Authorship of Publications Supported by NCI-Funded Grants Involving Low- and Middle-Income Countries.

Importance: Scientific publication is an important tool for knowledge dissemination and career advancement, but authors affiliated with institutions in low- and middle-income countries (LMICs) are historically underrepresented on publications. Objective: To assess the country income level distribution of author affiliations for publications resulting from National Cancer Institute (NCI)-supported extramural grants between 2015 and 2019, with international collaborating institutions exclusively in 1 or more LMICs. Design and Setting: This cross-sectional study assessed authorship on publications resulting from NCI-funded grants between October 1, 2015, and September 30, 2019. Grants with collaborators in LMICs were identified in the National Institutes of Health (NIH) Query/View/Report and linked to publications using Dimensions for NIH, published between 2011 and 2020. Statistical analysis was performed from May 2021 to July 2022. Main Outcomes and Measures: Author institutional affiliation was used to classify author country and related income level as defined by the World Bank. Relative citation ratio and Altmetric data from Dimensions for NIH were used to compare citation impact measures using the Wilcoxon rank sum test. Results: In this cross-sectional study, 159 grants were awarded to US institutions with collaborators in LMICs, and 5 grants were awarded directly to foreign institutions. These 164 grants resulted in 2428 publications, of which 1242 (51%) did not include any authors affiliated with an institution in an LMIC. In addition, 1884 (78%) and 2009 (83%) publications had a first or last author, respectively, affiliated with a high-income country (HIC). Publications with HIC-affiliated last authors also demonstrated greater citation impact compared with publications with LMIC-affiliated last authors as measured by relative citation ratios and Altmetric Attention Scores; publications with HIC-affiliated first authors also had higher Altmetric Attention Scores. Conclusions and Relevance: This cross-sectional study suggests that LMIC-affiliated authors were underrepresented on publications resulting from NCI-funded grants involving LMICs. It is critical to promote equitable scientific participation by LMIC institutions in cancer research, including through current and planned programs led by the NCI.

Global oncology research and training at US National Cancer Institute-designated cancer centres: results of the 2021 Global Oncology Survey.

Global oncology research and training are crucial to address the growing global burden of cancer, which largely and increasingly occurs in low-income and middle-income countries. To better understand global oncology activities at the 71 National Cancer Institute (NCI)-designated cancer centres, the US NCI Centre for Global Health regularly surveys cancer centre directors, global oncology leads, and principal investigators in 36 US states and the District of Columbia. The survey results complement internal and publicly available data about global oncology research funded directly by the US National Institutes of Health to provide a comprehensive catalogue of global oncology research, training, and activities led by NCI-designated cancer centres. 91% (61 of 67) of responding cancer centres reported global oncology activities not directly funded by the National Institutes of Health. The survey results indicate that global oncology is an important priority at cancer centres and provide a valuable resource for these centres, researchers, collaborators, trainees, and the NCI and other funders.

The Development of Global Cancer Research at the United States National Cancer Institute.

International research and collaboration has been a part of the National Cancer Institute's (NCI) mission since its creation in 1937. Early on, efforts were limited to international exchange of information to ensure that US cancer patients could benefit from advances in other countries. As NCI's research grant portfolio grew in the 1950s, it included a modest number of grants to foreign institutions, primarily in the United Kingdom and Europe. In the 1960s, the development of geographic pathology, which aimed to study cancer etiology through variations in cancer incidence and risk factors, led to an increase in NCI-funded international research, including research in low- and middle-income countries. In this paper, we review key international research programs, focusing particularly on the first 50 years of NCI history. The first NCI-led overseas research programs, established in the 1960s in Ghana and Uganda, generated influential research but also struggled with logistical challenges and political instability. The 1971 National Cancer Act was followed by the creation of a number of bilateral agreements with foreign governments, including China, Japan, and Russia, to support cooperation in technology and medicine. Although these agreements were broad without specific scientific goals, they provided an important mechanism for sustained collaborations in specific areas. With the creation of the NCI Center for Global Health in 2011, NCI's global cancer research efforts gained sustained focus. Because the global cancer burden has evolved over time, increasingly impacting low- and middle-income countries, NCI's role in global cancer research remains more important than ever.

Structural Racism and Triple-Negative Breast Cancer Among Black and White Women in the United States.

Purpose: To determine the associations between state-level indicators of structural racism and incidence of triple-negative breast cancer (TNBC) among black and white women diagnosed with breast cancer. Methods: Black and white women diagnosed with breast cancer between 2010 and 2016 were identified from 12 states represented in the Surveillance, Epidemiology, and End Results (SEER18) program. State-level disparities were measured by black to white rate ratios in educational attainment, political participation, incarceration, and unemployment; and dichotomized to "high" or "low" structural racism using the median rate ratio of the 12 states. Logistic regression was used to examine the associations between indicators of structural racism and TNBC among black and white women. Results: Living in states with high levels of structural racism in the domains of educational attainment, judicial treatment, and political participation were generally associated with greater odds of TNBC among black and white women. The increased odds of TNBC was greater for black women living in states with high levels of racial disparities than white women. Among black women diagnosed with breast cancer, the odds ratio (OR) of being diagnosed with TNBC comparing women living in states with high disparities in educational attainment versus those with low disparities was 1.50 (95% confidence interval [CI]: 1.27-1.77). For white women, the OR for educational attainment was 1.17 (95% CI: 1.10-1.23). Conclusion: Results from this study support the notion that racial health disparities need to be contextualized. Further research should address mechanisms through which structural racism influences health disparities.