“My past experiences with Teach for America in North Philadelphia were a prologue to what I am doing now,” said Austin Williams, MD, MSEd, FACS, a surgical oncologist specializing in breast cancer at Fox Chase Cancer Center and Associate Program Director of the Breast Oncology Fellowship at Fox Chase. Prior to medical school, he spent two years teaching chemistry in an underserved high school, where he learned many lessons that he translates to patient care.

“I learned that a student’s intellect, enthusiasm, and work ethic may be stifled when rigid structural and environmental factors stand in the way,” said Williams. “We sometimes need to be creative with how we address these issues to ensure the best outcomes.”

This paradigm also applies to medicine, where positive patient outcomes are often constrained by cultural, socioeconomic, and geographic barriers that can limit access to lifesaving clinical trials and therapies despite an individual’s best efforts. “While important for individual patients, lack of representation in clinical trials has broader population impacts, potentially resulting in treatments that, although proven safe and effective in one group, may be less effective in another.”

These lessons fueled Williams’ effort to address such barriers, and in the summer of 2025, he was awarded a $240,000 Robert A. Winn Excellence in Clinical Trials Career Development Award (Winn CDA).

The rigorous, two-year national program trains early-career physician investigators to design, lead, and deliver community-focused clinical trials tailored to the specific needs of underserved communities.

A Gap in Breast Cancer Risk Assessment

One clinical trial Williams is building stems from new breast cancer guidelines from the American College of Radiology (ACR), which recommend that all women receive a formal breast cancer risk assessment before age 25, especially Black women and women of Ashkenazi ancestry.

The challenges are multifactorial: current breast cancer risk assessment tools are designed primarily for older women rather than younger age groups, and in underserved communities, risk assessment for women of any age is often less prevalent than in other settings. The goal is to ultimately provide education, clinical tools, and an actionable pathway for breast cancer risk assessment, detection, and diagnosis for those under age 25.

“Designing a clinical trial is daunting,” Williams said. To further his own learning, Williams participates in weekly didactic sessions where Winn CDA Scholars from across the country, also in the throes of first-time clinical trial development, share strategies for community engagement, building trust, and overcoming logistical challenges.

Community First

Before the trial could be built, Williams and his colleagues involved the community, inviting input that would shape the study from the beginning. Early engagement can improve enrollment later because the needs of the community have been heard, honored, and acted upon.

Working in close collaboration with the Fox Chase Office of Community Outreach and Engagement, Williams and colleagues assembled a community study advisory board for the trial, conducted focus groups, and determined which materials study participants needed, including what would be culturally appropriate. They are now developing a clinical-level infrastructure for breast cancer risk assessment in young women and will then write trial protocols for approval and launch the study.

Developing and implementing trials such as this is just one of the ways training and working at Fox Chase is unique. “It is important for faculty to teach fellows about the barriers and obstacles that patients from underserved communities may face—barriers that are not always part of traditional surgery or treatment discussions,” Williams said.

The question, according to Williams, is how clinical trials can be better designed to help potential patients move past the barriers that keep them from participating. First and foremost, the work begins at home: by understanding and relating to a community and the individuals who live and work there.