Addressing Barriers to Vital Cancer Treatment for Minoritized Communities

Inequities in Cancer Screening, Care and Treatment 

Minoritized populations receive lower-quality healthcare and have less access to cutting-edge medical technologies. In oncology, this means lower rates of cancer screening, diagnoses, and treatment for these populations – a problem rooted in the following systemic, socio-economic, and cultural factors.

Lack of Awareness and Education: Many minority communities have limited knowledge about biomarker testing, which involves testing tumors for specific markers that predict cancer risk, detect cancer early, or personalize treatment. Biomarker testing is also required for participation in many clinical oncology trials. As biomarker testing is relatively new and complex, potential candidates for these tests may not fully comprehend their importance or availability without tailored educational campaigns. 

Healthcare Access and Economic Barriers: Minoritized populations often have lower health insurance coverage rates, which limits their access to regular medical care and advanced and costly diagnostics, including biomarker testing. High out-of-pocket costs can discourage individuals from seeking these tests even when insurance is available. Other expenses, such as travel and time off work, can be prohibitive for low-income individuals who are disproportionately from minority groups. 

Trust and Mistrust in the Healthcare System: Historical and ongoing instances of discrimination and mistreatment in the healthcare system contribute to widespread mistrust among minoritized populations. This mistrust continues to lead to reluctance to engage with healthcare providers. 

Cultural and Language Barriers: Cultural beliefs and language differences can affect conversations between healthcare providers and individuals about cancer screening and biomarker testing. Health communication that is not culturally sensitive or available in multiple languages can fail to reach and engage minoritized populations effectively.  

Geographic Barriers: Specialized services such as genetic counseling, advanced diagnostics, and certain targeted therapies are typically provided at large medical centers in urban areas, leading to delayed diagnoses and higher mortality rates for minority populations living in rural areas.  

Systemic Inequities in Healthcare: Systemic bias, institutional racism, and economic disparities result in fewer referrals for advanced diagnostics, even when certain types of cancers are more prevalent in minoritized groups. Implicit biases and a lack of training for healthcare professionals in culturally humble care can result in minoritized patients not consistently receiving the same level of information and encouragement to undergo advanced screening compared to their white counterparts. For example: 

• Studies indicate that sexual and gender minority (SGM) individuals are less likely to receive preventive screenings such as Pap smears and colorectal cancer screenings due to fear of discrimination and a lack of culturally humble healthcare providers (National LGBT Cancer Network, 2022). Consequently, this population is often diagnosed with cancer in a more advanced stage. 

• Hispanic women are less likely to receive timely mammograms compared to non-Hispanic white women, resulting in later-stage diagnoses of breast cancer and poorer outcomes (CDC, 2023).  

Need for Diversity in Clinical Trials 

According to the U.S. Food and Drug Administration, only 25% of participants in clinical trials for medicines approved in 2022 were non-white. Increasing diversity in clinical trials is crucial to improving cancer outcomes among minoritized populations. Key reasons to engage minoritized populations for clinical trial recruitment include: 

1. Health Equity, Safety, and Efficacy: Historically, minoritized populations have been underrepresented in clinical research. Clinical trial findings have been generalized across populations, which fails to reflect that treatment responses can vary due to genetic, environmental, and lifestyle factors. By including minoritized communities in trials, researchers can identify potential adverse effects or varying responses, ensuring that a treatment is safe and effective for all affected by the studied disease. 

2. Regulatory Requirements: Regulatory agencies increasingly require diverse populations in clinical trials to ensure that approved treatments are safe and effective for all population segments. Since 2023, the FDA has required that sponsors submit a diversity action plan for Phase 3 clinical trials. 

3. Building Trust: Engaging minoritized populations in clinical research helps build enduring trust between these communities and the medical research field. This can lead to increased participation in future research and improved health outcomes. 

Mitigating Cancer Inequities: Considerations for the Biopharma Industry  

The biopharma industry can take the following measures to drive equitable cancer drug development while improving the utilization of biomarker testing among minoritized populations: 

1. Inclusive Clinical Trial Design: Start by designing clinical trials with eligibility criteria that allow for the inclusion of diverse populations and actively recruit participants from underrepresented groups. 

2. Affordable Access Programs: Expand healthcare coverage and reduce financial barriers to access advanced diagnostic tests. Advocate for policies and programs that expand healthcare coverage and improve access to healthcare services, including assisting low-income and uninsured individuals with access to cancer screenings, biomarker testing, and treatments. 

3. Building Trust Through Community Engagement: Work on building trust with minoritized communities by involving community leaders and partnering with trusted community-serving organizations to disseminate information about the importance of cancer screenings, biomarker testing, and clinical trial participation. Implement community education campaigns engaging minoritized communities in multiple languages with culturally tailored information. Communities are not monoliths, so communications must be customized within minoritized groups. 

4. Culturally Humble Care: Invest in training healthcare providers and community health workers in cultural humility, including addressing implicit biases, to improve communication and trust with patients from minoritized groups. 

5. Improving Access in Rural Areas: Develop initiatives to bring advanced diagnostics to rural areas, such as mobile health units, telemedicine services, and partnerships with local clinics to offer biomarker screenings. 

6. Data Transparency and Reporting: Commit to expanding transparent reporting of clinical trial outcomes by race, ethnicity, SGM status, and geographic location to identify gaps and inform targeted interventions. 

Addressing cancer inequities among minoritized populations requires comprehensive strategies that tackle much more than the clinical aspects of the disease. By addressing social and systemic barriers, healthcare systems can work toward ensuring that all populations, regardless of background, have equitable access to advanced cancer screening and diagnostic tests and treatment.  

The biopharma industry can play a pivotal role in reducing these inequities by enhancing diversity in clinical trials and implementing tailored solutions. Collaborative efforts with healthcare providers, community organizations, and policymakers are essential to drive meaningful progress toward equitable cancer care for all. 

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