Reforms Urged to Bridge Gender Gaps in Cancer Care

The cancer field needs a gender-inclusive overhaul. So says an international group of oncologists, researchers, and policymakers who outlined a series of reforms and equity initiatives aimed at rectifying gender disparities and unequal power dynamics throughout cancer care and research systems.

In a new report, members of the Lancet Commission on women, power, and cancer call for collecting sex-disaggregated data in all cancer health statistics; studying emerging cancer risk factors that disproportionately affect women; and creating economic frameworks that encapsulate the contributions of cancer caregivers, many of whom are often unpaid women (Lancet 2023 Sep 26 [Epub ahead of print]).

The commission urges the promotion of more women globally into senior leadership positions at cancer hospitals, in academic centers, and on oncology journal editorial boards, as well as training and mentorship programs geared toward fostering a gender-inclusive professional culture. Going further, the report calls for stronger policies to prevent sexual harassment and gender-based discrimination in cancer workforces around the world.

“This kind of document can help increase awareness and bolster commitment” to equity, says Pilar Garrido, MD, PhD, of the University Hospital Ramón y Cajal in Madrid, Spain, who wasn't involved. Gender is still a major impediment to career advancement in the field, so “we need to do more.”

Gender also factors into cancer diagnosis rates and attendant consequences. As commission co-chair Ophira Ginsburg, MD, from the NCI's Center for Global Health, and others have shown, women account for roughly two thirds of cancer cases among individuals under 50 (Lancet Oncol 2021;22:166–7). Cancer-related deaths among these young women, in turn, leaves more than 1 million children motherless each year (Nat Med 2022;28:2563–72).

However, Ginsburg is quick to point out that the commission is not about women's cancers per se. “This is about the interaction between women and cancer, both as recipients of care and as providers,” she says.

The commission's findings were formally presented on September 26 in Geneva, Switzerland. Regional symposia will spread the message globally as well—at the first, scheduled to coincide with the International Conference on Cancer in Africa in Senegal in early November, a major focus will be on boosting the number of women in the African cancer workforce.

“If this ends up being just another report that people note for a day and then forget, we will have failed,” says Ginsburg. The goal is for the commission to work with government agencies, multilateral organizations, and professional societies to put the recommendations into practice. She and her fellow co-chairs have also outlined metrics to track and evaluate progress over time.

“It's really powerful work,” Stephanie Graff, MD, of the Lifespan Cancer Institute in Providence, RI, says of the report. “Laying out the scope of the problem and potential future directions is always a first step.”

Graff, who has studied sexual harassment's impact in clinical oncology, additionally commends the authors for delineating their recommendations “into particular courts of action, so there can be a sense of ownership amongst different stakeholders” who can bring about gender-inclusive reforms.

One indication of progress: The NCI, for the first time in its 86-year existence, has a woman at the helm—and she is committed to seeing the commission's conclusions translated into meaningful change.

“Achieving gender equality in the context of cancer research and care will require broad implementation of the recommendations…including the overarching priority action that sex and gender be included in all cancer-related policies and guidelines so that they are responsive to the needs and aspirations of women in all of their diversities,” NCI Director Monica Bertagnolli, MD, wrote in a related commentary (Lancet 2023 Sep 26 [Epub ahead of print]).

“This is something that we can and should all support.” –Elie Dolgin