The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved

Supports research projects in cancer control.
Supports a national network of cancer centers.
Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.
Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.
Collects and disseminates information on cancer.
Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants (National Cancer Institute, 1998d).

Although NCI directs a large and comprehensive program of cancer research within its portfolio and collaborates with other groups on research or cosponsors other cancer research at other ICDs, the committee finds that there is little evidence of a strategic plan for cancer research relevant to ethnic minority and medically underserved populations at NIH coordinated through NCI or any other central mechanism, as noted below.

This section describes the range of ongoing cancer-related research and programs at NCI and other ICDs, summarizes cancer-related research programs at NCI and other ICDs that are relevant to ethnic minority and medically underserved populations, and reviews the funding for these programs. Particular emphasis is placed on the programs and functions of NCI, given its stated role in coordinating cancer-related research at NIH.

Overview of NIH Appropriations and Funding for Cancer Research

Over the past decade, NIH and NCI have enjoyed significant increases in congressional appropriations, from periods of little to no growth in the early 1980s to steady increases in the mid-1990s (Figure 3-1). NCI experienced a slight decline in its budget from 1980 ($1 billion) to 1983 ($987.6 million), but by 1986 the Institute's budget reached $1.26 billion, and it had reached nearly $1.6 billion by the end of the decade (National Cancer Institute, 1998e). Annually, nearly 80 percent of the institute's budget is dedicated to research, whereas approximately 10 percent of the budget is allocated toward both resource development and cancer prevention and control activities. In fiscal year (FY) 1997, $1.411 billion was allocated for research grants, including $577 million for investigator-initiated grants (R01 grants) and $132 million for cancer center grants. More than $412

Table of Contents

Front Matter R1-R14

Executive Summary 1-15

1 The Struggle Against Cancer 16-32

2 The Burden of Cancer Among Ethnic Minority and the Medically Underserved Populations 33-92

3 Overview of Programs of Research on Ethnic Minority and Medically Underserved Populations at the National Institutes of Health 93-153

4 Evaluation of Priority Setting and Programs of Research on Ethnic Minority and Medically Underserved Populations at the National Institutes of Health 154-186

5 Advancing State-of-the-Art Treatment and Prevention 187-229

6 Cancer Survivorship 230-245

7 Monitoring and Reporting 246-260

References 261-274

Appendix A: Methodology 275-281

Appendix B: A New Agenda for Cancer Control Research: Report of the Cancer Control Review Group 282-282

Appendix C: National Cancer Institute Health Promotion Branch Publications and Public Service Announcements 283-284

Appendix D: Survey of Ethnic Minority Researchers and of Researchers Interested in Cancer Among Ethnic Minority and Medically Underserved Groups 285-292

Appendix E: National Institutes of Health and National Cancer Institute Background Material 293-294

Appendix F: Information Provided by the National Center for Health Statistics on the Potential Reductions in Mortality from Cancer, by Ethnic Group 295-314

Committee and Staff Biographies 315-322

Index 323-338

Overview of NIH Appropriations and Funding for Cancer Research