). We estimated BE prevalence and adjusted odds ratios (AOR) to assess magnitude of association between dysplastic BE with age and gender using logistic regression models. Overall BE prevalence was 4.4% (95% CI = 4.1-4.6). Most BE patients were males (male-to-female ratio = 2.3:1) with mean age of 64 ± 13 years. Ninety one percent of BE biopsies showed no dysplasia whereas 6.2% had EAC. BE patients age > 74 years had an increased risk of EAC (AOR: 2.38, 95% CI = 1.14-4.94) compared to those < 55 years old. Males had increased EAC risk (AOR: 2.23, 95% CI = 1.23-4.06) compared to females. BE prevalence in PR is similar to that of non-Hispanic whites and Hispanics in US. The lower occurrence of dysplastic BE in PR could explain EAC incidence disparities between PR and other groups in the US.
    Puerto Rico health sciences journal 12/2014; 33(4):184-9. · 0.67 Impact Factor
  • Cancer Epidemiology Biomarkers & Prevention 11/2014; 23(11 Supplement):B69-B69. DOI:10.1158/1538-7755.DISP13-B69 · 4.13 Impact Factor
  • Cancer Research 10/2014; 74(19 Supplement):2394-2394. DOI:10.1158/1538-7445.AM2014-2394 · 9.33 Impact Factor
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    ABSTRACT: Objective: Scientific findings need to be summarized for the better understanding of the community and for the development of the respective preventive actions that they espouse, suggest, or imply. The news media play a critical role in communicating health information to the public. Among chronic diseases, cancer receives a great deal of attention from the media, possibly because of its position as a leading cause of death. While the news media are vital to the dissemination of health information, one of the main information sources comes from epidemiological studies. Thus, it is important that health professionals interpret the results of these studies in order to efficiently communicate the results in a thorough and comprehensible manner. This special article aims to guide health professionals through the process of reading and interpreting the most relevant components of epidemiological literature. Methods: Guiding questions were prepared based on the main components of the aforementioned literature. Results: An abstract that was chosen from the available literature was used for the responses to the proposed guiding questions. Conclusion: We expect that reading the proposed questions will improve the communication and dissemination of epidemiological findings, thereby contributing to the understanding of the health problems of our community. Also, we expect the readers to visit the recommended web sites presented at the end of this document for more complete definitions of the epidemiological terms found herein.
    Puerto Rico health sciences journal 06/2014; 33(2):39-44. · 0.67 Impact Factor
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    ABSTRACT: The objective of this study was to estimate the incidence of cancer and human papillomavirus (HPV)-related cancers and the risk of death (by cancer status) among people living with AIDS (PLWA) in Puerto Rico. We used data from the Puerto Rico AIDS Surveillance Program and Central Cancer Registry (1985-2005). Cancers with highest incidence were cervix (299.6/100,000) for women and oral cavity/oropharynx for men (150.0/100,000); the greatest excess of cancer incidence for men (standardized incidence ratio, 86.8) and women (standardized incidence ratio, 52.8) was for anal cancer. PLWA who developed a cancer had decreased survival and increased risk of death compared with those who did not have cancer. Cancer control strategies for PLWA will be essential for improving their disease survival.
    Preventing chronic disease 05/2014; 11(5):E80. DOI:10.5888/pcd11.130361 · 2.12 Impact Factor
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    ABSTRACT: This study examined the prevalence and association of diabetes mellitus (DM) and prediabetes with cardiovascular risk factors among Puerto Ricans adults. Data from a household survey of 857 adults aged 21-79 years who underwent interviews, physical exams, and blood draws were analyzed. Prevalence of total DM and prediabetes was estimated using American Diabetes Association diagnostic criteria of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c). Poisson regression models were used to estimate the prevalence ratio for each cardiovascular risk factor under study. Age-standardized prevalence of total DM and prediabetes, detected by FPG and/or HbA1c, was 25.5 and 47.4 %, respectively. Compared with participants with normoglycemia, those with previously diagnosed DM, undiagnosed DM, and prediabetes had more adverse cardiovascular risk factor profiles, characterized by a higher prevalence of general and abdominal obesity, hypertension, low HDL cholesterol, elevated LDL cholesterol, elevated triglycerides, and elevated plasminogen activator inhibitor 1 (p < 0.05). The high prevalence of DM and prediabetes calls for public health actions to plan and implement lifestyle interventions to prevent or delay the onset of DM and cardiovascular disease.
