information dissemination services, served as the focal points of the committee's inquiry, along with other institutes and centers (ICs) of NIH that collaborate with NCI on cancer-related research. Although NCI holds the lead role in the development and implementation of the National Cancer Program, other federal agencies, such as the Centers for Disease Control and Prevention (CDC), the U.S. Department of Veterans Affairs (VA), the U.S. Department of Defense, and others perform related cancer prevention, control, and information collection and dissemination services, and therefore share responsibility with NIH for making improvements in the nation's health. The work of these other agencies lies outside of the purview of this committee, but they are critical components of the National Cancer Program and need to be incorporated into the National Cancer Plan.

Findings and Recommendations

To address the study charge, the committee reviewed extensive information provided by NIH and NCI staff, and received input from outside of NIH via a panel of community representatives and a survey of researchers interested in cancer among ethnic minority and medically underserved populations. The committee's recommendations are listed in Box 1.

Determining the Burden of Disease: Cancer Surveillance and Risk Factor Research

The development of sound cancer prevention and control strategies begins with an all-encompassing cancer surveillance effort. Differences in rates of cancer among various population groups detected by cancer surveillance efforts can lend clues to etiologic factors (e.g., environmental exposures, genetic susceptibility, and dietary patterns) and can therefore point to intervention and prevention strategies. In addition, disparities in cancer survival rates can lend clues to inequities in health care service accessibility and delivery, or cultural factors affecting individuals' attitudes toward the health care system. Studies of differences in the cancer experiences of various groups also have the potential to benefit the entire U.S. population, as policies and practices associated with groups that are at lower risk for cancer may be applied to those populations at greater risk.

NCI's data collection and surveillance efforts are shaped by Directive No. 15 of the U.S. Office of Management and Budget (OMB), which stipulates that the U.S. population be classified according to one of four basic ''racial" categories (American Indian or Alaska Native, Asian or Pacific Islander, black or African American, or white) and one of two ethnic groups (Hispanic or non-Hispanic). Although these classifications carry



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