A Closer Look At...NCI's Center to Reduce
Cancer Health Disparities (CRCHD):
Integrating Resources — Building Solutions

One in four deaths in the U.S. is attributable to cancer, and one in three Americans will eventually develop some form of cancer. In 2010 alone, it was estimated that 1,529,560 new cases of cancer would be discovered in the United States. From that number, 569,490 people would die from cancer-related disease, averaging 1,500 deaths each day. But the burden of cancer is too often greater for populations such as the poor, racial/ethnic groups, and those with limited access - or no access -- to health care than it is for the general population.

To address disproportionate burdens of cancer, the Center to Reduce Cancer Health Disparities (CRCHD) was established in March 2001. CRCHD is the cornerstone of the National Cancer Institute's (NCI's) efforts to reduce cancer health disparities and train the next generation of competitive investigators in cancer and cancer health disparities research.

Cancer health disparities are adverse differences in cancer incidence (new cases), prevalence (existing cases), mortality (deaths), survivorship, and burden that exist among specific population groups. Populations may be characterized by age, disability, education, race/ethnicity, gender, geographic location, socioeconomic status (SES), and/or access to health care. One example of a cancer health disparity is that although White women in the U.S. have the highest incidence of breast cancer, African American/Black women are most likely to die from the disease.

There are many complex and interrelated factors, including both biological and non-biological, that contribute to cancer health disparities. The ones that come to mind first are low socioeconomic status (SES) and little or no access to health care. Research shows that SES is closely correlated with a person's access to education, jobs, and health insurance, and exposure to environmental toxins. Each of these factors, in turn, contributes to a person's likelihood of developing and surviving cancer. SES also influences whether a person partakes in cancer risk behaviors such as smoking, drinking, physical inactivity, obesity, and not adhering to health screening guidelines.

Studies also show that medically underserved populations, including those with little or no access to health care and insurance, have higher mortality rates, since they are more likely to be diagnosed at a late stage in their cancers.

In 2001, CRCHD was created as an expansion of NCI's Office of Special Populations Research. Over the next few years CRCHD grew, particularly in the area of community-based population research. In 2007, the Center merged with NCI's Comprehensive Minority Biomedical Research Branch, which provided the critical infrastructure needed to spawn new research examining the biological basis of cancer disparities. The combined resources and focus enabled NCI, for the first time, to link cancer health disparities research and diversity training, thus establishing a firm foundation for the development of innovative scientific programs geared towards improving outcomes in communities experiencing an excess burden of cancer. To that end, CRCHD initiates, integrates, and engages in collaborative studies with NCI divisions, offices, and centers, and other National Institutes of Health (NIH) Institutes and Centers to promote research and training opportunities in cancer health disparities.

Since its inception, CRCHD has sought to contribute scientific insight and solutions towards the reduction and elimination of cancer health disparities. The Center supports NCI's strategic objective to overcome disparities across the cancer control continuum from disease prevention through end-of-life care by studying and identifying factors contributing to disparities, developing culturally appropriate intervention approaches, and disseminating information. The research conducted within CRCHD's Disparities Research Branch will enable a better understanding of which—and how—biological factors, social factors (e.g., access to health care, socioeconomic status, sociocultural issues), or a combination of both (epigenetics), contribute to differences in cancer incidence and seriousness. Furthermore, research of this type can help lead to the development of tailored treatments that target the specific genetic profile of a disease, and to improved outcomes. It can also help ensure that patients do not undergo treatments that are unlikely to yield benefits.

In addition to research, CRCHD's other major focus is on training the next generation of competitive cancer researchers from diverse backgrounds. Although minorities (racial/ethnic, disabled, disadvantaged) comprise nearly 25 percent of the U.S. population, only 3.2 percent of NIH-supported Principal Investigators on research grants, and 5.5 percent on NIH training grants, are from minority populations. CRCHD's Diversity Training Branch is committed to significantly increasing the number of competitive and independent investigators from underserved and underrepresented populations, thus creating a workforce that is reflective of the heterogeneity of the U.S. population, as well as one that can more efficiently and effectively address the reduction of cancer health disparities.

Funding and training opportunities are provided to trainees across the academic continuum, starting as young as high school students and extending through to independent and competitive researchers. This support helps to grow a diverse workforce in cancer and cancer health disparities, and assists underserved students and professionals who otherwise are at risk of being lost from the training pipeline. After their training, these individuals often give back, in terms of their research and clinical practices, to advance the health and well-being of their own communities, thus helping to relieve the unequal burden of cancer in underserved groups.

Cancer health disparities are affected by a multitude of health, biological, environmental, and social factors. Complex problems require complex solutions. CRCHD's approach to identifying and unraveling the interplay of cancer health disparities determinants is an integrative strategy that employs a multipronged approach to finding answers. This strategy fosters collaborations and resource-sharing across disciplines, programs, communities, and cancer centers throughout the country.

Integral to CRCHD is evaluation of programs. Every program's performance and outcomes are monitored to ensure that the Center's programs are actually working towards the goal of reducing cancer health disparities. Evidence-based information gives the Center the basis upon which to identify gaps in programming and areas to target.

Team science is critically important and results in state-of-the-science, culturally sensitive research, and training. However, unless the information is disseminated, the ultimate goal of eliminating cancer health disparities cannot happen. Recognizing the critical importance of this piece of the battle against cancer, CRCHD spends a great deal of effort on communication and dissemination of culturally tailored messages and materials to best suit the particular audience being targeted. The Center distributes information using a variety of print, electronic, and video formats as part of its outreach and educational strategy. The information is designed to inform diverse and underserved populations at high risk or with poor outcomes about cancer facts, resources, screening options, diagnostic tools, and treatment options.

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