to all of these conditions—conditions that are more accurately emphasized when groups are defined on the basis of ethnic background.

Ethnic groups include individuals who share a unique history different from that of other groups, in addition to other attributes, such as language, customs, ancestry, and religion. Usually, a combination of these features identifies an ethnic group. In the U.S., many groups commonly referred to as "racial groups" may be more accurately referred to as "macro-ethnic" groups. These include "white" Americans of European descent, African Americans, Asian Americans, Hispanics, and Native Americans. It is important to recognize, however, that there is considerable cultural and biological heterogeneity within these groups, and therefore the precision of population-based research can be enhanced by referring to specific subgroups. For example, within the Asian American population, there are many ethnic subgroups, including individuals of Southeast Asian, Korean, Japanese, Chinese, and Indian descent.

Distinguishing many ethnic groups from one another is therefore useful in medical and epidemiologic research, provided that researchers are clear on the nature and source of human variation (e.g., cultural and behavioral patterns, environmental influences, and genetic variation) and their relationship to health outcomes. Researchers must therefore use caution in interpreting the sources of observed differences between these groups. Ultimately, greater precision in understanding and describing human diversity is needed to distinguish genetic and environmental contributions to cancer risk and the complex effects of the gene-environment interaction. This precision can be improved with greater clarity in the conceptualization and definition of population groups.

The views of AAA are pertinent to this approach. AAA recognizes that classical racial terms may be useful for many people who prefer to use such terms about themselves with pride, but it recommends phasing out the term "race" and recommends that it be replaced with more correct terms related to ethnicity, such as "ethnic origin," which would be less prone to misunderstanding (American Anthropological Association, 1997).

Recommendation 2-4: The committee recommends an emphasis on ethnic groups rather than on race in NIH's cancer surveillance and other population research. This implies a conceptual shift away from the emphasis on fundamental biological differences among "racial" groups to an appreciation of the range of cultural and behavioral attitudes, beliefs, lifestyle patterns, diet, environmental living conditions, and other factors that may affect cancer risk.

This change should not be difficult because, under the present arrangements,

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