Recommendation 11: Public and private initiatives to reduce disparities in the cancer burden (e.g., initiatives of the National Cancer Institute and the American Cancer Society) should be supported.

There are glaring disparities in rates of morbidity and mortality from cancer between socioeconomic groups, insured and uninsured populations, and certain racial and ethnic groups (IOM, 1999b). The differences among these various groups present both a challenge in terms of understanding the reasons and an opportunity in terms of reducing the burden of cancer (US DHHS and Office of Disease Prevention and Health Promotion, 2000). Lack of health insurance coverage is a key predictor of lower rates of use of cancer screening tests. Other psychological and sociocultural factors may also be at play. Personal barriers can include cultural differences, language barriers, not knowing what to do or when to seek care, or concerns about confidentiality or discrimination (US DHHS and Office of Disease Prevention and Health Promotion, 2000). In a nation of increasing diversity, interventions to improve cancer prevention and early detection must accommodate different languages, cultural values, and beliefs.

The elimination of racial and ethnic disparities in health is an over-arching goal of Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000), and an ongoing initiative involving agencies of the U.S. Department of Health and Human Services is in place. Cancer screening and management is one of six focus areas of the initiative (http://raceandhealth.hhs.gov/sidebars/sbinitOver.htm). The National Institutes of Health (NIH) has drafted a trans-NIH, 5-year Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities (www.nih.gov/about/hd/strategicplan.pdf), and in December 2000 NCI established the Center to Reduce Cancer Health Disparities (http://crchd.nci.nih.gov) to implement the NCI Strategic Plan to Reduce Health Disparities. Through this initiative, NCI aims to understand the causes of health disparities as they relate to cancer and develop effective interventions to eliminate these disparities. Specific initiatives and an action plan have been developed for each of the five objectives outlined in the strategic plan (http://www.cancer.gov/announcements/healthdisp.html):

  1. expand the capacity to conduct fundamental cancer control and population research to elucidate the determinants of cancer-related health disparities;

  2. expand the ability to define and monitor cancer-related health disparities;

  3. support intervention research in prevention, early detection, treatment, and communications that may reduce cancer-related health disparities;

  4. expand the channels for research dissemination and diffusion and



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