On July 17, 1989, the American Cancer Society issued a "Report to the Nation'. It was the culmination of a series of fact-finding hearings held in collaboration with the National Cancer Institute and the Centres for Disease Control and prevention in May-June. There was representation from all states in USA. The report listed the five most critical issues related to cancer and the poor.

l Poor people endure greater pain and suffering from cancer than other US citizens.

l Poor people and their families must make extraordinary personal sacrifices to obtain and pay for care.

l Poor people face substantial obstacles in obtaining and using health insurance and often don't seek care if they can't pay for it.

l Cancer education is insensitive and irrelevant to many poor people.

l Fatalism about cancer is prevalent among the poor and prevents them from seeking care.