those in underserved situations, we find that declines in cancer incidence and death have not occurred for all populations" (National Cancer Institute, 1998b, p. 1).

Acknowledgment of the role of "burden of disease" in guiding NCI program direction and the acknowledgment that declines in cancer incidence and death have not occurred for many minorities are significant in view of a recommendation of the NCI Special Action Committee's 1996 report, which led to the creation of OSPR. In that report, the committee also recommended that "the NCI research portfolio needs to be [data driven and] reviewed with a focus on the cancers noted as significant in the minority cancer statistics monograph. Cancers that disproportionately affect special populations should be carefully examined to identify research opportunities…. [T]he results of such a review should be discussed in the broader context of NCI's mission under the auspices of the National Cancer Advisory Board and the Boards of Scientific Advisors/Counselors" (National Cancer Institute, 1996a, p. 11). The committee concurs with this recommendation, as will be discussed below in greater detail in a review of NCI and NIH mechanisms for research priority setting.

Recommendation 4-3: For NCI to address the needs of ethnically diverse and medically underserved populations effectively, the Office of Special Populations Research (or some other designated entity or entities) must possess the authority to coordinate and leverage programs and resources across the divisions and branches of NCI to stimulate research on ethnic minority and medically underserved populations. This authority can be established by providing such an office with:

  • a leadership role in major NCI-wide priority-setting bodies and
  • special resources to fund programs specifically targeted to these populations, or
  • accountability for the institution-wide allocation of program resources.

Special Populations and Priority Setting at NCI

The evaluation of priority setting for research on cancer among special populations must be undertaken against the backdrop of three basic considerations. First, the fundamental missions of NCI and NIH frame the larger public policy context within which issues such as the types of research and levels of funding commitment for special populations should be judged. Second, a clear and persuasive rationale for any special research



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