recently published survival data for minorities other than African Americans is from the 1978 to 1981 SEER program registry and is therefore nearly 20 years old. These data suggest that the rate of survival from cancer is much poorer among minorities and that additional follow-up is needed. The most recent SEER program monograph to address racial and ethnic patterns of cancer (1988 to 1992) evaluates survival rates only among African Americans and whites. In addition, the reported SEER program data do not adequately address patterns of cancer survival among medically underserved white populations.

Recommendation 2-3: Annual reporting of cancer surveillance data and population-based research needs to be expanded to include survival data for all ethnic groups, as well as for medically underserved populations.

Human Diversity, Population Groups, and Cancer

As noted earlier in this chapter, NCI's population-based data collection efforts are shaped by Directive No. 15 of the OMB, which stipulates that the U.S. population be classified according to one of four basic "racial" categories (American Indian or Alaska Native, Asian or Pacific Islander, black or African American, or white) and one of two ethnic groups (Hispanic or non-Hispanic). Although these classifications carry important historical, social and political significance in the United States, they are of limited utility for purposes of health research because the concept of race rests upon unfounded assumptions that there are fundamental biological and behavioral differences among racial groups (Cooper, 1984; Williams, Lavizzo-Mourey, and Warren, 1994; President's Cancer Panel, 1997; American Anthropological Association, 1998). In reality, human diversity cannot be adequately summarized according to the broad, presumably discrete categories assumed by a racial taxonomy. Furthermore, "racial" groups as defined by OMB are not discernible on the basis of genetic information (President's Cancer Panel, 1997; American Anthropological Association, 1998).

Although the four racial groups defined by OMB are broad and imprecise, and greater genetic heterogeneity exists within groups than between groups, health researchers may nonetheless benefit from understanding differences in health status between these groups. Health differences between "racial" groups may be due to many factors, including discrimination in the health care system, limited access to prevention and treatment services, poverty and socioeconomic factors, exposure to environmental toxins, and cultural factors, such as attitudes about health, beliefs, diet, and lifestyle patterns. Health is therefore a biological response



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