    Journal of Immigrant and Minority Health 04/2014; 17(4). DOI:10.1007/s10903-014-0025-8 · 1.16 Impact Factor
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    ABSTRACT: The incidence of anal cancer is increasing, particularly among HIV and men who have sex with men (MSM) groups. The vast majority of cases are associated with human papillomavirus (HPV), the most common sexually transmitted infection. Epidemiological studies have also documented low survival, which might be linked to lack of appropriate screening, access, and utilization of pertinent health care services. Our objective was to assess the relative survival (1 and 3 years) of anal cancer in Puerto Rico for men and women during the period from 2000-2007. All histological types of cancer of anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcomas, were included. Relative survival was estimated with the use of life tables from the population of Puerto Rico. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model. The overall 3-year relative survival in Puerto Rico was the same (53 %) for men and women. Our findings establish baseline survival data for anal cancer in Hispanics from Puerto Rico. Since now, the national guidelines for anal cancer screening and treatment are on their way to be determined; baseline information about survival will allow monitoring the efficacy that standardized screening programs may eventually have in increasing anal cancer survival in this population.
    Journal of Gastrointestinal Cancer 04/2014; 45(2). DOI:10.1007/s12029-014-9607-x · 0.38 Impact Factor
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    Puerto Rico health sciences journal 03/2014; 33(1):34-6. · 0.67 Impact Factor
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    ABSTRACT: Previous studies have found a link between a low DNA repair capacity (DRC) level and increased risk for breast cancer (BC). A recent study by Matta et al. 2012 showed that women with BC have an average reduction of 60% in DRC compared to controls (P < 0.001). Using the same group of Hispanic women, we selected a subgroup of cases (n=35) and controls (n=2) who donated their tumors and normal tissue for performing molecular studies in order to 1) compare the expression of DNA repair genes in breast tissue between BC cases and controls without this disease, 2) assess the correlation between gene expression and DRC levels, 3) examine whether DRC levels are associated with tumor DNA repair gene expression profiling when women were stratified according to their hormone receptor status. DRC levels were measured in lymphocytes by means of a host-cell reactivation assay. Gene expression levels were measured in tumors by means of DNA microarray analysis. Twenty-one DNA repair genes were found to be differentially and significantly expressed in women with BC. Those candidate genes were CHEK2, EME1 (MMS4L), ERCC3 (XPB), FANCM, H2AFX (H2AX), HMGB1, HUS1, MBD4, NEIL3, PCNA, RAD1, RAD23B, RAD51, RAD54B, RDM1 (RAD52B), SHFM1 (DSS1), TP1, UBE2N (UBC13) and XRCC5 (Ku80). Most DNA repair genes (n=18 or 82%) were overexpressed, ranging from 3.76-fold (RDM1) to 1.47-fold (XRCC5). Only 4 genes (18%) were underexpressed, ranging from 62% (SAPCD1) to 25% (RAD23B). Statistically significant positive correlations between DRC level and gene expression were found for the RAD51, FANCB and FANCA genes. We discuss the clinical and translational significance of these findings. Our results support the usefulness of studying DNA repair as a measure of BC risk. This study also provides a list of candidate DNA repair genes that might be associated with dysregulation of DNA repair in breast cancer.
    02/2014; 1(1). DOI:10.9777/mcb.2013.10006
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    ABSTRACT: This study aimed to estimate the prevalence and correlates of seropositivity to human papillomavirus (HPV)-16 in a subsample of adults who participated in the parent study Epidemiology of Hepatitis C in the adult population of Puerto Rico (PR). The parent study was a population-based household survey aimed to estimate the seroprevalence of hepatitis C and other viral infections (hepatitis A, hepatitis B, HIV, and herpes simplex type 2) in PR (n=1654) between 2005 and 2008. A subsample of the last 450 consecutive adults aged 21-64 years, recruited between February 2007 and January 2008, who participated in the parent study and agreed to participate in HPV testing. The samples were tested by ELISA for HPV-16 viral-like particle-specific immunoglobulin G. Information on sociodemographic, health, and lifestyle characteristics was collected. Logistic regression modelling was used to estimate the prevalence odds ratio (POR) to assess factors associated to HPV-16 seropositivity. Prevalence of seropositivity to HPV-16 was 11.3%. Seroprevalence was higher in women (15.8%) than men (5.6%; p=0.001). After adjusting for age and sex, ever smokers (POR 2.06, 95% CI 1.08 to 3.92) and participants with at least five lifetime sexual partners (POR 2.91, 95% CI 1.24 to 6.81) were more likely to be HPV-16 seropositive. HPV-16 seropositivity is similar to that reported in the USA (10.4%) for NHANES 2003-2004 participants, although different assays were used in these studies. While future studies should evaluate HPV seroprevalence using a larger population-based sample, our results highlight the need to further understand the burden of HPV infection and HPV-related malignancies in PR, population with a low vaccine uptake.
