Race No Barrier When Breast Cancer Patients Are Actually Offered Clinical Trials

Racial disparities in breast cancer mortality are well documented, with Black women facing 40% higher death rates than White women. Clinical trials offer access to novel therapies and generate data across diverse populations, yet Black and Hispanic patients are chronically underrepresented in oncology trials. Understanding whether this gap reflects unequal access to trial discussions or differential willingness to participate is critical for designing interventions.

Researchers surveyed 1,150 participants enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC) between July and September 2022. Respondents were asked whether a clinical trial was discussed during their cancer care, whether they were offered and enrolled in a trial, and what barriers or motivators influenced their decision. The cohort was 73% White, 19.5% Black, 4.4% Asian, and 3.1% Hispanic—a notably more diverse sample than most trial populations.

Only 38.9% of all patients reported ever discussing a clinical trial with a healthcare provider, a finding that itself signals a major systemic gap. Crucially, after adjusting for AJCC stage, molecular subtype, age, education, insurance, income, and comorbidities, there were no statistically significant differences in trial discussion rates across racial and ethnic groups. Similarly, among the 443 patients who were offered a trial, 64.3% enrolled, and participation rates did not differ significantly by race or ethnicity after covariate adjustment. This challenges the narrative that minority patients are less willing to participate.

Among the 158 patients who declined enrollment despite being offered a trial, 23.4% cited ineligibility, 10.8% worried about receiving a placebo, 10.1% cited the extra time required, and 8.9% feared adverse effects. Time toxicity—the burden of additional visits, procedures, and scheduling demands—emerged as a modifiable barrier that disproportionately affects patients with fewer resources, longer commutes, or inflexible employment.

The study's key implication is that the most impactful lever for increasing minority enrollment in breast cancer trials may be ensuring equitable access to trial discussions in the first place, rather than overcoming patient reluctance. Structural reforms—including decentralized or hybrid trial designs, transportation support, and flexible scheduling—could meaningfully address time-related barriers. The authors note that these findings serve as a practical roadmap for expanding equitable trial access.