Addressing Racial Disparities, Social Barriers to Breast Cancer Care

Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, FACS, spoke with CancerNetwork^® about potential initiatives to reduce racial disparities and other social barriers to receipt of guideline-concordant care for inflammatory breast cancer.

She discussed these strategies in the context of a study she published in JAMA Network Open demonstrating that 25.1% (n = 1740) of evaluable patients received guideline-concordant care. Additionally, investigators noted various modality-specific disparities across racial and ethnic populations, such as lower likelihoods of neoadjuvant systemic therapy receipt for Asian, Black, or Hispanic patients compared with White populations.

According to Fayanju, a potential strategy to mitigate these disparities is revising stringent inclusion criteria for clinical trials that may disproportionately exclude racial minority populations with certain comorbidities or medical conditions. Such initiatives may help increase treatment access and bolster outcomes across all patient populations.

Fayanju is the Helen O. Dickens Presidential Associate Professor, chief in the Division of Breast Surgery at Penn Medicine, surgical director of Rena Rowan Breast Center, director of Health Equity Innovation at Penn Center for Cancer Care Innovation, and senior fellow at Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania.

Transcript:

Inclusion in clinical trials—not only looking at, for instance, sequences of therapy and receipt of guideline-concordant care but literally in the development of the drugs that are being used—can give us a better understanding of whether these drugs work efficaciously across all populations. [For example], whether they work efficaciously in people with different levels of comorbidity. One of the things we’re concerned about in clinical trials is trying to isolate the effect of a particular medication, which means our inclusion criteria are often very stringent and require that patients not have certain types of medical conditions that may confuse the perceived effects of the medication or make it harder to keep patients on trial. This type of adherence to fairly strict inclusion criteria regarding the exclusion of other comorbidities can disproportionately exclude people of color who have higher rates of diabetes and other types of medical conditions.

We need to be thoughtful about—again, from the development of these drugs and these regimens—who the population is, looking at trials that mirror real-world scenarios and real-world populations and all the comorbidities we see in those populations, as well as the social barriers to receiving medication in consistent fashion. One of the things that is notable about these large data sets, looking at guideline-concordant care receipt, is that we have some sense of initiation and some sense of duration. We don’t know what’s happening between the beginning and the end of these regimens. Is there consistent dosing? Is that dosing happening in optimal fashion? Are there social circumstances surrounding the patient’s care that mean that their treatments are actually interrupted or the regimen is not happening the way it’s supposed to? Looking at both the development of these medications and then better understanding how they’re actually being delivered once they’re delivered and, of course, looking mechanistically to see if there are things we’re missing about people who may have certain predispositions for other conditions that are making them less efficacious will be important to see. Why don’t people get guideline-concordant care? If they get guideline-concordant care, why is it not achieving the same results across all people?

Reference

Tadros A, Diskin B, Sevilimedu V, et al. Trends in guideline-concordant care for inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454506. doi:10.1001/jamanetworkopen.2024.54506