Ethnic minority patients remain under-represented in breast cancer clinical trials, according to a systematic review published recently in Ethnicity and Health. Researchers say improving inclusion will require coordinated changes in how studies are designed, explained and made accessible.
The review authors wrote that addressing cultural barriers, improving communication and reducing financial and logistical obstacles could help ensure that research findings apply to a broader range of patients.
Clinical trials are essential for developing new cancer treatments, but when certain groups are missing from research, the results may not fully reflect how therapies work for everyone. The authors noted that limited diversity in breast cancer trials can restrict the generalizability of findings and may contribute to ongoing disparities in outcomes among different ethnic populations.
To better understand the problem, investigators reviewed studies published over the past 10 years that examined ethnic representation in breast cancer clinical trials. Using the SPIDER tool to select studies and several established quality assessment frameworks, including CASP, ISPOR, CONSORT and CARE, the team evaluated research addressing both barriers to participation and potential solutions. In total, 15 studies met the inclusion criteria for the analysis.
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“Addressing disparities in clinical trial participation among ethnically diverse populations requires a multilevel approach,” explained the authors of the review.
Across those studies, several barriers appeared repeatedly. Language differences and limited health literacy often made it difficult for patients to understand trial information or consent forms.
Mistrust of the healthcare and research systems, sometimes rooted in historical injustices, also discouraged participation. In addition, financial pressures such as travel costs, time away from work and childcare responsibilities created practical challenges. Researchers also found that limited involvement from healthcare providers in discussing or recommending trials reduced enrollment opportunities.
The review highlighted several strategies that could help overcome these barriers. Culturally adapted educational materials may improve understanding of trials among patients from diverse backgrounds. Programs that use patient navigators who share the same cultural or language background can guide patients through the research process and help build trust. Providing financial assistance, transportation support or decentralized trial options that allow patients to participate closer to home may also increase access.
For patients with breast cancer, these changes could mean more opportunities to join clinical trials and benefit from new therapies being tested. Greater participation from diverse communities may also help scientists better understand how treatments work across populations. Researchers emphasized that improving inclusion is not only a matter of fairness but also essential for ensuring that advances in precision oncology benefit all patients.
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