Differences in breast cancer screening practices among elderly women in various ethnic groups have been examined in an NCI-supported study to measure the effect of legislation allowing Medicare reimbursement for breast cancer screening. Analyses comparing African-American and white women's usage patterns are ongoing. In addition, NCI has sponsored a national survey of mammography facilities to understand the characteristics of mammography services and providers and participation in price-subsidized programs for low-income women. NCI classifies these studies as Category I and II studies.

NCI is also supporting a Category I study to develop and validate needs assessment instruments to measure the effectiveness of cancer control methods among American Samoans. This project will develop a culturally sensitive survey instrument to assess knowledge and attitudes regarding cancer among a sample of American Samoans in Los Angeles, Hawaii, and American Samoa.

Studies That Use Databases

DCCPS sponsors several population-based studies relevant to ethnic minority populations. The Black/White Cancer Survival Study, begun in 1983, investigates the role of "social, behavioral, lifestyle, biological, treatment, and health care factors as contributors to the observed differences in survival" among African-American and white cancer patients (National Cancer Institute, 1998b, p. 18). NCI notes that several publications have developed from this study, which followed 3,400 individuals with breast, colon, corpus uteri, or urinary bladder cancers. In addition, SEER program and Medicare data have been used by DCCPS staff to examine patterns of care and costs of cancer treatment, in some studies according to clinical and sociodemographic factors. These studies are described by NCI as Category I and II studies.

Several SEER program special studies are ongoing. They report on data on patterns of care and treatment outcomes among white and non-white populations collected as part of the SEER program. One project reports on differences in treatment outcomes for African-American and white men with non-metastatic prostate cancer and has found differences related to race and socioeconomic status. Another study examines quality-of-life issues for Asian-American and Pacific Islander cancer survivors. Another series of studies examines trends in treatment for early-stage breast cancer by age, race, geographic region, and socioeconomic characteristics. Similarly, the Prostate Cancer Outcomes Study provides information about diagnostic and treatment practice patterns for prostate cancer and describes health-related quality of life according to geographic region, racial or ethnic subgroup, income, education, and health insurance status of



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