Why Black Women Are Underrepresented in Breast Cancer Trials and What Dr Coral Omene Is Changing

Breast cancer does not kill equally. Across every racial and ethnic group in the United States, Black women die from breast cancer at rates up to 40% higher than their white counterparts. They are more likely to be diagnosed with triple-negative disease—the most aggressive subtype—and they are far more likely to face those odds without ever having been included in the research that produced the treatments being used to fight it.

Some FDA-approved drugs cleared trials where minority enrollment was under 2%. Others had 0 Latino patients. One had 5 Black patients total. These are not rounding errors. They are a design failure, and Coral Omene, MD, PhD, has been saying so publicly for years.

Omene is a breast medical oncologist and program director for Breast Cancer Disparities Research at Rutgers Cancer Institute in New Brunswick, New Jersey. She holds both her MD and PhD from Columbia University, runs breast cancer clinical trials as site PI for the iSPY 2 adaptive platform, and held a V Foundation grant, awarded in partnership with ESPN, specifically to increase clinical trial participation among Black women. Rutgers Cancer Institute, where she works, enrolls nearly 50% minority participants in clinical trials. She believes they may be the only institution in the country hitting that number.

On the latest episode of The Moonlight Shift, host Gina Mauro asked her what she does when a Black patient says no to a clinical trial. Dr Omene’s answer was precise.

“You have to find out why she’s saying no,” she said. “It cannot be a 5-minute discussion. It cannot be ‘okay, patient declined.’ You have to be aware of why that is, and then try to educate them on why things have changed.”

The history is not abstract. Tuskegee is not a distant reference point. It is something that gets passed down, Dr Omene explained, through generations of families who watched what the medical system did and decided, reasonably, not to trust it. Breaking through that requires time, follow-up, family conversations, and an honest accounting of how much the system has changed and how much it hasn’t.

That accounting was on full display in the episode’s game, Progress or Promise, built for someone who lives at the intersection of what breast cancer science can do and who it actually reaches. Omene called antibody-drug conjugates and bispecific antibodies—and the I-SPY 2 platform itself—progress. She called the field’s response to medical mistrust in the Black community, diversity requirements in clinical trials, and the prospect of equal outcomes for Black women with triple-negative breast cancer in 10 years what they are: Promise.

Not yet. Not close enough.

The I-SPY 2.2 data, presented at the 2026 ASCO Annual Meeting, gave her something real to hold onto. Rilvetgostamig plus fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) produced a 57% pathologic complete response rate in the hormone receptor–positive/immune-positive signature—exceeding the platform’s own benchmarks and sparing patients anthracycline-containing regimens. Patients with residual disease in Block B achieved complete responses at rates above 90%. The trial’s patient population mirrored national demographics across racial and ethnic groups. That, Omene noted, is exactly the point: data that comes from a diverse patient population is data that applies to a diverse patient population.

The V Foundation grant funded a multi-pronged approach: patient navigation, dedicated educational materials for Black women, and community outreach through a town hall series she still runs with patient advocate Dara Reed. The series invites Black patients, family members, and community members to ask questions directly about trials, about mistrust, about why their data specifically matters to the science. There was a measurable uptick in enrollment. The town halls continue.

“We have all these advancements,” Omene said, “but there are still populations that are significantly doing less in terms of survival than everyone else. And that there’s still more to do. It’s not a home run yet.”

The Moonlight Shift is available on YouTube and across MJH Life Sciences’ oncology platforms. New episodes, released bi-weekly, feature leading and early-career oncologists from the Tri-State corridor in peer-level conversations about where the field is going and what it still has to work out.