A survey from the Metastatic Breast Cancer Alliance found that 8 out of 10 Black people living with metastatic breast cancer were open to participating in a clinical trial. Yet, only 5 out of 10 reported even knowing about a trial occuring and only 4 out of 10 reported having a member of an oncology team notify them about one. While there is a history of medical mistrust in the Black community, it seems that a lack of awareness rather than mistrust drives much of the underrepresentation. Another major factor driving low representation in clinical trials stems from the lack of trials available in community clinics that serve Black and Hispanic people with cancer. “People of color are more likely to get their cancer care at their community institution — even when there are National Cancer Institute (NCI)-designated cancer centers in their vicinity,” Gary said. “They want to go with more doctors and staff that look like they do,” Another hurdle: Many clinical trials have criteria that can exclude Black and Hispanic women. “Trials exclude candidates with [two or more health conditions], like hypertension, that are very prevalent among Black people,” said Damé Idossa, a breast oncologist and assistant professor of medicine at the University of Minnesota School of Medicine. Many pharmaceutical companies won’t use people in clinical trials who have other medical conditions because they worry about how the experimental therapy may interact with other medications or affect other medical conditions. However, this exclusion doesn’t keep in mind the people who will actually be taking the medicine. For example, a Black woman with diabetes may be excluded from a clinical trial for a particular medicine, but she would still likely be prescribed the medication once it's FDA-approved. This means that many Black patients may take medications that could lead to negative reactions to the other conditions they haven’t been studied. Even for women who have knowledge and access to trials, significant indirect costs, especially time and money, can make it difficult for them to participate. “From a patient factor standpoint, it [takes] a lot to be on trials. The treatments are free, but there are more blood draws and imaging. There might be indirect costs that you don't always think about like taking more time off of work, paying for parking and gas or finding childcare for patients with kids,” Idossa said.