The unequal cancer burden. Efforts of the Centers for Disease Control and Prevention to bridge the gap through public health.

Received April 1, 2000; accepted August 31, 2000. Despite the broad advances made in cancer research and interventions in the last quarter of a century, inequality still persists as we confront challenges arising from the unequal burden of cancer among Americans. Some racial and ethnic minorities, people with low incomes, those in rural areas, and other medically underserved populations suffer disproportionately from cancer. We know, for example, that African Americans are about 34% more likely to die of cancer than whites and more than two times more likely to die of cancer than Asian/Pacific Islanders, American Indians, or Hispanics. Disparities also exist among the major racial and ethnic groups in health-risk behaviors, such as cigarette smoking, and use of clinical preventive services, such as screening for breast, cervical, and colorectal cancers. The Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), which was developed in cooperation with federal, state, and private-sector partners, has equipped us with knowledge of variations in health risks as well as information about differences among racial and ethnic groups for health-risk behaviors. Results from the 1997 BRFSS Survey showed that American Indians/Alaska Natives were most likely among all groups to report cigarette smoking. Hispanic and American Indian/ Alaska Native women were less likely than women in other racial and ethnic groups to use preventive services, such as Papanicolaou testing and mammography. These statistics are disheartening and remind us that much work remains to remove the disproportionate burden of cancer among our nation’s diverse populations. Achieving better cancer control within minority and underserved populations in the United States is an important CDC goal. In its commitment to reducing disparities in the nation’s cancer burden, CDC focuses its cancer control resources on support for surveillance systems that provide high quality cancer data for all Americans and on the design and implementation of interventions that promote the prevention and early detection of cancer, with emphasis on the underserved.