progress against cancer. Decreasing rates of death from cancer reflect improvements in both prevention and treatment. Rates of mortality from cancer were steadily increasing in the United States since they were first measured by the SEER program in 1973. However, the recent "Report Card to the Nation" on progress against cancer indicates that this trend was reversed for the first time during 1991–1995, when a decrease in overall cancer mortality in the United States could be shown (Wingo et al., 1998). However, this may not reflect trends in the cancer burden experienced by ethnic minorities and underserved groups.

SEER program data are the major source for cancer survival statistics in the United States, and one of the biggest accomplishments of the War on Cancer has been the ability to measure improvements in the rate of survival among patients with some cancers (American Cancer Society, 1997). Advances in diagnosis and treatment have improved the overall rate of survival among these populations from one in four cancer patients in 1930 to one in two patients today.

Today, no single database provides information on incidence, mortality, and survival data on all cancer cases in the United States. Therefore, SEER program data are frequently used as an estimate of cancer rates in this country. Data from the SEER program are used by legislators, health professionals, advocacy groups, educators, patients, and the public to guide cancer prevention and control efforts, and to allocate funds for research and treatment based on the assumption that SEER program data can be extrapolated to geographic areas and populations not covered by the SEER program. Unfortunately, this assumption does not hold for ethnic minorities and medically underserved populations. It is important that cancer surveillance information truly reflect the national populations for which programs are to be developed if the War on Cancer is to be effective.

Cancer Burden Among Ethnic Minority and Underserved Populations—Existing SEER Program Data

Cancer can strike persons of any age, race, gender or SES. However, the occurrence of cancer, mortality rates, and length of survival can vary from group to group. In fact, research suggests that the cancer experience of ethnic minorities and underserved populations is very different than that of the majority of Americans. Data collected by the SEER program were used to target cancer prevention and control efforts in minorities beginning in 1985, when then Secretary of Health and Human Services Margaret M. Heckler noted a "stubborn disparity" in the cancer experience of minorities in comparison to the nation as a whole (U.S. Department of Health and Human Services, 1985). The SEER program registry



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