Racial, ethnic minority populations underrepresented in precision oncology studies
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Racial and ethnic minority populations remain underrepresented in many precision oncology trials relative to their cancer incidence in the U.S., according to study results published in JAMA Network Open.
“It is already known that general cancer clinical trials are underrepresentative of the diverse U.S. cancer population based on prior evaluations. We, therefore, had suspected that in precision oncology studies there would be similar underrepresentation of minority racial and ethnic groups,” Sophia C. Kamran, MD, radiation oncologist in the department of radiation oncology at Massachusetts General Hospital, told Healio. “However, this has never been specifically evaluated. Given that precision medicine has revolutionized oncology during the past 2 decades and is expected to continue to transform cancer management, we sought to understand how well precision oncology studies represented the diverse U.S. cancer population.”
Investigators compared racial and ethnic representation in 93 breast, prostate, lung and colorectal cancer trials with actual incidence of those cancer types among racial and ethnic minority groups in the general U.S. population. The analysis included 5,867 patients from the SEER database between December 2020 and April 2021 (82.3% white, 10% Black and 4.1% Asian).
“We found that most studies do not report race or ethnicity of their participants, already creating a barrier for clinicians to understand whether findings can be applied to patients they may see in their clinic,” Kamran said.
Results showed that, overall, white participants were overrepresented in all studies at a ratio of 1.35 (95% CI, 1.3-1.37) as were Asian participants at a ratio of 1.46 (95% CI, 1.28-1.66). Conversely, the most underrepresented groups were Black individuals (ratio, 0.49; 95% CI, 0.45-0.54), Hispanic individuals (ratio, 0.24; 95% CI, 0.2-0.28) and American Indian and Alaskan Native individuals (ratio, 0.43; 95% CI, 0.24-0.78).
“Generally, among all studies, white and Asian participants were overrepresented by 35% and 46%, while other racial groups — Black, Hispanic and American Indian/Alaskan Native — were substantially underrepresented relative to their cancer incidence in the U.S. cancer population,” Kamran said.
In lung cancer trials, researchers found the greatest underrepresentation of Black participants (by 68%) and Hispanic participants (by 69%), whereas Asian participants were overrepresented by 196%. Hispanic individuals were the most underrepresented in prostate cancer studies, by 67%.
“Our findings highlight the need to increase enrollment of these groups into future clinical studies. In addition, we advocate for prospective collection of social determinants of disease to further analyze associations found by race or ethnicity, as these two variables must be studied as social constructs,” Kamran said. “All individuals deserve to benefit from cancer research breakthroughs and deep understanding of underlying tumor biology, not only in the context of race and ethnicity, but in the context of social determinants of health, as well. A multipronged approach must be implemented to increase diverse enrollment onto precision oncology trials moving forward.”
These results highlight a clear need for additional research in this area, she added.
“We hope to better understand barriers and fears surrounding research recruitment in these communities for such trials. Early data suggest there are additional challenges with recruitment to these types of studies related to mistrust, miscommunication, misunderstanding and lack of appropriate education surrounding genetics and genetic counseling, with documented fears of discrimination by insurance companies if found to have a tumor/genetic mutation and general fear of finding/having a mutation. More resources are necessary to combat these barriers,” Kamran said.
“In addition, all precision studies should report the race and ethnicity, as well as other social/environmental determinants of health, so that improvements in diversity and representation can be tracked over time, with this analysis serving as a benchmark with which to compare future progress.”
For more information:
Sophia C. Kamran, MD, can be reached at Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114; email: skamran@mgh.harvard.edu.
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