dietary intakes alter environmental risk factors. Such effects may be responsible for differences in breast cancer among racial and ethnic groups who may have risks related to genetic polymorphisms and excessive exposures.

PRIORITIES AND SPECIAL POPULATIONS: TIES THAT BIND

Armin Weinberg, Ph.D.

It becomes clear as we examine charts and data on health such as the those in Healthy People 2000 that socioeconomic status (SES) plays a role in cancer and many other health care issues. Individuals and groups with a higher SES (1) can obtain better housing, (2) can live in better neighborhoods, (3) have opportunities to engage in healthy behaviors, (4) have better access to health care, and (5) can more readily participate in clinical trials. Thus, in order to understand clinical data as it relates to gene–environment interactions, we need to include analysis of the communities and SES.

Studies today use descriptive phrases such as “special populations,” “priority populations,” and “vulnerable populations.” These terms are used extensively in research and discussions, but there is a great diversity of opinion as to their definition. As we continue to use these phrases in our communities, research will have to refine the definitions to better describe—not label—these groups. Additionally, they will have to provide a certain degree of flexibility to accommodate the subgroups that emerge.

More than 2,500 individuals immigrate to the United States each day—a trend that complicates gene–environment research. Many of these individuals are from Latin America and Mexico, as well as other countries throughout the world. As we start to include these foreign-born residents in our studies, we must pay attention to the fact that these individuals are mostly young and have had different exposures in their country of origin at a time when they were most vulnerable. Additionally, migratory patterns have shifted in the United States as individuals from different countries or regions of a country immigrate distinctly to geographic regions in the United States.

The NCI’s national special population networks have been formed to consider factors related to these and other issues. The steering committee for one network Radas En Acum, which has research sites in California, Illinois, New York, Florida, and Texas, was formed to help establish both a research agenda and research priorities. In addition to the genetics and the gene–environment issues, language and health literacy will require special attention. As we try to close the gap in enrollment in clinical trials, these other issues will become more important. We will have to be sensitive to cultural differences in these communities and ensure that material is available in many languages. Further, as we talk to communities about gene–environment interactions, we must communicate what this means, what we want, and what we hope to learn.



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