1. What is a Progress Review Group (PRG)?

   PRGs are panels made up of prominent members of the scientific, medical, and advocacy communities assembled to identify areas of strength, gaps, opportunities, and priorities related to a specific programmatic need and make recommendations for future research and interventions. The process culminates in the release of the group's findings and priorities published in a comprehensive report. PRG reports become road maps to guide future planning, implementation, and evaluation.

   The National Cancer Institute has sponsored PRGs to assess progress and the need for research on cancers of the breast, prostate, colon and rectum, brain, pancreas, and lung, as well as groupings of cancers including gynecologic cancers; leukemia, lymphoma, and myeloma; kidney and bladder cancers; stomach and esophageal cancers; and sarcomas.

2. What is the purpose of the Trans-HHS Cancer Health Disparities PRG?

   The Trans-HHS Cancer Health Disparities PRG is serving as a demonstration project to test the PRG approach to identify priorities for eliminating health disparities. The purpose of this PRG is to facilitate a coordinated and comprehensive analysis for identifying new opportunities for HHS agencies to address cancer health disparities, implementing new initiatives, and evaluating their progress.

   The goals of the Cancer Health Disparities Progress Review Group are to:

   • Comprehensively define and describe issues related to cancer health disparities.

   • Identify areas of strength, gaps, opportunities, and priorities to address cancer health disparities in research and intervention development.

   • Facilitate the adoption and implementation of evidence-based research, policy, community programs, and clinical interventions and evaluate their impact on specific cancer health disparities.

   • Ensure unbiased access to standard and continuous preventive care, early detection, and treatment of cancer for every American.

3. How is this Cancer Health Disparities initiative different from others?

   Unlike the other expert panels that have been convened to review cancer health disparities, this effort was initiated by HHS and not by a third party. The deliberations of the panel have been focused primarily on finding solutions rather than identifying problems. Furthermore, the process has been unique in that the panel has been working in partnership with - not independently from - HHS, making the results a more practical set of recommendations. Additionally, the panel solicited advice from a broad constituency of cancer health disparity experts.

4. What has been the impact of PRGs on NCI research agendas?

   PRG recommendations are central to sustaining the best possible science and making the fastest advances against specific cancers. They have proven to be a valuable asset to NCI strategic planning. For example:

   • PRGs have helped shape research directions. PRG reports have had substantial impact. NCI divisions and programs use PRG reports in planning and developing new initiatives. Extramural scientists cite them in their grant applications. They are cited regularly in Congressional documents. They also are used by advocates, researchers, and members of professional societies to attract funding from other sources.

   • PRGs have led to an expanded understanding and awareness of opportunities related to cancer research. PRG members and roundtable participants report that new collaborative research relationships have been formed as a result of their interactions with a diverse, multi- disciplinary group of people involved in all aspects of cancer research.

   • PRGs have led to the development of new information tools. Developed in response to needs identified by the PRGs, new tools are now available to aid both NCI staff and the community in learning about and responding to needs and opportunities for cancer research. For example, the Common Scientific Outline is a classification system that provides a consistent approach to comparing and assessing cancer research supported by different funding organizations. The Cancer Research Initiatives Web site provides user-friendly access to a database of selected NCI research funding opportunities that can be searched by type of research or type of cancer. And the Cancer Research Portfolio Web site provides a structure for searching, organizing, and analyzing NCI-supported research by type of cancer or type of research.

   • PRGs have provided new opportunities for interaction between NCI and the extramural community. Participants have found the PRG venue a very effective way to gain input from the wider community and for individuals to influence both NCI priority setting and overall disease-specific priority setting. The NCI PRG process has been highly successful as a model for gaining outside input and feedback focused on opportunities, needs, and gaps in research and fostering greater understanding of common issues across diseases.

5. How are health disparities defined?

   While the overall health of the nation has improved over the last two decades, there continue to be striking disparities in the burden of illness and death experienced by groups such as people in Appalachia, African Americans, Hispanics, Native Americans, Alaska Natives, Asians, and Pacific Islanders. The most striking disparities include shorter life expectancy, as well as higher rates of cardiovascular disease, cancer, infant mortality, birth defects, asthma, diabetes, stroke, sexually transmitted diseases, and mental illness. These disparities are believed to be the result of the complex interaction among biological factors, the environment, and specific health behaviors. Inequalities in income and education also appear to underlie many health disparities in the United States. Disparities in income and education levels are associated with differences in the occurrence of illness and death, including heart disease, diabetes, obesity, elevated blood lead level, and low birth weight.

   There are sub-populations within the United States that are significantly more likely than the overall U.S. population to:

   • Be diagnosed with and die from preventable cancers.
     
   • Be diagnosed with late-stage disease for cancers detectable at an early stage by screening.
     
   • Receive either no treatment or treatment that does not meet currently accepted standards of care.
     
   • Die of cancers that are generally curable.
     
   • Suffer from terminal cancers in the absence of adequate pain control and other palliative care.

   These sub-populations, distinguished by race/ethnicity, gender, age, socioeconomic status, geographic location, occupation, and/or education, bear a greater cancer burden than the rest of the nation.

6. What are some key cancer health disparities?
   • African Americans have the highest death rates from all cancer sites combined -- and from malignancies of the lung and bronchus, colon and rectum, female breast, prostate, and uterine cervix -- of all racial or ethnic groups in the United States.

