Lifting the Unequal Burden of Cancer on


Minorities and the Underserved


NCI Develops Strategic Plan to Reduce Cancer-Related Health Disparities 

By Houkje Ross


Closing the Gap, Cancer • August 2000


The National Cancer Institute (NCI) recently unveiled a major 

new effort to identify and address the underlying causes of 

cancer-related disease and disability in racial and ethnic minority and underserved communities throughout the country. As 

part of this effort, NCI appointed renowned cancer researcher Harold 

P. Freeman, MD, as associate director for reducing health disparities. 

Dr. Freeman will ensure implementation of a strategic plan, released in 

May 2000, which aims to improve efforts to understand and reduce 

the cancer disparities seen in many minority and underserved populations. 

“Addressing the unequal burden of cancer has never been more 

important,” said NCI Director Richard Klausner, MD, in announcing the Freeman appointment. National data and reports from the 

Institute of Medicine (IOM), NCI, and other sources document the 

extent of the problem. 

This year, the American Cancer Society (ACS) estimates that over 

1.2 million cases of cancer will be diagnosed. The disease is now the 

second leading cause of death among Americans and is expected to 

creep up to number one, according to NCI. Many racial and ethnic 

minorities, and other medically underserved groups are more vulnerable to the disease, and some forms of cancer are seen at much higher 

rates in these populations. 

For example, although the rate of breast cancer in African Americans is not as high as in white women, African American women are 

more likely to die from the disease once it is detected. Hispanic and 

Vietnamese women have some of the highest rates of cervical cancer, 

while many American Indians experience the lowest survival rates of 

any other population 

Some disparities can be explained by late diagnosis, lifestyle factors, and access to health care. But researchers still need to be asking 

the right questions when it comes to certain ethnic and minority 

groups, said Moon Chen, PhD, professor and chair of the College of 

Medicine and Public Health, Ohio State University. “Like why do 

smoking rates increase for Asian American women the longer they 

have been in this country, but the rates go down for Asian American 

men?” Dr. Chen asked. The NCI strategic plan will help answer these 

types of questions. 

NCI’s plan to improve programs for minorities and the medically 

underserved 

Part of the National Institutes of Health, NCI carries out research 

on the prevention, detection, treatment, and control of cancer. NCI’s 

strategic plan to reduce cancer health disparities follows thoughtful 

review of the IOM report, 

The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Minorities and the Medically 

Underserved. The report reviewed programs within 

NCI that specifically target minorities and other medically underserved groups. 

The report made recommendations to NCI as to where the agency 

could improve its efforts in understanding the causes of health disparities in cancer. 

NCI’sresponse, the Strategic Plan to Reduce Health Disparities, 

sets objectives in five major areas, including expanding research on the 

determinants of cancer-related disparities; expanding capacity to define and monitor these disparities; strengthening research on prevention, early detection, treatment and communications; improving research dissemination and collaborations that will translate research 

into practice; and strengthening professional education and training, 

and working to increase the numbers of minority scientists. 

Some of the specific initiatives included in the NCI plan are: 

•	 Expand the Surveillance, Epidemiology and End Results (SEER) 

Program. NCI will expand SEER to include populations that are 

currently underrepresented. These include non-Mexican Hispanics, rural African Americans, and American Indians. If feasible, NCI will also provide technical assistance and training to 

non-SEER population-based registries. 

•	 Expand cancer communications survey re-search. NCI will conduct a biennial Health Information National Trends Survey 

(HINTS) of a nationally representative sample of the United 

States, with underserved populations over-sampled. This will 

help identify the cancer information seeking strategies and needs 

of the American public. HINTS will be the first nationally representative longitudinal analysis of the public’s access to and use of 

health information. The survey will provide a clear picture of 

both current and emerging trends in cancer information seeking 

practices, needs, channel utilization, channel preferences, and 

source preferences. 

•	 Redesign the clinical trials system. NCI will improve its efforts to 

recruit and retain minorities, underserved populations, and the 

elderly in clinical trials and tailor its approaches to address linguistic and cultural differences so that interventions developed 

can be applied to sub-populations. 

•	 Increase collaborations with minority professional organizations. 

The NCI and the National Medical Association (NMA) have a 

successful collaboration to increase participation of minority medical professionals in NCI-sponsored clinical trials. NCI will aim to 

in-crease both the number of NMA physicians involved in the 

current collaboration and the dialogue with Hispanic, Asian, and 

other professional groups. 

•	 Strengthen training in minority colleges and universities. NCI 

will facilitate participation of minority students and 

faculty of minority schools, support promising young 

continued>>>> 

Office of Minority Health Resource Center	 1 U.S. Department of Health and Human Services 
Lifting the Unequal Burden of Cancer on


Minorities and the Underserved


NCI Develops Strategic Plan to Reduce Cancer-Related Health Disparities 

By Houkje Ross


Closing the Gap, Cancer • August 2000


minority high school and undergraduate minority students, and 

attract underrepresented minorities into cancer-related research 

activities. 

•	 Develop special partnerships. This initiative will model how to 

best reduce health disparities in underserved communities through 

re-search dissemination and diffusion. A partnership program 

with the ACS and Centers for Disease Control and Prevention 

(CDC) will focus on community-based needs assessment, and 

how to set priorities for program implementation based on local 

needs, intervention evidence, and local resources. Special partnerships will be developed with local and regional public health 

organizations to help develop the program. 

•	 Other initiatives. NCI has recently developed the Expanded 

Participation Project and the Special Populations Networks. 

Overseeing implementation will be Dr. Freeman, currently chairman of the President’s Cancer Panel, a three member board that reports directly to the President of the United States. Known as one of 

the first scientists to point out the relationships between race, poverty, 

and cancer, Dr. Freeman is a past President of the ACS, and for 25 

years was director of surgery at New York’s Harlem Hospital before 

taking his current post as president and CEO and director of surgery 

at North General Hospital in New York City. 

Armin Weinberg, PhD, former chair of the Intercultural Cancer 

Council (ICC), a multicultural coalition that helped promote the 

initiation of the IOM study, said he is optimistic about NCI’s plan, 

especially if the institute does a good job of monitoring it. “NCI has 

made significant changes in its infrastructure and has taken major 

steps to be responsive to the IOM report,” said Dr. Weinberg. “The 

ICC stands ready to work with and give input to NCI on its goals to 

better understand cancer disparities.” 

“We also look forward to working with the CDC, Health Resources and Services Administration, and the Office of Minority Health 

to improve education, outreach, access, research, and training to help 

those organizations fulfill their missions while we fulfill ours,” Dr. 

Weinberg said. 

“NCI has taken the IOM report very seriously and we are starting 

to see benefits from it,” said Dr. Chen. 

To obtain the full strategic plan, contact Susan Sieber, director of 

communications, NCI (301) 443-5946, or view it on Web: http:// 

www.nci.nih.gov/ announcements/healthdisprpt.pdf. NCI invites comments on the strategic plan.

Office of Minority Health Resource Center	 2 U.S. Department of Health and Human Services