Impact of structural racism on inclusion and diversity in precision oncology: A scoping and critical review of the literature

Abstract

This scoping review provides a precise mapping of recruitment and participation barriers that racial and ethnic minorities are likely to face in precision oncology and related activities. It provides useful actionable insights for researchers, clinicians, healthcare and research institutions, and policy-makers to identify how systemic discriminatory pathways can lead to cancer disparities along racial and ethnic lines in precision oncology. In addition, it is the first scoping review to utilize the Public Health Critical Race Praxis (PHCRP) -an analytical framework rooted in critical race theory -to uncover how assumptions, simplifications, norms and paradigms used by researchers in their respective studies can further explain the limited representation of minorities. For instance, the PHCRP analysis revealed that researchers tend to embrace a monolithic view of racialized populations, wrongly equating self-reported race to the presence of specific genetic variants or homogeneous genetic backgrounds within these populations. Such a view was also found to be primed by inherent limitations of certain tools used commonly in genomic studies and precision oncology. For instance, publicly available genomic databases missing genetic ancestral information and failing to capture the genetic diversity of populations represented therein. Other factors revealed by the PHCRP analytical framework include the Black-White binary paradigm, researchers ignoring the contribution of racism to observed cancer disparities, and the lack of conceptual clarity on the meaning and use of race and ethnicity. Although predominantly centered on US studies and publications, results of this scoping review and of the PHCRP analysis are likely to be useful to the broader scientific community at tackling the lack of inclusion and diversity in their respective projects since structural racism knows no borders.

Introducing Cambridge prisms: Precision medicine

“…Legal and ethical governance are integral to healthcare frameworks with diversity, equity, and public understanding being key topics under review. A great challenge is in managing the “backdrop of promotional public discourses” that accompany population-level genomic sequencing projects (Horton and Lucassen, 2023 ), while inequity and lack of inclusion, particularly within clinical trials and polygenic risk scores, remain a great challenge to the field (Geneviève, 2022 ).…”