Disparities and unmet needs in HR-positive breast cancer

Gina Wang, Senior Director and Distinguished Scientist
Nicole Richie, Global Head of Health Equity and Population Science

While breast cancer is a disease with many types¹, it’s important to remember that every person with breast cancer is unique – with a unique set of personal circumstances, history, geography, and socioeconomic considerations that accompany the diagnosis. Only when we work to understand the whole picture, can we help improve and tailor breast cancer care. We hear from some of our brilliant women working to help improve care in the most common type of breast cancer, known as hormone receptor (HR)-positive breast cancer.

Gina: For me, it is always important to step back and reflect on how tremendously meaningful it is to work in breast cancer. As a scientist and researcher, I have witnessed incredible breakthroughs in care in the last few decades, and yet this year we saw breast cancer become the leading form of cancer worldwide.2 This is evident when you talk to people; most people have been touched by breast cancer in some way whether it be a family member, friend, or colleague. With one in seven people in Europe diagnosed at some point in their life, the burden of breast cancer on society is huge.3

Nicole: Absolutely, and it’s so important to highlight that it’s a global issue. We need to be focused on helping to resolve inequities in breast cancer care that we know exist around the world.4 My work focuses on improving inclusion and access to our clinical trials to ensure that certain patient populations aren’t left behind. This involves creating new foundations for reaching patients, supporting better patient representation, and helping to improve healthcare ecosystems. But how do we build clinical studies that are as diverse as people with breast cancer are?

Gina: Exactly, it starts with setting up studies that speak to and support different people. This is a key focus for our teams within Roche who run studies in HR-positive breast cancer – the most common type of breast cancer.5 We have branched out from regions where studies have ‘traditionally’ been run (e.g., predominantly in Europe and the US) to new territories in East Africa, South America, the Philippines, and India, for example. This means we can reach out as widely as possible to areas where access to innovative medicines may be more limited.

Nicole: We’re also building support systems in our studies that aim to be as diverse as the people we enrol. This could involve providing upfront stipends to cover travel costs, to ensuring that we have patient liaison representatives who belong to the same community as them. And let’s not forget, many people with breast cancer are also parents as well – how do they continue to care for their children when they're participating in a clinical trial? So, we also offer childcare reimbursement in our aim to be as inclusive as possible.

And we know that in some countries and regions, as well as certain populations within countries, that disparities exist in breast cancer outcomes.4,6 We certainly know this is the case in hormone receptor-positive breast cancer.6

Gina: Yes, and there needs to be more awareness of this. At the heart of understanding these disparities is the need to study them. We know that biology matters, access to healthcare matters, and socioeconomic factors matter6,7 – but we need to tease out the impact of each and we can only do this by ensuring we have representation in our clinical studies.

Nicole: One of the things I was just reflecting on is the role women have as decision makers in their households. Did you know that women make 80% of healthcare decisions for their families?8 They're the CEOs of healthcare in their households! The decisions that women with breast cancer make have massive implications for their family, as well as them personally. This also applies to other diseases that disproportionately affect women, or disproportionately have poorer outcomes in certain populations of women.

 Gina: And when trying to improve outcomes for people with breast cancer, we have such an incredible legacy at Roche. We’re developing the medicines of tomorrow to improve care for every patient, and if we do this, we will also positively impact those around them. As mentioned, the majority of diagnoses in breast cancer are of the HR-positive type (this represents about 70% of cases).5 We know that people with HR+ breast cancer have many unmet needs,9 and my team is fully focussed on helping to overcome them. A major problem is poor adherence to standard of care treatment due to the impact of side effects. In fact, up to 50% of people discontinue treatment10– this is an alarming figure that we need to resolve through the development of more effective and tolerable medicines.

Nicole: And what if you are a single parent or the sole breadwinner of the family, or in a situation where you simply cannot afford not to comply with your treatment? People with HR-positive breast cancer are having to make incredible sacrifices, so helping develop a potentially more tolerable and effective treatment could have such an impact. Its impact that goes far beyond the medicine itself.

Gina: And this comes back to our patient centric focus, our culture that fosters innovation and our focus on research to find better, more tailored therapies. Let’s continue to shine a light on some of the disparities and unmet needs that exist for people with breast cancer. It’s a tremendous privilege to be working with you all on this – we know that this is not easy but through incremental steps, passion and persistence we will see in breakthroughs that people with breast cancer are waiting for.


  1. Breast Cancer Network Australia. Types of breast cancer. [Internet; cited October 2021]. Available from:

  2. Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

  3. European Cancer Information System. Breast Cancer Factsheet Oct 2020 [Internet; cited October 2021]. Available from:

  4. Breast cancer in developing countries. Lancet. 2009;374(9701):1567.

  5. Lim E, Metzger-Filho O, Winer EP. The natural history of hormone receptor-positive breast cancer. Oncology (Williston Park). 2012;26(8):688-94, 696.

  6. Benefield HC, Reeder-Hayes KE, Nichols HB, Calhoun BC, Love MI, Kirk EL, et al. Outcomes of Hormone-Receptor Positive, HER2-Negative Breast Cancers by Race and Tumor Biological Features. JNCI Cancer Spectr. 2021;5(1):pkaa072.

  7. Roberts MC, Wheeler SB, Reeder-Hayes K. Racial/Ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review. Am J Public Health. 2015;105 Suppl 3:e4-e15.

  8. Matoff-Stepp S, Applebaum B, Pooler J, Kavanagh E. Women as health care decision-makers: implications for health care coverage in the United States. J Health Care Poor Underserved. 2014;25(4):1507-13.

  9. Başaran GA, Twelves C, Diéras V, Cortés J, Awada A. Ongoing unmet needs in treating estrogen receptor-positive/HER2-negative metastatic breast cancer. Cancer Treat Rev. 2018;63:144-55.

  10. Finitsis D, et al. Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta-analysis. Psycho-Oncology 2019;28:255-63.


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