At the beginning of the twentieth century, infectious diseases were the major causes of death but as the century progressed, epidemiologists noted a major change. By the mid-1900s, the leading causes of death had shifted from infectious diseases, such as pneumonia, influenza and tuberculosis, to chronic diseases, such as heart disease, cancer and stroke.1 In response to these changes in causes of mortality, important changes in national health policy began to occur.
The Public Health Service Act of 1965,2 for example, provided grants-in-aid to support regional medical programs (RMPs) for research and training, as well as for the diagnosis and treatment of these major diseases.3 The RMPs were centered at medical schools and their affiliated hospitals. Their intent was to improve the quality of care for these conditions by establishing linkages between the medical centers and community hospitals.4 There was also a plan to develop a network of regional comprehensive cancer centers, recommended by the President's Commission on Heart Disease, Cancer, and Stroke.5 These centers were established to focus on cancer control, establishing cancer control programs and conducting cancer-related studies at the various centers. The intent was for these centers to be at the forefront of the War on Cancer.
The War on Cancer was declared by the Cancer Act of 1971.6 The Cancer Act brought increased funding for the National Cancer Institute (NCI) and made major changes to previous efforts against cancer. It provided for greater authority for the NCI Director, including making the NCI director a presidential appointee, and created the President's Cancer Panel and the National Cancer Advisory Board. The Act also called for a broad National Cancer Program to coordinate NCI research with federal and nonfederal cancer-related programs. The hope was that the War on Cancer would be won by 1976, and this expectation was strengthened when the NCI later expressed the goal to decrease the incidence of cancer by 50% by the year 2000.
Reports on progress are not always accepted and specialists argued about how much progress had actually been made. In 1998, for example, the American Cancer Society, NCI, Centers for Disease Control and Prevention, and National Center for Health Statistics reported decreases in death rates due to cancer.7 However, the Intercultural Cancer Council challenged this report on the grounds that there had been undercounting of a large percentage of the population, especially among minorities and the poor. Concurrently, Congress noted that despite improvements in cancer care and delivery, a disproportionate burden of cancer was experienced by certain populations. Together these factors prompted legislation authorizing a review by the Institute of Medicine (IOM). The IOM Committee's report, entitled ‘The Unequal Burden of Cancer,’ reviewed the status of cancer research relative to minorities and medically underserved populations, examined how well cancer prevention and treatment programs are disseminated among minorities and medically underserved populations, and examined recruitment of minorities and medically underserved populations to clinical trials.1 The report provided recommendations for the NCI but most importantly, provided evidence for a greater allocation of resources to address the needs of minorities and the medically underserved. In response to the IOM analysis and recommendations, the NCI has made a serious effort to address these issues and effect progress against cancer.
Another important initiative developed around this time was the Special Populations Networks (SPNs) for Cancer Awareness, Research, and Training. The SPNs were intended to foster cancer awareness and community-based educational activities.8 In addition, the Networks aimed to establish an infrastructure around information dissemination activities to support research in cancer control in minority populations and to enable investigators from these communities to compete successfully for research support. The 18 SPNs were designed to build, expand, and surpass previous programs, such as the National Black Leadership Initiative on Cancer (NBLIC),9 the National Hispanic Leadership Initiative10 and the Appalachian Leadership Initiative on Cancer.11 These latter NCI Leadership Initiatives fostered partnerships with concerned individuals, such as researchers, community-based organizations, and community leaders, to begin to address the disproportionate cancer burden experienced within these populations.