identify HIV-infected individuals who are at risk for rapid disease progression and who may benefit from early therapeutic intervention, thereby reducing associated cancer risks. In addition, NCI and the National Institute of Child Health and Human Development are sponsoring research to reduce the rate of mother-to-infant transmission of HIV.

Several studies are under way to understand adult T-cell leukemia (ATL) and human T-cell lymphotropic virus type I (HTLV-I) and type II (HTLV-II) infection. ATL and infection with its causal agent, HTLV-I, are more common among African Americans than among whites. NCI staff seek to define host susceptibility to infection and modes of transmission of HTLV-I and improve surveillance of ATL patients. Epidemiologic studies are also conducted to better understand the modes of transmission of HTLV-II. Similarly, Category I and II studies are being conducted to assess the roles of Epstein-Barr virus in Hodgkin's disease among Hispanic patients, Burkitt's lymphoma among Ghanaians, and gastric cancers among Japanese Americans. DCEG and DCP staff are also studying the relationship of HPV and the etiology of lymphoma, hepatocellular cancer, and cervical cancer in American Indians.

DCEG staff are also engaged in studies of occupational exposure to hazardous agents and cancer risk. These Category I studies examine links between exposure to chemical and other environmental agents across a range of occupations, racial and ethnic groups, and socioeconomic backgrounds, given that lower-income and ethnic minority workers are often exposed to carcinogens at higher levels. A number of studies assess cancer risks for farmers or individuals living in rural areas and have found excess incidence rates for several cancers. Another project assessed the feasibility of conducting studies on cancer risks among migrant workers of African, Hispanic, and Asian backgrounds. In addition, intramural staff are working in collaboration with investigators at the University of Minnesota to assess the linkages between occupational and environmental risk factors among women in Shanghai, China.

Access to Care and Cancer

NCI has attempted to stimulate research on patterns of health care, cancer, and variations by socioeconomic differences and racial and ethnic groups. This research also attempts to identify barriers to state-of-the-art diagnosis and care for patients in rural areas.

NCI sponsored two workshops, one in 1989 and another in 1992, on patterns of care and the economic and social burdens of cancer on families. In addition, NCI issued a program announcement to improve the understanding of the economics of cancer care. "Grants funded under this Program Announcement," according to an NCI report, "include studies



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