Since 2014, May 20th has been promoted as Clinical Trials Day by the Association of Clinical Research Professionals. It is a moment to recognize the pivotal role clinical trials play in advancing research and treatment for many diseases, including breast cancer. This day was chosen to honour Scottish surgeon James Lind, who, in May 1747, conducted what is generally acknowledged as the first clinical trial. At the time, Lind was a ship’s surgeon on board the Salisbury, a Royal Navy vessel that was at sea enforcing a blockade in the English Channel. In the 18th century, scurvy, a disease caused by a lack of vitamin C in the diet, was responsible for many sailors’ deaths.
Lind found a cure for scurvy using a sample of only 12 men, as similar in diet and size as possible, and ensured they even slept in the same area on the ship. He divided them into random pairs and assigned each pair a different treatment, such as drinking vinegar three times a day, a tincture of diluted sulphuric acid, or a medicinal paste, each day for a period of two weeks. Out of the group, it was the two men who were assigned to eat oranges and lemons who showed the most sudden and dramatic improvement after only 6 days. Unfortunately, Lind was not a good promoter of his discovery, and it wasn’t until 1795 that an ounce of lemon juice was mandated to be given each day to every sailor in the British Navy. This act nearly wiped out scurvy in one fell swoop.
Today, clinical trials, as defined by Clinical Trials Ontario, “are a type of research that involves people and tests health-related interventions. Through clinical trials, it is determined whether a new intervention is safe and effective, whether it helps people live longer than other treatments, or whether it improves the quality of life for patients.”
Modern clinical trials are strictly controlled and are required to pass an ethics review in order to protect the wellbeing and rights of participants. Any cancer drug available for use in Canada has been tested through a clinical trial program, starting with laboratory testing, and moving on to phases with human subjects. There are three phases in clinical trials. Phase 1 and phase 2 trials generally have a smaller number of participants and researchers are trying to understand whether a new treatment is effective and safe, what the side effects may be, and what the best dose is for that treatment. Phase 3 trials can involve as many as 3,000 people and are usually offered in several cities across the country.
There are several key benefits to participating in clinical trials. One is the opportunity to contribute to the advancement of knowledge and treatment for breast cancer. By enrolling in a clinical trial, you can play an integral role in not only shaping the future of breast cancer care but also of your own health care. It can also give you the opportunity to access new treatments and to be monitored more closely by a specialized oncology team.
Despite these benefits, and the potential for clinical trials to improve and transform cancer care, participation remains low, particularly among certain demographic groups. Disparities in equity impact individuals based on factors such as age, race, socioeconomic status, and geographic location. Lack of awareness, misconceptions about clinical trials, language barriers, financial constraints, and limited rural or remote access are barriers that contribute to lower enrollment rates. Fostering equitable access to clinical trials can lead to a better understanding of how breast cancer presents and responds to treatment across diverse groups of people and can ensure that treatments are benefiting everyone regardless of background or circumstance.
If you have the opportunity, consider participating in a clinical trial. Your participation can not only benefit you but can also improve breast cancer care overall. If you’re interested in participating in a clinical trial, you can download a list of questions to ask your healthcare team here. You can also check Clinical Trials Ontario’s Clinical Trials Finder to see what trials are actively recruiting across the country.
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