Report: Persistence of Gender Inequalities in Cancer Care, and a Call to Action

A global imbalance in “power dynamics” has negatively affected women’s access to cancer prevention, detection, and care, according to a report from a Lancet Commission.

Cancer remains one of the top three causes of premature death among women in almost every country. Worldwide, 2.3 million women die prematurely of cancer each year. Of those deaths, 1.5 million could be prevented by eliminating exposure to key risk factors or by early detection and diagnosis. An additional 800,000 deaths could be prevented by access to optimal care, authors of the report concluded in The Lancet.

The commission blames gender inequalities and discrimination for impeding women’s chances to avoid cancer risk factors and to gain access to timely diagnosis and quality cancer care, and calls for a “new feminist agenda” to eliminate gender inequality in cancer, as outlined in the report, “Women, power, and cancer: a Lancet Commission.”

“The impact of a patriarchal society on women’s experiences of cancer has gone largely unrecognized,” said Commission Co-Chair Ophira Ginsburg, MD, of the NCI Center for Global Health, in a statement. “Our commission highlights that gender inequalities significantly impact women’s experiences with cancer. To address this, we need cancer to be seen as a priority issue in women’s health and call for the immediate introduction of a feminist approach to cancer.”

Estimates of cancer mortality and potential to save lives by prevention and access to optimal care are reported in an accompanying study, published in The Lancet Global Health. Data for the estimates came from an International Agency for Research on Cancer (IARC) database.

The impact of gender inequalities and discrimination goes beyond “women’s cancers,” said Commission Co-Chair Isabelle Soerjomataram, PhD, of the cancer surveillance branch of the IARC.

“About 300,000 women under 70 die each year from lung cancer, and 160,000 from colorectal cancer, two of the top three causes of cancer death among women, globally,” she said. “Furthermore, for the last few decades in many high-income countries, deaths from lung cancer in women have been higher than deaths from breast cancer. The tobacco and alcohol industry target marketing of their products specifically at women. We believe it’s time for governments to counteract these actions with gender-specific policies that increase awareness and reduce exposure to these risk factors.”

Issues and Action Points

Beyond the cancer mortality estimates, key findings of the commission included:

• Cancer is less amenable to primary prevention in women
• In countries with a low Human Development Index, more than 70% of cancer deaths in women were premature (younger than 70)
• Women in many countries, irrespective of geography and economics, are more likely than men to lack the knowledge and power to make informed cancer-related decisions
• Patriarchy dominates cancer care, research, and policy, and those in power decide priorities, funding, and topics studied
• Women are under-represented in healthcare workforce leadership
• Women in the cancer workforce report frequent, severe gender-based discrimination
• Women are the primary sources for unpaid caregiving for people with cancer

The commission also enumerated priorities for action to address gender inequalities in cancer:

• Data collection and cancer statistics
• Policymaking related to risk exposures
• Monitoring emerging cancer risks that disproportionately affect women
• Develop “transformative” strategies to increase equitable access to early detection and diagnosis of cancer
• Create accessible and responsive health systems that provide respectful quality care for women and girls
• Ensure equitable access to cancer research resources, leadership, and funding
• Develop, strengthen, and enforce gender-based harassment and discrimination in the cancer workforce
• Integrate a gender competency framework into cancer education and training
• Develop and validate a feminist economics approach to economic evaluations of cancer
• Develop and enforce pay standards that are fare, equitable, and inclusive

Readily Applicable to U.S.

The commission report’s relevance and importance extend far beyond cancer’s impact on women, said Julie Gralow, MD, chief medical officer for the American Society of Clinical Oncology.

“It highlights not just the impact of a cancer diagnosis on a woman, but the cascading impact of that diagnosis on the family, the workforce, and society,” Gralow told MedPage Today in an email. “For example, it’s shocking to see how many estimated orphans are left behind each year (1 million globally) due to a cancer death in a younger woman.”

Although many observers might see the report as applying mostly to developing and underdeveloped nations, the findings are applicable to the U.S. and other developed nations.

“The report is directly applicable to the experience of women with cancer in the U.S., although some of the gender-based inequities in access to care may be higher in other regions of the world,” said Gralow. “But it also goes beyond care for patients with cancer who are women. It addresses the role (and inequities) of women in the cancer workforce, women as cancer researchers, women as caregivers for family members with cancer and as healthcare decision makers, and the broader issue of the impact of gender inequality on women’s health in general, as well as the impact on cancer prevention, early detection, treatment, and outcomes.”

The report is “absolutely” applicable to the cancer environment in the U.S., said Erin Medlin, MD, of Colorado Permanente Medical Group in Denver, who is a spokesperson for the Society of Gynecologic Oncology.

“[The report] highlights that globally, as well as in the U.S., we continue to face these problems in terms of access to care, access to good quality care, safe care for all people,” she said. “It really highlighted how much of cancer is preventable.”

Closing the Gender Gap

Collectively, the key findings of the commission lead toward “closing the gender gap, in terms of resources that can be applied,” Medlin continued. “I think it really highlights the intersectionality of multiple factors that affect women and cancer in terms of financial, geographic, socioeconomic, cultural, and religious impacts on women’s health.”

The action points are vague and leave room for interpretation on an individual or local level, she said. They point more generally to actions that can make a difference in the lives of people in individual communities and globally.

The report almost certainly will elicit multiple reactions and responses, including some men who might feel threatened by the findings and recommendations. Should they be worried?

“Gender has become recognized as an impacting factor in terms of health,” said Medlin. “It obviously leads to polarizing discussions from a political standpoint. We need to put that aside and recognize that women are unique and there has been a multigenerational impact of gender that has resulted in some of these disparities. We have an opportunity to improve upon that. We have an opportunity to recognize what women have contributed and make that financially feasible.”

“We also need to recognize that women are the mothers and sisters and daughters of all these men and that early death among women may lead to maternal orphans, young children and young adults, who then don’t have a mother,” she added. “What is the financial burden to the family that has that emotional burden? Improving health among women will improve the health of the nation and potentially the health of all, including men and their families.”

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