Ethnoracial Disparities in Clinical Trial Access for Breast Cancer in Europe

Finnley MacLeod^*
*Correspondence: Finnley MacLeod, Department of Oncology, University of Sussex, Brighton BN1 9RH, UK, Email:

Introduction

Breast cancer remains one of the most common malignancies affecting women worldwide. In Europe, it is the most frequently diagnosed cancer among women, with significant efforts directed towards improving prevention, diagnosis and treatment. Clinical trials play a critical role in advancing our understanding and treatment of breast cancer, offering insights into the efficacy and safety of new therapies. However, the representativeness of clinical trial participants has long been a subject of concern, particularly regarding racial and ethnic disparities. While Europe is often perceived as less racially diverse than regions such as the United States, the continent is home to a variety of ethnic groups and an increasing number of migrants from diverse racial backgrounds. This diversity should ideally be reflected in clinical trials to ensure that the findings are applicable to all populations. Unfortunately, disparities in clinical trial participation persist, raising significant ethical, scientific and health equity issues [1].

Description

The European landscape of clinical trials for breast cancer reveals a complex interplay of historical, social and systemic factors that contribute to racial and ethnic disparities. Historically, the majority of clinical research has been conducted on predominantly Caucasian populations, a trend that has continued into contemporary studies. This homogeneity can be attributed to various factors, including the demographic composition of European countries, socio-economic barriers and potential biases in the recruitment and inclusion processes. One of the primary factors influencing these disparities is the demographic composition of Europe. Many countries in Europe have a majority Caucasian population, which naturally leads to a higher representation of this group in clinical trials.

However, with increasing migration and the presence of longstanding ethnic minorities, such as Romani people, African, Asian and Middle Eastern populations, there is a pressing need to ensure these groups are adequately represented. The underrepresentation of non-Caucasian groups in clinical trials can lead to a lack of data on how different therapies affect these populations, potentially resulting in less effective or inappropriate treatments for these groups. Socio-economic barriers also play a significant role in the underrepresentation of racial and ethnic minorities in clinical trials. Economic disadvantages, lower levels of education and limited access to healthcare services are common issues faced by many minority groups. These factors can hinder their participation in clinical trials, either because they are not aware of the trials, cannot afford to participate, or are not eligible due to pre-existing health conditions that are more prevalent in these populations. For example, the Romani people, one of the largest ethnic minorities in Europe, often face extreme poverty and marginalization, which severely limits their access to healthcare and opportunities to participate in clinical research.

Another critical factor is the potential biases in the recruitment and inclusion processes of clinical trials. Researchers may unconsciously or consciously favor participants who are more accessible, easier to communicate with, or perceived as more reliable. This can lead to the exclusion of minority groups who may have different languages, cultural practices, or who live in less accessible areas. Additionally, there may be a lack of targeted efforts to recruit minority populations and the materials used to promote trials may not be culturally sensitive or available in multiple languages, further deterring participation from these groups. The implications of these disparities are profound. Scientifically, the lack of diversity in clinical trial participants can result in findings that are not generalizable to all populations.

Different racial and ethnic groups can have varying genetic makeups, environmental exposures and socio-cultural factors that influence their response to treatments. For instance, the efficacy and side effects of certain breast cancer therapies can differ significantly among racial and ethnic groups. Without sufficient representation of these groups in clinical trials, the resulting data may not accurately reflect the true efficacy and safety profiles of these therapies, potentially leading to suboptimal treatment for minority populations. Ethically, the underrepresentation of racial and ethnic minorities in clinical trials raises questions of justice and equity. It is fundamentally unjust to exclude certain groups from the benefits of clinical research. All populations have a right to be represented in studies that may affect their health and well-being [2].

Conclusion

Disparities by race and ethnicity in European clinical trials for breast cancer highlight a critical issue in the pursuit of health equity. The underrepresentation of minority populations in these trials poses significant scientific, ethical and health equity challenges. It limits the generalizability of research findings, perpetuates health disparities and raises questions of justice and fairness. Addressing these disparities requires concerted efforts from researchers, healthcare providers, policymakers and communities. By adopting inclusive and culturally sensitive recruitment strategies, reducing socio-economic barriers and implementing supportive policies, it is possible to increase the diversity of clinical trial participants and ensure that all populations benefit from advances in breast cancer research and treatment. The journey towards equitable representation in clinical trials is ongoing, but with commitment and collaboration, meaningful progress can be achieved.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Gnant, Michael, Florian Fitzal, Gabriel Rinnerthaler and Guenther G. Steger, et al. "Duration of adjuvant aromatase-inhibitor therapy in postmenopausal breast cancer." New Eng J Med385 (2021): 395-405.

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