Bridging the Gap: Addressing Disparities in Cervical, Endometrial, and Ovarian Cancer Trials and Care in the US
According to a recent study published in JAMA Network Open, gynecological cancers in the US remain a significant health burden, with over 110 000 new cases and more than 30 000 deaths annually. These cancers, affecting organs such as the cervix, uterus, and ovaries, disproportionately impact marginalized racial and ethnic groups. Mortality rates for cervical, endometrial, and ovarian cancers are notably higher among Black individuals compared to other racial groups, with Black and Hispanic patients also less likely to receive care. In response to these disparities, initiatives were employed to focus on women’s health and cancer funding aim to address systemic inequities.
Clinical trials are seen as a crucial pathway for improving cancer outcomes, offering equitable treatment when accessible. Research has shown that in ovarian cancer trials, Black and White participants achieve similar results when provided the same care, underscoring the role of trials in bridging disparities. However, socioeconomic factors, such as wealth and access to resources, often intertwine with racial disparities. Socioeconomic status can influence trial participation and outcomes, complicating efforts to address racial inequities.
Barriers to trial participation for minoritized groups include historical mistrust of the healthcare system, lower availability of trials in regions with higher minority populations, and challenges matching patients with racially concordant practitioners. These geographic and systemic issues reduce trial enrollment among marginalized communities, limiting the generalizability of findings. Addressing these barriers is essential to improving trial accessibility and ensuring equitable advancements in gynecological cancer care.
A comprehensive study analyzed 1561 gynecological cancer trials in the US between 2013 and 2024. Ovarian cancer was the most studied, while vulvar and vaginal cancers had the fewest trials. Geographic disparities were evident, with states like South Dakota and Rhode Island having the highest population-adjusted trial rates, while populous states like California and regions with large minoritized populations had the lowest. This disparity suggests that trial locations are influenced by factors such as population demographics and funding priorities.
Further analysis revealed weak or inverse correlations between trial availability and cancer incidence rates, suggesting misalignment in resource allocation. States with higher social vulnerability and predominantly minoritized populations had fewer trials, while predominantly White states had more. This highlights a significant gap in access for minoritized communities, underscoring the need for targeted strategies to improve trial accessibility and address geographic and racial disparities in gynecological cancer research.
“We found that states with higher minoritized populations (identified using the percentage non-Hispanic White persons in each state) had fewer trials per 100 000. Although this did not achieve statistical significance, we found that all states with 4 or more trials per 100 000 individuals had more than 50% non-Hispanic White persons in 2020, and the only exception to this was the District of Columbia. Therefore, states with high minoritized populations had lower gynecological cancer trials per 100 000 persons, but there were gaps in trial availability across the entire US,” said study authors.
Reference
Boland MR, Tubridy E, Spataro Solorzano S, et al. Geographic disparities in gynecologic oncology clinical trial availability in the US. JAMA Netw Open. 2024;7(11):e2447635. doi:10.1001/jamanetworkopen.2024.47635
