Bridging the Gap: Enabling Equal Access to Biomarker Cancer Testing and Clinical Trials for Black Patients

By: Thais Rivas, Medical Affairs Intern 

Advancements in biomarker testing, clinical research and targeted th­­erapies offer personalized treatment plans that can improve patient health outcomes, but Black patients with cancer often do not have access to these breakthroughs in cancer care. Some of the barriers faced by many Black patients with cancer include lack of insurance coverage, medical biases, medical mistrust and lack of awareness. In particular, this survey found that the main barriers were, in fact, a mistrust in the medical system, a fear for safety and a concern about being a “guinea pig” a test subject for unproven therapies without their knowledge or consent. 

Past events have created distrust between Black populations, researchers and the medical community. Two such events were the Tuskegee Study of Untreated Syphilis, where men with syphilis were observed rather than being treated for their condition, and the case of Henrietta Lacks, where her cancer cells were used widely and unknowingly for medical research. These examples are well known and remain on the minds of Black Americans today. 

Some Black Americans still believe that the risks of testing and research participation are high and are not inclined to believe that researchers prioritize their well-being, even with rules and regulations that protect them. Many people are impacted by serious and life-threatening illnesses, including cancer, yet there are many challenges for patients to access high-quality care often affecting communities of color. Labcorp is committed to addressing racial health disparities and enabling equitable access to cancer care and other necessary treatments for all patients. 

Understanding biomarker testing

Please visit our previous blog, Spilling the Tea on Biomarkers to learn more. Biomarker testing involves identifying the unique biological elements of a patient’s cancer, the fingerprint of the cancer. This is done by collecting blood and/or tissue samples to identify changes in the cell’s genetic roadmap or the presence of proteins on the surface of the cancer cell. Biomarker testing allows healthcare providers to use this extremely specific information to work with patients to develop personalized treatment plans that can improve the results of treatment. As a result of these improvements, patients could live longer, experience fewer or less severe side effects or have a better chance of recovery from cancer through early detection.

Biomarker testing can take many forms. In the past, most tests looked at one biomarker at a time, whereas tests available now are more thorough and look at hundreds of biomarkers at the same time. These tests are growing in their use and becoming increasingly popular. One example of a growing biomarker testing technology is next-generation sequencing (NGS). This is a technology that enables quick and accurate reading of genetic information in a person’s cells by looking closely at the DNA, which forms the building blocks of the cell. NGS allows scientists to identify specific changes in the cell, or mutations, that can guide cancer treatment. 

Disparity in access to biomarker testing

Despite breakthroughs in biomarker testing for cancer treatment, Black patients are less likely to receive these tests compared to their White counterparts. Socioeconomic factors, including job status and where a person lives, insurance coverage and assumptions and/or beliefs of healthcare providers add to racial health disparities. Studies have shown that elderly Black patients with advanced non-small cell lung cancer (NSCLC) whose insurance is through Medicaid have lower chances of receiving biomarker testing with this new technology. Not receiving biomarker testing for NSCLC can have negative effects on patient health outcomes as critical new information that can guide treatment decisions would not be available without the testing. Lack of access to advanced diagnostics emphasizes the need for broad changes to improve healthcare for Black patients with cancer and other serious and life-threatening illnesses.

Clinical trial enrollment disparities

Thorough biomarker testing helps guide healthcare providers to find the best treatment options based on specific characteristics of a cancer. It can also determine if patients qualify for a clinical trial. Unfortunately,  there are major differences in who participates in clinical trials in the United States based on race, with White patients being represented disproportionally more than minority patients.²Additionally, another study showed that clinical trial participation was higher in patients living in urban areas compared to those in rural and less populated areas.³ All of these differences result in significant healthcare challenges.

Racial, cultural and socioeconomic disparities coupled with the mistrust underscore the need to include and reach out to communities of color and those who live in less populated areas. Increasing diversity in clinical trials is critical for understanding how treatments work for patients of different backgrounds and enabling access for them. The following are some initiatives we can implement to address gaps in access.

1. Expanding access to biomarker testing: Biomarker testing needs to be available to all communities, especially for rural communities and people of color. Broader insurance coverage and patient assistance programs are essential can also improve access to biomarker testing 
2. Community outreach: Engaging with the community with transparency and fostering trust among researchers, healthcare providers and the community has shown to increase recruitment and retention in clinical trials.⁴ Outreach initiatives that focus on educating patients and healthcare providers can improve awareness about the biomarker testing process and highlight the benefits of targeted cancer therapy approaches. Educational initiatives can include setting up mobile education sites in majority Black and rural regions. 
3. Increasing clinical trial diversity: Increasing enrollment of communities of color in clinical trials may help build trust in clinical research and raise awareness of new, effective treatments. Advocating for policy changes that mandate more inclusive clinical trial recruitment policies can play a crucial role in increasing diversity. 
4. Collaborating with healthcare organizations: Collaborating with oncology centers, especially through community-based practices, across the United States will help patients of all backgrounds have access to advancements in biomarker testing and clinical trials. Healthcare organizations can engage communities of color by partnering with local organizations, like the National Urban League, churches, and areas where people gather, like barber shops and beauty salons, to hold informational sessions, develop programs that offer financial assistance and involve community members to build transparency and accountability in the community. 

Addressing racial health disparities in biomarker testing and clinical trial enrollment is a crucial step in improving cancer patient outcomes. Labcorp prioritizes health equity and access by advocating for an inclusive healthcare environment.