   • It has been known for more than 50 years that women living in certain rural areas have a much greater likelihood of dying of cervical cancer than other women.

   • Hispanic-Latino women have the highest incidence of uterine cervix cancer.

   • Nearly 90 percent of all cases of lung cancer can be attributed to the preventable behavior of cigarette smoking, and cigarette smoking rates are especially high in low socioeconomic populations and among those who never completed high school.

   • Asian American/Pacific Islander males, followed by females from the same ethnic group, have the highest death rate from liver and bile duct cancer, as well as the highest incidence and mortality rates from stomach cancer.

   • The prevalence of cigarette smoking, which can lead to lung cancer, is highest among Native American/Alaska Native men followed by Native American/Alaska Native women.

   • Invasive cervical cancer is four times higher among Vietnamese women compared to all Asian American/Pacific Islander women.

7. What is NCI's Center to Reduce Cancer Health Disparities?

   NCI is strongly committed to a wide-ranging research program that will address these cancer health disparities across the cancer control continuum from disease prevention to end-of-life care. As a demonstration of that commitment, NCI created the Center to Reduce Cancer Health Disparities on March 20, 2001. Harold P. Freeman, M.D., a leading cancer surgeon and foremost spokesman expressing concerns about cancer health disparities, serves as the center's director.

   The Center to Reduce Cancer Health Disparities is responsible for directing and coordinating an institute-wide plan to address disparity issues. To effectively accomplish this goal, new understanding is needed to explain the social, cultural, environmental, biological and behavioral determinants of cancer, their interactions and how they contribute to disparities in cancer care and prevention. Funding will be used to further research into causes of cancer health disparities; to define and monitor disparities; to develop and implement new policy, community and clinical interventions, and evaluate their impact; and to expand minority participation, both as investigators and as patients, in health disparities research and clinical trials.

8. What is the National Institute of Health's role in fighting health disparities?

   The mission of the National Center on Minority Health and Health Disparities (NCMHD) is to promote minority health and to lead, coordinate, support, and assess the National Institutes of Health (NIH) effort to reduce and ultimately eliminate health disparities. In this effort, NCMHD will conduct and support basic, clinical, social, and behavioral research, promote research infrastructure and training, foster emerging programs, disseminate information, and reach out to minority and other communities affected by health disparities.

   The NIH is also seeking to improve the visibility of minority health disparities research and other health disparities research, as well as to expand the role of such research in learning why some groups have disproportionately high rates of disease. In addition to awarding grants and contracts independently, the center continues the legacy of the former NIH Office of Research on Minority Health in partnering with the NIH institutes and centers to support programs of health disparities research with a focus on basic and clinical research, training, and the dissemination of health information. In particular, NCMHD will serve as the focal point for coordinating and focusing the minority health disparities research and other health disparities research programs at the NIH into a national health research agenda. The specific goals and purposes of the center include the following:

   • To assist in the development of an integrated national health research agenda, across disciplines, that reflects the current and emerging health needs of racial and ethnic minorities and other health disparity groups.

   • To promote and facilitate the creation of a robust minority health research environment with sustained funding for a wide breadth of studies -- basic, clinical, and population research; studies on the influences of health processes; and research on the societal, cultural, and environmental dimensions of health -- all aimed at identifying potential risk factors for disparate health outcomes.

   • To promote, assist, and support activities that build research capacity in minority and medically underserved communities, focusing on research infrastructure development, faculty career development, and increasing the number of underrepresented minority students and students from health disparity groups with an interest in biomedical and bio-behavioral research careers.

9. What role does HHS' Office of Minority Health (OMH) play in reducing health disparities?

   The mission of the Office of Minority Health (OMH) is to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities.

   OMH was established in 1985 by the U.S. Department of Health and Human Services (HHS). It advises the Secretary and the Office of Public Health and Science on public health program activities affecting American Indians and Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians, and other Pacific Islanders. Nathan Stinson Jr., Ph.D., M.D., M.P.H., is deputy assistant secretary for minority health and director of OMH.

   OMH advises the Department on health policy issues affecting health status and access to care among minority populations. It coordinates programs to help HHS implement minority initiatives, including the HHS Disparities Initiative, the White House Initiative on Historically Black Colleges and Universities, the White House Initiative on Educational Excellence for Hispanic Americans, the HHS Hispanic Agenda for Action, the White House Initiative on Tribal Colleges and Universities, the Executive Order on Increasing Participation of Asian Americans and Pacific Islanders in Federal Programs, and the HHS Minority HIV/AIDS Initiative.

   OMH works with HHS operating divisions and other federal departments to improve collection and analysis of data on the health of racial and ethnic minority populations. It also monitors efforts to achieve Healthy People 2010 goals for minority health.

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   NCI Resources:

   The PRG report - titled, "Making Cancer Health Disparities History" - is available online at http://www.chdprg.omhrc.gov.

   To visit NCI's Web site: http://www.cancer.gov

   For information about research currently supported by NCI: http://researchportfolio.cancer.gov/

   For general information:
   Cancer Information Service: 1-800-4-CANCER (1-800-422-6237)
   TTY (for deaf and hard of hearing callers): 1-800-332-8615
   LiveHelp: Cancer Information Specialists offer online assistance through the LiveHelp link on the NCI's Web site.

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