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In terms of disparities, the Navigator Program was actually designed to address the disparity issue, and, using unpublished data from the American College of Surgeons National Cancer Database, Elizabeth Ward has compared educational levels of cancer patients with survival data and found that mortality is inversely related to education level. Education level is more important than income in terms of determining survival, and this is not just true for cancer.

We think the Navigator Program will help these people navigate the system better than they would if they were alone. We also are looking at establishing a national vice president for disparities, because one of the internal complaints that we have had is that, although we talk about doing something about disparities, we have not done a great deal so far.

Ms. Boyle: In terms of the earlier comment about culture, I just tried to review the literature on breast and prostate cancer specific to African Americans in getting ready to do a talk in South Carolina, and there is very little. So it is another area where there is a big question mark.

Dr. Robinson: There is a website by the Office of Minority Health Resource Center, HtmlResAnchor, that has information from the different racial and ethnic groups on different health topics, including cancer, with statistics on various cancers in the major racial and ethnic minority groups. I do not recall specifically if there is detail about age groups.

Dr. Silliman: The age structure of many of these minority populations, such as Hispanics, is younger. Only about five percent of older breast cancer patients with early-stage disease are African American, and this sort of thing makes the numbers problematic for studies in one geographic location. So you need to have integrated health systems or take advantage of SEER-Medicare data. Those are some of the challenges, not to say it is not really important. In integrated health plans such as Kaiser where people have uniform coverage, the disparities are nonexistent.

Dr. Moses: Concluding Remarks and Adjourn: I would like to thank all the speakers and the discussants. It has been a good day, and when it is written up I think it will make a good report. Many thanks to all of you.

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