    BMJ Open 01/2014; 4(2):e004203. DOI:10.1136/bmjopen-2013-004203 · 2.27 Impact Factor
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    ABSTRACT: Puerto Rico's (PR) epidemiological data on each oral cavity and pharynx cancer (OCPC) site is yet largely unexplored. Our aim was to compare OCPC incidence in PR, by anatomical site, with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanic (USH) individuals in the USA. Data from the Surveillance Epidemiology and End Results program and the PR Central Cancer Registry were collected and analyzed. Age-standardized rates, percent changes, and standardized rate ratios were estimated with 95% confidence intervals. Although declining incidence rates were observed for most anatomical sites in most racial/ethnic groups and in both sexes, the incidence of oropharynx cancers slightly increased for cancers in the oropharynx among PR women, both in the base of tongue and soft palate/other oropharynx (p>0.05). The incidence of soft palate/other oropharynx cancers in PR men was about 2.8 times higher than in USH men (p<0.05) and about 1.4 times higher than in NHW men but 21% lower than in NHB men (p>0.05). Significant interactions terms formed with racial/ethnic group and age were shown in various sites. The largest differences between sexes were consistently noted in PR. Further research in PR should assess the effect of the HPV infection, as well as of other risk factors, in OCPC incidence by anatomical site in younger populations. These data could explain more precisely the reasons for the differences observed in this study, particularly among sexes in PR.
    Puerto Rico health sciences journal 12/2013; 32(4):175-81. · 0.67 Impact Factor
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    ABSTRACT: The objective of this study was to compare sociodemographic, behavioral and clinical characteristics associated with HIV among Men who have sex with Men (MSM) and men who have sex with women (MSW) in Puerto Rico. Data from a population-based cross-sectional study in PR (2005-2008) was analyzed. Descriptive statistics were used to describe the study sample and bivariate analyses were performed to identify differences of sociodemographic, behavioral and clinical characteristics between MSM and MSW. Exact logistic regression models adjusting for age were constructed for each risk behavior associated to MSM in bivariate analysis. Of the 674 men interviewed, 6.1% (n=41) reported ever having sex with men. Age-adjusted logistic regression models indicated that MSM were significantly more likely than MSW to have first sexual intercourse before the age of 15 (POR=2.6; 95%CI= 1.3, 5.3) and have at least 10 lifetime sex partners (POR=2.8; 95%CI= 1.4,5.9). Also, MSM were significantly more likely to report lifetime use of marihuana (POR=2.7; 95%CI= 1.3,5.8), cocaine (POR=2.5; 95%CI= 1.2,5.0), amphetamines (POR=3.8; 95%CI= 1.4,9.2) and sedatives or tranquilizers (POR=3.3; 95%CI= 1.4,7.2). Also, MSM were 13 times more likely to be HIV seropositive as compared to MSW (POR=13.3; 95%CI=1.7,102.0). In this population-based sample of men living in Puerto Rico, self-reported same-sex behavior is strongly associated with HIV, and other behavioral factors associated with HIV. Future targeted research is still necessary for the development of intervention programs among MSM in Puerto Rico.
    Sexuality Research and Social Policy Journal of NSRC 09/2013; 10(3). DOI:10.1007/s13178-013-0130-9
  • Cancer Research 08/2013; 73(8 Supplement):3610-3610. DOI:10.1158/1538-7445.AM2013-3610 · 9.33 Impact Factor
  • Cancer Research 08/2013; 73(8 Supplement):3619-3619. DOI:10.1158/1538-7445.AM2013-3619 · 9.33 Impact Factor
  • Cancer Research 08/2013; 73(8 Supplement):4159-4159. DOI:10.1158/1538-7445.AM2013-4159 · 9.33 Impact Factor

Publication Stats

487 Citations
206.71 Total Impact Points


  • 1999–2015
    • University of Puerto Rico, Medical Sciences Campus
      • • Department of Biostatistics and Epidemiology
      • • Department of Health Services Administration
      • • Department of Medicine
      San Juan, San Juan, Puerto Rico
  • 2014
    • Ponce School of Medicine and Health Sciences
      • Department of Surgery
      Ponce, Ponce, Puerto Rico
  • 2000–2013
    • Polytechnic University of Puerto Rico
      San Juan, San Juan, Puerto Rico
  • 2009–2010
    • University of Puerto Rico at Humacao
      HUC, Humacao, Puerto Rico
  • 2008
    • University of Puerto Rico at Ponce
      Ponce, Ponce, Puerto Rico