underserved groups, behavioral and social science research should be expanded, particularly with respect to prevention and outreach efforts. Lerman et al., (1997) note that approximately 65 percent of cancer deaths are attributable to behaviors such as smoking, sexual risk behavior, and to factors such as diet. For example, over the past half-century, more than 300,000 women have died from cervical cancer, including a disproportionate number of women from ethnic minority and medically underserved backgrounds, even though the technological tools have been available since the 1940s to vastly decrease mortality due to cervical cancer. Similarly, greater research is needed to illuminate barriers to cancer care (Chapter 5) and strategies to overcome them.
Although the committee does not seek to imply that NCI's research resources should be allocated entirely on the basis of likely etiologic factors, it is noteworthy that the NCI division with primary responsibility for funding behavioral and population-based research, DCCPS, allocated approximately $21 million to "minority health and assistance programs" in FY 1997 (as noted above, this figure is based on a percent relevancy calculation, which suggests that many projects were not specifically targeted to ethnic minority and medically underserved populations). This figure represents approximately 17 percent of the total NCI funding for MHAPs and is likely an inflated estimate of funding for behavioral and social science research, given that a large percentage of DCCPS's resources are allocated to important programs such as the SEER program and other nonbehavioral research.
The agenda for such research should be based on an analysis of the prevalence of particular cancers in these population and their preventability (Chen, 1994). Particularly for ethnic minority populations, this research should include investigations of ethnically appropriate interventions, including culturally competent and linguistically appropriate approaches. In addition, more research is needed on barriers to cancer care among these populations, and strategies to overcome them.
Recommendation 3-4: The newly established program of behavioral and social science research at NCI addresses an area of research that has been neglected in the past. The committee urges that this program of research identify as one of its highest priorities a focus on the cancer prevention, control, and treatment needs of ethnic minority and medically underserved groups.
Such focused research will require collaboration and coordination between DCCPS and the NCI Divisions of Cancer Prevention and Cancer Treatment. As will be discussed in Chapter 4, coordination of this research