US cancer body 'must do more for minorities'
28 January 1999 [WASHINGTON] The US National Cancer Institute (NCI) is falling short in strategic planning, data collection and spending on cancer research in minorities and the poor, to which it devoted only 1 per cent of a $2.4 billion budget in 1997, according to a new report from the Institute of Medicine (IOM).
The higher incidence and mortality of some cancers among ethnic minorities and the poor call out for more action by the National Institutes of Health (NIH) and the NCI, according to the report, which was released last week. It was requested in 1997 by the Senate appropriations subcommittee that funds the NIH.
Alfred Haynes, the chair of the fifteen-member committee that wrote the report, and former president and dean of the Drew Postgraduate Medical School in Los Angeles, California, said last week that it was "critical that we learn why some ethnic minorities and the medically underserved are more prone to cancer and less likely to survive it."
But some of the report's conclusions were challenged by NCI officials. Richard Klausner, director of the institute, told the Senate subcommittee last week that, far from lacking a strategic plan for minority research, the institute has "a very active, dynamic and visionary planning process" that incorporates minority research concerns.
The report notes that African American men develop prostate cancer 15 per cent more often than white men; that African American women who develop breast cancer are more likely to die from it than white women; and that other minorities get specific cancers at higher rates than whites, such as stomach and liver cancer among Asian Americans and cervical cancer among Hispanic and Vietnamese American women. Poor whites, it adds, face similar problems. For instance, in Appalachia, rates of lung cancer are higher than elsewhere.
But in the face of these facts, "no blueprint or strategic plan to direct or coordinate this research activity appears to exist" at NCI, the committee writes, while funding for research addressing the needs of minorities and the poor is "inadequate". It adds that NCI's system for monitoring cancer incidence, mortality and survival in different populations misses key minority groups.
And it argues that NIH and NCI should be more active in shaping the kind of minority cancer research that gets done. As it is, the report says, the institutes leave "critical gaps" unfilled and 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 successfully prevented breast cancer in high risk women, only 2 per cent of the participants were African American, and fewer were from other non-white groups.
The authors did commend NCI for taking action already on a number of the report's recommendations. And NCI officials, testifying before the senate subcommittee last Thursday (21 January), said that they agreed with some of its suggestions. These included the need to classify groups for epidemiological purposes by ethnicity and not race, thus allowing for the role of factors like culture and behaviour in cancer incidence and mortality.
But NCI director Klausner disputed the finding that the institute spent just $24 million on research in minorities in 1997, when its budget was $2.39 billion. He put the figure at $124 million. The discrepancy arises because the IOM study included in its definition 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. If the NCI pursued minority research only through projects designed specifically to answer questions pertaining to minorities, HE SAID, an entire parallel research structure would be required. This "is impractical, it's inefficient and it's counterproductive."
But Arlen Specter (Republican, Pennsylvania), who chairs the subcommittee, declared his intent to "get to the bottom" of the funding discrepancy. "We want to be sure that minorities and the underserved are fairly treated," he said. "It may be that [money] could be directed more specifically to those groups."
Specter said that he might include in this year's NIH spending bill "specific standards as to what needs to be done."
MEREDITH WADMAN
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Nature © Macmillan Publishers Ltd 1999 Registered No. 785998 England.