. "5 Advancing State-of-the-Art Treatment and Prevention." The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington, DC: The National Academies Press, 1999.
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trials to test the effectiveness of various chemoprevention strategies and cancer screening methodologies in reducing cancer incidence and mortality. The ALTS cervical cancer screening trial assesses the screening and management of minor Pap smear abnormalities. Four sites are involved in this trial, including the University of Pittsburgh, the University of Alabama at Birmingham, the University of Washington, and the University of Oklahoma. The PLCO screening trial is a large-scale, prospective randomized study to determine whether screening for these types of cancers will reduce the rate of associated morbidity (all four types of cancers account for nearly half of all cancer deaths in the United States). Ten centers around the United States are participating in this trial. To increase the rate of accrual of ethnic minorities, two screening centers focused on the recruitment of ethnic minorities were to be added in 1998, in addition to a new center cosponsored by the Centers for Disease Control and Prevention (CDC) to focus on the recruitment of African Americans. CDC is also working with the Henry Ford Health System in Michigan and the University of Pittsburgh PLCO screening trial center to identify effective methods for increasing the rate of recruitment of ethnic minorities and reducing barriers to participation. PCPT includes 222 sites across the United States and is coordinated by SWOG; its purpose is to test whether the drug finasteride will prevent prostate cancer in a randomized trial involving 18,000 men. Finally, BCPT is a randomized, double-blind trial that will assess whether the drug tamoxifen can prevent breast cancer in women at increased risk of developing the disease. More than 13,000 women were recruited from nearly 180 sites for this trial, managed by the National Surgical Adjuvant Breast and Bowel Project.
Data provided by NCI on the rates of accrual of subjects as of February 1998 for these trials indicate that only one trial, ALTS, experienced success in recruiting ethnic minorities. ALTS reports that of the 1,910 women enrolled, 1,102 (57.7 percent) are non-Hispanic whites, whereas 629 (32.9 percent) are African American. Recruitment of other minority groups into this trial, however, is inconsistent: of the women enrolled in the trial, only 65 individuals (3.4 percent) are identified as ''white Hispanic" (no data are provided for non-white Hispanic groups), an additional 3.7 percent are Asian, and 2.25 percent are identified as American Indian or Alaska Natives. Figure 5-3 depicts these accrual patterns.
The PLCO trial screens patients for three cancers simultaneously, including prostate, lung, and colorectal cancers for male patients and lung, colorectal, and ovarian cancers for female patients. Of the more than 80,000 participants in this trial, 72,000 (88.9 percent) are white, 3,546 (4.4 percent) are African American, 1,135 (1.4 percent) are Hispanic, 3,505 (4.3 percent) are Asian American, 439 (0.5 percent) are Pacific Islander, and 151 (0.2 percent) are American Indian or Alaska Natives. The rate of