ArcaMax

“Remember that all women are getting endocrine therapy, and some got chemotherapy in addition,” Hoskins said. “What we’re looking at is how much better is the survival rate if you add chemotherapy versus the endocrine therapy alone. The difference was greater in young Black women in particular compared to young white women. Now the question becomes: Is that because the chemotherapy works better, or because the endocrine therapy doesn’t work as well in Black women? Either one of those would give you a bigger difference.

“This needs to be confirmed with additional study, but in our study, the chemotherapy effect appeared the same,” Hoskins said. “What appeared to be different was how well the endocrine therapy worked. It looks like it doesn’t work as well in Black women. Therefore, if you give chemotherapy, you can overcome that, negate that difference.”

Endocrine therapy slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones. Chemotherapy, which is usually given intravenously, uses drugs to destroy cancer cells and prevent tumor growth.

Hoskins said the UIC study shines a light on what happens years later, if inclusion and diversity is not in the mix when data is being collected in clinical trials: The exclusionary deficits snowball. He said everyone needs to work harder to improve inclusion in research, funding and pharmaceutical areas.

“If you have underrepresentation in the original trial, not only can it potentially skew the results of the original trial, but what has happened more and more is people trying to leverage information from one trial for other purposes,” Hoskins said. “You just magnify the problem. Now we have a test that was developed and validated in populations that do not reflect the U.S. population demographically, and in particular, that have underrepresentation of racial and ethnic minority women.

“If there were no differences in anything, then that wouldn’t be a problem,” he said. “But there are differences. We’re assuming that a test developed in one population is going to perform exactly the same in other populations, which maybe that’s true, but good chances are it’s not true.”

A new initiative by the Lynn Sage Breast Cancer Foundation is trying to rectify underrepresentation in cancer clinical trials. The Chicago Breast Cancer Research Consortium is a partnership among University of Chicago Medicine, the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and RUSH University System for Health. The consortium will allow patients to participate in drug trials previously unavailable to them without leaving their own providers. It will create a network of trial sites that diversifies the patient pool.

The Chicago Department of Public Health commended the consortium for its joint initiative to improve access to clinical trials, particularly for minority populations and those who face barriers to participation.

“This focus reflects CDPH’s own investments in comprehensive breast health programs that, through partners, provide screening mammograms, navigation support and innovative community outreach to Black and Latina women,” said Dr. Olusimbo Ige, commissioner of the Chicago Department of Public Health.

The Lynn Sage Breast Cancer Foundation is giving the initiative $1.8 million in an attempt to remove barriers for those who cannot afford to participate in trials. Part of the donation will be earmarked for expenses like travel and child care to ensure equity among all cancer patients.

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