Death rates from cancer are falling and access to potentially lifesaving treatments is increasing — except among Africans and Americans of African descent. This gap must be closed.
Overall, the picture for cancer looks better than it did 30 years ago. In the last two decades, death rates for cancer in the U.S. have declined 26 percent. That translates into nearly 2.4 million lives saved. This drop is largely due to improvements in our understanding of the disease that have led to treatment innovations and breakthroughs.
But this wave of improved outcomes is largely bypassing patients of African descent in the U.S. and around the world.
The death rate from cancer is 24 percent higher in African-American men than in white American men, and 14 percent higher in African-American women than white American women. In Africa, cancer now kills 60 percent more people each year than malaria. Without intervention, the number of deaths due to cancer across the African continent is projected to double by 2040.
Why are 13 percent of Americans and 17 percent of the world’s population being left behind? The answer, at least in part, is the clinical trials used to study treatments for the disease.
In clinical trials for 24 of the 31 cancer drugs approved by the U.S. Food and Drug Administration since 2015, fewer than 5 percent of participants were of African ancestry. On a global scale, fewer than 2 percent of cancer clinical trials are conducted in Africa. These numbers reflect the dramatic underrepresentation of patients of African descent in cancer clinical trials and, by extension, the failure of innovative treatments to reach them.
The current situation is problematic for two reasons. First, the low enrollment of individuals of African descent in clinical trials is preventing them from accessing treatments that could potentially improve their quality of life and chance of survival. For patients who have exhausted all other treatment options, clinical trials can be a sign of hope, possibly offering life-extending opportunities. The second reason is more nuanced. Without adequate representation in clinical trials, it is impossible to gather comprehensive and accurate information as to how or if these drugs work in individuals of African ancestry.
Clinical trials generate data about safety and effectiveness that are used in two key ways: to obtain regulatory approval and to define protocols for how medications are administered. If the participants in a clinical trial are overwhelmingly Caucasian, its results offer little or no information for how individuals of African or other descent will respond to the treatment.
Patients of African descent are disproportionately affected by certain malignancies. Cervical cancer rates are four times higher in African women than in American women, and both African and African-American women are more likely than white women to be diagnosed with triple-negative breast cancer, a particularly aggressive form of the disease. Similarly, African-Americans are more likely to have colorectal cancer, multiple myeloma, and lung cancer than the general population. And the death rate for prostate cancer is more than twice as high in African-American men as in white American men.
By failing to enroll significant numbers of patients of African ancestry, clinical trials are perpetuating existing health care disparities across the globe. My organization, BIO Ventures for Global Health, is trying to change this.
We recently launched the African Consortium for Cancer Clinical Trials (AC3T) under the umbrella of our larger African Access Initiative. AC3T is designed to close the clinical trials data gap by providing funding for trials and the drugs used in them so African investigators can conduct clinical trials in their home countries. The project aims to provide for free innovative “gold standard” drugs that have been approved for use in the U.S. Not only does this program provide access to tested lifesaving medications and technologies, but it also generates data on the safety and effectiveness of cancer drugs in patients of African descent. Given the fact that cancer clinical trials in the U.S. do not adequately recruit African-Americans, conducting these trials in Africa will help generate desperately needed safety and effectiveness data for individuals with diverse African ethnicities.
BIO Ventures for Global Health is collaborating with industry partners to build clinical trial capacity at our African Access Initiative hospitals and is also working with African investigators to develop proposals for cancer clinical trials. We are coordinating directly with African ministries of health to define priorities for the types of cancer and types of drugs to investigate, form partnerships with pharmaceutical companies, and create sustainable solutions to change current cancer patterns.
This fall we worked with Dr. Isaac Adewole, Nigeria’s minister of health, to develop and distribute a request for proposals (RFP) to help combat that country’s rapidly rising cancer burden. The RFP, aimed at pharmaceutical company CEOs, is based on data from hospitals in Nigeria that are affiliated with the African Access Initiative. A number of companies have responded with proposals to make their medicines available for patients in Nigeria in a safe and affordable manner.
Lack of reliable clinical trial data from cancer patients of African descent, wherever they may live, translates into lives lost. By providing early access to lifesaving oncology drugs and generating safety and effectiveness data for patients of African origin, AC3T seeks not only to eliminate existing disparities in our current understanding of cancer but also to close the growing cancer mortality gap.
Jennifer Dent is the president of BIO Ventures for Global Health.