group. The decline in colorectal cancer among all ethnic groups is also not satisfactorily explained.

The report was immediately challenged by the Intercultural Cancer Council (ICC) on the grounds that the database from which the statistics were drawn had major blind spots that leave nearly half of the U.S. population, especially minority and poor individuals, undercounted (Intercultural Cancer Council, 1998). ICC urged that the director of NCI follow his commitment to place a high priority on achieving better statistics on the rate of cancer among these populations.

The director of NCI, Richard Klausner, presented a more optimistic note to Congress. He pointed out that the problem of cancer among ethnic minority populations is not monolithic but varies by ethnic group, gender, and disease site, with some ethnic groups having lower rates of some cancers than the overall population. When questioned by Representative Louis Stokes about the disparity in the rate of mortality from cancer among African Americans, Klausner noted that there had been a decline in mortality among African Americans. When questioned about the Institute's ability to make good use of increased funds, Klausner stated, "We know cancer is a complicated puzzle, but I actually believe we know what we need to do to push us much farther to knowing what the puzzle looks like. I don't know how long it will take to finish, and I don't know what we will find, but we really do know what to do" (The Cancer Letter, 1998, p. 4).

The Healthy People 2000 Review

Another way of assessing progress is on the basis of the Healthy People 2000 cancer objectives. NCI organized the progress review for a meeting chaired by the Surgeon General on April 17, 1998. That review focused on the 17 objectives in the Healthy People 2000 cancer priority area (U.S. Public Health Service, 1991). In 1995, the year 2000 target for overall death rates from all forms of cancer was achieved with the finding of a rate of 130 cases reported per 100,000 population. In 1995, the death rate among African Americans had exceeded the year 2000 target of 175 by reaching 172 per 100,000 population. Deaths from cervical cancer, however, were continuing to rise among African-American and Hispanic women to levels of 5.2 and 3.1 per 100,000 population, respectively, whereas the death rate from cervical cancer for all females was 2.5 per 100,000 population in 1995. This increase was disturbing, given that with the present state of knowledge, death from this form of cancer is practically preventable. The decrease in deaths from colorectal cancer exceeded the year 2000 target. Smoking rates among African Americans, Hispanics, and American Indians



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