Breast Cancer Awareness Month: Beyond Pink Ribbons

Every October, Breast Cancer Awareness Month, people around the world wear pink ribbons to show support for those affected by breast cancer. Figures from the World Health Organization (WHO) show that each year, 2.3 million women are diagnosed with breast cancer and 685,000 sadly die making it the world’s most commonly occurring cancer in women.

There is some good news. Mortality rates have been decreasing over time – in high-income countries at least. However, racial disparities still exist. This year, breast cancer patient advocacy group BreastCancer.org, released a special report on increasing racial diversity in breast cancer clinical trials. The report highlights the shocking statistic - that while Black and white women in the United States get breast cancer at the same rate, Black women are 40% more likely to die. The inequality is baked in at every step of treatment – including before diagnosis. Even though Black women are more likely to develop a more aggressive form of breast cancer – triple-negative breast cancer, they are less likely than white women to undergo genetic screening to assess cancer risk or have preventative treatments. And, they are less likely to be represented in clinical trials.

To be clear, this is by no means a problem limited to the United States. Across the world, disparities in care and mortality outcomes between Black and white women are stark. Studies in the UK found that first-generation Black African women experience the most barriers and longest delays in early diagnosis of symptomatic breast cancer and that Black women are twice as likely to be diagnosed with advanced breast cancer than white women. Urgent action needs to be taken to break down the multiple barriers inhibiting access to clinical trials.

Carving a Path Forward

Here at Teckro we’ve long championed the importance of diversity in clinical trials. But as the findings of the report show, so far, the awareness campaigns and industry-wide moves to tackle the access problem have not been enough. The key to closing the gap lies in greater cross-industry awareness of what inhibits underrepresented communities from taking part in trials.

The BreastCancer.org report cites common barriers preventing people from enrolling in trials that we discuss below as we seek to carve a path forward to tackle unequal patient participation. Barriers include:

• Not knowing about clinical trial opportunities - many communities don’t know about trials because their doctors don’t offer them as an option. Physicians are often pressed for time, and it can be hard to find suitable trials for patients that are recruiting. One solution is for sponsors to partner with trial sites that have relationships with physicians so patients can be recommended for trials by sources who are familiar to them. Another topic we’ve touched on at Teckro is the concept of the patient as stakeholder. This can be supported by patient organizations that can raise awareness of trial opportunities among members, especially those in underrepresented communities
• Lack of trust – people in some communities may not trust that trials are conducted in an ethical way and feel they are in danger of being used as “guinea pigs.” This could be due to their own history dealing with the healthcare system or come from knowledge of historical incidents concerning unethical medical practices. Greater education is key so they can understand that they can get access to best possible care through clinical trials. Another option is to expand and grow the site pool – sponsors can seek out sites that aren’t as well-known in the industry but have more knowledge of specific patient populations.
• Travel and other out-of-pocket costs – traveling to and from clinical trial sites can be time-consuming and expensive. Other out-of-pocket expenses such as taking time off work and childcare can also affect those who have fewer resources at their disposal. A greater understanding of how finances affect trial participation could help industry stakeholders develop a fairer system for trial compensation.

A Greater Role for Sites

Sites also have their role to play. One way they can ensure more access for diverse patient populations is through the SCRS Diversity Site Assessment Tool (DSAT) which allows sites to self-assess capacity for recruitment and enrollment of diverse populations. When a site engages with the tool, the DSAT tool analyzes factors that influence sites’ understanding of how they recruit. Responses are captured and a report generated with a score that represents how the site uses best practices to ensure that underrepresented communities are represented. By making greater use of tools and technology available such as this, sites can help lead the way in the move towards full, equal representation for all patients.

Time for Change

Lack of access to oncology clinical trials is one of the largest sources of health disparities in cancer, especially in breast cancer. This Breast Cancer Awareness Month we should remember that the ticket to better outcomes – especially for Black women and other minority patients – is access to best possible care with more inclusive clinical trial participation. The pink ribbon campaign has been one of the most successful health campaigns in terms of raising awareness of breast cancer across the globe. But now we need to go beyond that to highlight that when it comes to access to treatment and trials all is not equal – and progress is too slow. We have outlined some solutions we believe can work above in response to the BreastCancer.org report and now the global community must work together to seriously move the needle when it comes to equal access to best possible care through clinical trials.

Malia Lewin

Life Sciences Strategy Leader

Guest

Malia is a senior business strategist with a passion for accelerating new ideas, technologies and innovations within the biopharma industry. In a career spanning over 20 years, Malia has led organizations and spearheaded successful projects from R&D, launch planning and market access through post-market growth strategy, execution and analysis.