Closing the Gaps: Breast Cancer Clinical Trials, Minority Representation, and What Young Patients Need to Hear with Rani Bansal, MD

Rani Bansal, MD, a breast oncologist at Duke University Cancer Center Breast Clinic, talks about a systemic problem where minority patients are consistently underrepresented in breast cancer trials, and that gap has real consequences. If the data on how a drug performs, what adverse effects it causes, and how durable its results are, come overwhelmingly from one demographic, then the evidence base guiding treatment decisions for everyone else is incomplete.

"If we're looking only at a certain patient population," she says, "then we're not able to collect data on diverse patients and how they actually do on those drugs." A 2017 analysis found that Black patients were less likely to be represented in oncology clinical trial participants despite accounting for a disproportionate share of cancer mortality, highlighting how deeply the enrollment gap runs.¹

At Duke, Bansal is actively working on improving this, with a particular focus on younger patients, as this is another group she identifies as underrepresented in trials. The assumption that younger patients might not be interested in or suited for a trial is one she wants to dismantle. Participating in a clinical trial isn't opting out of good care. But rather, she explains, it can be part of it, especially for a demographic that is increasingly affected by a disease the research world hasn't fully caught up to yet.

She also talks about the guilt that young patients carry into her clinic. Because roughly 70% of breast cancers have no identifiable genetic or familial cause, the "why me?" question has no clean answer, but it still weighs heavily, especially on younger patients. The majority of breast cancer cases occur in women with no first-degree family history of the disease, reinforcing that most diagnoses cannot be traced to a single identifiable risk factor. She states that a breast cancer diagnosis is not a consequence of something a patient did wrong. The cause, in most cases, is simply unknown.

Reference

1. Duma N, Vera Aguilera J, Paludo J, et al. Representation of minorities and women in oncology clinical trials: review of the past 14 years. J OncolPract. 2018;14(1):e1-e10. doi:10.1200/JOP.2017.025288