Black Americans develop pancreatic cancer more often and die from it more often than other groups, yet they are underrepresented in the clinical trials that test new pancreatic cancer treatments. This is not the result of any single cause. It reflects a web of structural factors: where trials are located, how patients are referred, eligibility rules that screen people out, the cost and burden of taking part, and a long history of mistrust. Understanding the disparity accurately, rather than reducing it to one explanation, is what points toward fixing it. Here is what the evidence shows.
The Underlying Disparity
Pancreatic cancer falls hardest on Black Americans.
Incidence is highest in this group. One analysis of national cancer data put it at roughly 15.4 per 100,000 among Black Americans, compared with 13.2 among non-Hispanic White Americans and 11.6 among Hispanic Americans. Mortality follows the same pattern, with Black Americans facing higher death rates and modestly higher adjusted odds of dying from the disease. This gap has persisted for decades.
The Enrollment Gap
Despite carrying more of the burden, Black patients are consistently underrepresented in pancreatic cancer trials.
Black Americans make up about 13% of the US population but have historically been a much smaller share of cancer trial participants across oncology. Precise figures vary by dataset, so single headline percentages should be treated as approximate rather than exact.
One pancreatic-specific study, published in the Journal of Clinical Oncology in 2022, is particularly revealing. Researchers applied standard trial eligibility criteria to a real-world patient cohort in which Black patients made up 42.5% of the population. They found Black patients were significantly less likely to be eligible for trials than White patients, with eligibility rates of 33.2% versus 42.4%. In other words, the eligibility criteria themselves screened out Black patients at a higher rate, before any question of choice or willingness arose.
Why It Happens: Multiple Causes, Not One
This is the crucial point, and the reason simplistic explanations mislead. The disparity is driven by several overlapping factors.
Where trials are located. Pancreatic cancer trials are concentrated at academic and NCI-designated cancer centres, which are far from many patients, particularly those in rural or under-resourced areas.
Referral patterns. Whether a patient is told about a trial depends on their clinician’s awareness and referral habits, which vary.
Eligibility criteria. Requirements around other health conditions, performance status, and laboratory values disproportionately exclude Black patients, as the 2022 study demonstrated directly.
Socioeconomic barriers. Travel to distant trial sites, time away from work, and out-of-pocket costs fall harder on lower-income patients, and insurance limitations compound this.
Mistrust. A documented history of unethical research involving Black Americans, alongside ongoing experiences of unequal treatment, has left justified mistrust of the research system.
The research system itself. A lack of diversity among trial staff, implicit bias, and structural racism in healthcare all contribute.
No one of these explains the gap. They act together, which is why addressing only one at a time has limited effect.
What Is Being Done
Several efforts aim to narrow the gap.
Broadening eligibility criteria. Work led by ASCO and Friends of Cancer Research has pushed to modernise overly restrictive criteria that exclude patients without good scientific reason, which would directly address the eligibility gap.
Regulatory attention. The FDA has worked on guidance encouraging sponsors to set enrollment goals for underrepresented groups. The status of specific federal diversity guidance has shifted, so its current form should be checked rather than assumed.
Community engagement. Organisations including the Pancreatic Cancer Action Network run awareness and engagement efforts, and patient navigation, community trial sites, and implicit-bias training are being used to reduce practical and trust barriers.
Why It Matters
This is not only a fairness question, though it is that. When trials do not include the patients most affected by a disease, the results may not generalise to those patients, leaving uncertainty about whether a treatment works as well for them. And underrepresentation denies patients access to potentially better, cutting-edge treatment that trials can provide.
For anyone facing pancreatic cancer, our guide to cancer clinical trials covers how trials work, who pays, and how to find one.
Pancreatic Cancer Trial Disparity FAQs
Are Black Americans underrepresented in pancreatic cancer trials?
Yes. Although Black Americans have higher pancreatic cancer incidence and mortality, they are consistently a smaller share of trial participants than their share of patients, driven by several structural factors.
Why are minority patients underrepresented?
No single cause. Contributors include trial locations far from many patients, referral patterns, eligibility criteria that exclude patients at unequal rates, travel and cost barriers, and a documented history of mistrust in the research system.
Do eligibility criteria contribute to the gap?
Yes, directly. A 2022 study applying standard trial criteria to a real cohort found Black patients were significantly less likely to be eligible than White patients, 33.2% versus 42.4%, before any question of willingness.
Why does representation in trials matter?
Because results from trials that exclude the most affected patients may not generalise to them, and because trials offer access to cutting-edge treatment. Underrepresentation affects both the science and equitable access.
What is being done about it?
Efforts include broadening overly restrictive eligibility criteria, regulatory attention to enrollment diversity, community engagement by groups like the Pancreatic Cancer Action Network, patient navigation, and bias training.
Does pancreatic cancer affect Black Americans more?
Yes. Incidence and mortality are both highest among Black Americans, a pattern that has persisted for decades, which makes their underrepresentation in trials especially consequential.
