Despite very high health care expenditures, the USA does not offer a uniform standard of medical care to its population, and egregious deficits in cancer care continue to exist in various segments of the community, leading to significant disparities in outcome (1-3). This may affect ethnic and racial minorities, the elderly, the indigent and some geographically isolated populations. Contributing factors, which should be the target of programmatic approaches, include socio-economic (poverty, education, language barriers), access (lack of health insurance, medical home, access to care), cultural issues (stigma of cancer, minority community suspicion, low community expectations of outcome), medical issues (co-morbidities, delays in diagnosis), and health provider/system factors (overload, funding, language and cultural barriers, social stereotyping, paucity of relevant research) (1-4). The problem is not unique to the USA (5), and is not resolved by a national health insurance system. To achieve parity of outcomes for under-served populations, compared to the majority community, each of the above indices must be targeted. In particular, specific staff training, recruitment of culturally competent staff, funding for integrated clinical care and relevant research, approaches to overcoming barriers in culture, communication and education, and decentralization of care and research are essential. Programmes developed by the American Society of Clinical Oncology Disparities Task Force, American Cancer Society and Levine Cancer Institute illustrate strategic approaches to the resolution of these issues.