necessary data from the cancer incidence registries. Data may come from other databases such as those that are part of the Medicare program, but in that case, it would also be necessary to extrapolate the data to the general population. There may also be some differences of opinion about what should characterize the status of medically underserved individuals. Possible factors could include socioeconomic status, access to care, or occupation. The National Center for Health Statistics (NCHS) is already exploring ways of providing such information, as reported in Health United States, 1998 (National Center for Health Statistics, 1998).

Ideally, it would be best if the medically underserved status could be displayed in the same table with the ethnic group status, since the medically underserved status would cut across all ethnic groups. In that case the data for medically underserved and non-medically underserved individuals would be shown for each ethnic group. For the sake of clarity, however, it might be best to show the relationship between the two variables and cancer in separate tables, and until the data for medically underserved individuals can be incorporated into source documents, it may be necessary to obtain the information by performing special studies or by linkage with other databases.

Many Cancer Sites

Cancer is not a single disease, and the complexity of the disease combined with the increasing diversity of the population makes it necessary to group various forms of cancer for purposes of planning and control, in the same way that it is necessary to aggregate smaller ethnic groups into macro-ethnic groups. It is customary to focus on those forms of cancer that present the greatest risk because of the magnitude and severity of the problems involved. In recent years the major causes of death from cancer in the United States among all ethnic groups have been cancers involving the lung, female breast, prostate, and colon-rectum. It is important that these forms of cancer be identified when one attempts to assess progress against cancer for the nation as a whole. If one ranked the top five causes of death for each ethnic group, however, the list would be different for each ethnic group, and herein lies the importance of monitoring and reporting on cancer among different ethnic groups. Cancer of the cervix, for example, is not among the five leading causes of death among white women, but it is among African-American women. It may also be among the top five for white women who are medically underserved, but this group is not currently considered in reports of the causes of death. Cancer of the breast is the leading cause of cancer death among Hispanic women, but cancer of the lung is the leading cause of cancer death among white women. If one groups the categories by giving priority to the burden of



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