A government-mandated report charging the National Institutes of Health (NIH) with devoting too few resources toward studying cancer disparity has put the National Cancer Institute (NCI) in the position of defending its research efforts focused on minority populations.

In an analysis of who is most likely to suffer a poor outcome following cancer diagnosis, the US Institute of Medicine (IOM), a division of the National Academy of Sciences, pointed to status as an ethnic minority and low income as predisposing factors. To combat this, the IOM says that the NCI should expand efforts to learn why poor people and ethnic minorities develop cancer and die of the disease at disproportionately higher rates.

The IOM said that although the NCI has made progress in recent years at addressing cancer disparities, there are still gaping holes. For example, although minorities have been increasingly added to treatment studies, few have been in cancer-prevention trials. The 272-page report also suggests a reclassification of population categories from the one used presently, which has a more "historical, social and political significance," to one with greater biological relevance. However, some members of the IOM panel are aware of the enormity of this request, as it may mean an overhaul throughout the Health and Human Services Department.

Even though the NCI has funded an "impressive array" of cancer studies over the years, concludes the report, there has been no "overreaching strategy" to guide its efforts in studying the medically underserved. "There needs to be a greater emphasis on behavioral studies in particular, because we know that lifestyle is a question of behavior and impacts cancer incidence," says Alfred Haynes, former president and dean of the Drew Postgraduate Medical School in Los Angeles and chair of the IOM study group.

Otis Brawley, the NCI's director of the Office of Special Populations Research—one of two NIH Offices criticized specifically in the report for its inability to coordinate more ethnic research—admits that the document is likely to prompt the NCI to redouble its research efforts in this area. But, he says, many of the problems of cancer disparities are already well known. "Research done at the NCI 10 to 15 years ago told us what the problems are and the solutions are not within our purview," he says.

The IOM study group counters that although social problems figure prominently into cancer disparities, there is still much that the NCI can do. "The NCI may not be able to change poverty, but with the right data, we can develop strategies to reach low income populations with surveillance, cancer prevention, detection and treatment," says Susan Scrimshaw, dean of the School of Public Health at the University of Illinois at Chicago and a study group member.

Brawley is also sharply critical of the IOM's accounting methods that estimated the NCI's spending on cancer studies in the medically underserved to be $24 million, compared with NCI's own calculations of $124 million. The IOM figure, says Brawley, ignores 'relevant research', which includes studies designed to detect cancer early and prevent or treat it. "Those studies are relevant to all races," he insists. The IOM factored-in only 'targeted research', which is focused almost entirely on a special population. "I hope we continue to maintain a focus on what the scientific opportunities are and not less this [report] deter us," says Brawley. A copy of the report, The Unequal Burden of Cancer, is available at http://www.nap.edu