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Black death: a man at last September's cancer march in Washington pleads for more research. Credit: AP/KHUE BUI

The US National Cancer Institute (NCI) is falling short on work with ethnic minorities and the poor, according to a report from the Institute of Medicine (IOM). The report claims that the NCI devoted only 1 per cent of its $2.4 billion budget on strategic planning, data collection and spending on research in this area in 1997 — although the NCI disputes this figure.

The higher incidence and death rate of some cancers among ethnic minorities and the poor require more action by the NCI and the National Institutes of Health (NIH), according to the report, released last week. It was requested in 1997 by the Senate appropriations subcommittee that funds the NIH.

“It is critical that we learn why some ethnic minorities and the medically underserved are more prone to cancer and less likely to survive it,” says Alfred Haynes, chair of the committee that wrote the report, and former president and dean of the Drew Postgraduate Medical School in Los Angeles.

But some of its conclusions were challenged by NCI officials. Director Richard Klausner said that, far from lacking a strategic plan for minority research, the NCI has “a very active, dynamic and visionary planning process” that includes minority concerns.

The report notes that the rate of prostate cancer is 15 per cent higher in African American white men. African American women who develop breast cancer are more likely to die from it than white women. Asian Americans get stomach and liver cancer at higher rates than whites, and cervical cancer is highest in Hispanic and Vietnamese American women. Poor whites, it adds, face similar problems; for instance, rates of lung cancer are higher in Appalachia than elsewhere.

“No blueprint or strategic plan to direct or coordinate this research activity appears to exist” at NCI, the committee writes, and funding for minority research is “inadequate”. It says the NCI's system for monitoring cancer incidence, mortality and survival in different populations misses key minority groups.

The NIH and NCI should be more active in shaping minority cancer research, the report argues, as institutes leave “critical gaps” unfilled. They tolerate a research priority-setting process that “fails to serve the needs” of ethnic minority and poor groups.

Recruitment of research subjects is a problem, too, it says. For example, in one large study that showed that the drug tamoxifen prevented breast cancer in high-risk women, only 2 per cent of the participants were African American.

But the authors commended the NCI for having acted on several recommendations. And NCI officials, testifying before the senate subcommittee last Thursday (21 January), said they agreed with some of its suggestions. These included the need to classify groups for epidemiological purposes by ethnicity and not race, allowing for the role of factors like culture and behaviour in cancer incidence and mortality.

But Klausner disputed the finding that the institute spent just $24 million on research among minorities in 1997 out of a budget of $2.39 billion. He put the figure at $124 million. The discrepancy arises because the study included only research specifically designed to address cancer in minorities. The NCI also includes general studies involving minority participants where questions are asked that are relevant to them.

More generally, Klausner rejected the notion of segregating minority research. For the NCI to pursue minority research only through projects pertaining specifically to minorities would be impractical, inefficient and counterproductive, he said.

“We want to be sure that minorities and the underserved are fairly treated,” said subcommittee chair Arlen Specter (Republican, Pennsylvania). “It may be that [money] could be directed more specifically to those groups.” Specter said he might include in this year's NIH spending bill “specific standards as to what needs to be done”.