<p>Disparities in the treatment of breast cancer remain a significant public health challenge. Multiple studies presented at the recent <strong>2025 San Antonio Breast Cancer Symposium (SABCS 2025)</strong> highlighted persistent disparities in breast cancer care, showing that race, ethnicity, socioeconomic status, geography, and health system factors continue to influence how and when patients are diagnosed and treated.</p> <p><br></p> <p><em>Following these presentations, featured expert Sonya Reid, MD, MPH, was interviewed by </em>Conference Reporter<em> Associate Editor-in-Chief Christopher Ontiveros, PhD. Clinical perspectives from Dr Reid on these findings are presented here.</em></p>

One of the studies from SABCS 2025 that I thought was interesting was an analysis by Sarah Poland, MD, and colleagues that looked at racial and socioeconomic disparities in patients with de novo HR+/HER2- metastatic breast cancer using data from the National Cancer Database (poster PD1-02). Essentially, this study showed that more Black and Hispanic patients had visceral or brain metastases at initial diagnosis compared with their White counterparts.

<br>

These data make me wonder: What is driving these disparities? Is it the same factors that drive breast cancer disparities overall, such as differences in tumor biology, genomics, patterns of care, and socioeconomic factors? For example, we know that Black and Hispanic patients, as well as individuals living in rural settings, experience delays in treatment initiation. In addition, several studies have also shown that racial and ethnic minority groups experience more insurance-related delays and are less likely to be treated at comprehensive cancer centers.

<br>

In another study discussed at SABCS 2025, Lesley Coe et al found that Black patients with ER+/HER2- breast cancer also face disparities in biomarker testing, as they have lower rates of biomarker testing compared with their White counterparts (poster PS4-11-16). This is alarming in the era of precision oncology, where eligibility for targeted therapies is guided by the results of biomarker testing. In addition, targeted therapies are associated with improved survival, especially for patients with metastatic breast cancer; therefore, lower biomarker testing rates may widen existing racial disparities.

<br>

These disparities faced by racial and ethnic minority groups with breast cancer extend into clinical research as well. A study from this year’s SABCS meeting led by Vianessa Andion Camargo found that, over the past 25 years, Black and Hispanic patients have been underrepresented in breast cancer clinical trials (poster PS4-12-09). And again, not surprisingly, this study showed that, while some improvements in this area have been made over time, there is still a significant underrepresentation of racial and ethnic minority groups in these trials.

<br>

Another important study presented at SABCS 2025 evaluated the generalizability of breast cancer drugs from the past decade (poster PD1-03). Maya Birhiray, MS, and colleagues found that, not surprisingly, only 9 of the 33 breast cancer clinical trials that led to US Food and Drug Administration (FDA) approvals met their criteria for clinical trial excellence, which assess whether these studies are generalizable to the general population. For the most part, we know that these drugs have similar efficacy across different racial and ethnic groups, but their tolerability may differ. Taxanes are a good example. Prior research has shown that there are racial disparities in taxane-related toxicities, especially neutropenia and neuropathy, which may impact treatment recommendations.

<br>

It is imperative that we develop targeted interventions across patient, provider, system, and policy levels to effectively address these disparities. There was one study presented at SABCS 2025, the IMPACCT project by Melissa Taylor, MD, et al, that did just that (poster PD1-04). This study improved breast and gastrointestinal cancer clinical trial participation among underrepresented patients in the New Haven, CT, area by increasing community engagement and implementing the Just Ask implicit bias training, which was developed by the American Society of Clinical Oncology (ASCO) and the Association of Cancer Care Centers (ACCC) for their oncology teams. I think that one of the questions that still remains for us to answer is: How do we implement these interventions and scale them across different institutions?