I’ve always been interested in democratizing health care and have tried to incorporate this in my image-guided therapeutics research.
As a health care CEO, I’ve been afforded the opportunity to broaden my research scope and examine a personal area of interest: disparities in health care and how we can address these through innovation and scientific inquiry.
Racial disparities in health care outcomes are a pervasive issue, and breast cancer is not immune to this problem. Women of color are more inclined to be diagnosed with later-stage cancer and are, therefore, more likely to face a worse prognosis and lower survival rates than Caucasian women.
Significant factors contributing to the divide in outcomes include tumor biology in combination with quality of care. But much remains to be understood.
Physicians and researchers aim to understand disparities through scientific inquiry. One avenue is clinical trials, which are crucial in developing advances in breast cancer treatments and therapeutics.
Race and income play a complex factor in clinical trial participation. Visible minorities comprise a significant proportion of the U.S. population, nearly 44 percent. However, they only represent less than 10 to 15 percent of the participants in breast cancer clinical trials.
Without minority representation in clinical trials, the success of screening strategies may be incorrect because all aspects of the population are not targeted. Diversity amongst clinical trial participants is crucial to help ensure generalizability of the results.
The results of a study by researchers from Duke University and the University of Illinois may provide possible answers to the lack of diversity in trials. The researchers attempted to determine how breast surgical oncology patients’ participation in clinical trials changed over a 12-year period and what characteristics are associated with participation.
The trial demonstrated that targeted programs have the capacity to reverse the impacts of social disparities in clinical trial participation. This review showed that towards the end of the 12-year period, enrollment of lower-income Black, Asian/Pacific Islanders, and Hispanics had surpassed their higher-income counterparts. They noted gaps that still need to be addressed:
- Recruitment strategies targeting Black patients will need to address barriers, such as a lack of trust in the medical community in general.
- The representation of Hispanic Americans remains low despite them being the largest growing demographic in the U.S. This was ascribed to several factors, including failure to provide translated educational material and exclusions related to insurance status.
In order to increase minority representation in clinical trials, socioeconomic disparities must be further examined. In comparison to our understanding of breast cancer biology, our understanding of the determinants of inequality is still nascent.
A concerted large-scale effort is required to truly understand the intricacies of this leading health care issue.
Ananth Ravi is a health care executive.
