Gender inequities worsen impact of cancer in women, finds Lancet Commission

Discrimination affects their rights and opportunities to avoid risk factors, ability to get timely diagnosis & quality care

By Nandita Banerji
Published: Wednesday 27 September 2023
Cancer is less amenable to primary prevention in women than in men even though the disease is a leading cause of mortality in women and many die in their prime of life. Photo: iStock__

How women interact with cancer prevention, care and treatment is adversely affected by the unequal distribution of power throughout society, according to a new report by Lancet Commission. Women suffer more because of the disease due to gender inequities, despite the fact that women have roughly the same cancer burden as men.

Not only as patients, but gender inequality has a negative impact on how women interact with the cancer health system, said Women, power, and cancer: A Lancet Commission released September 27, 2023. Women are undervalued in the cancer workforce, where they account for the majority of unpaid carers and they are significantly underrepresented as leaders in research and policy organisations as well.

Read more: Younger people are more prone to cancer, here is why

An intersectional feminist approach highlighting and challenging existing power asymmetries in cancer decision making, knowledge and economics is urgently needed, according to the report. The Commission pointed out that in nearly every country, cancer is one of the top three causes of premature death among women.

Elimination of key risk factors or early detection and diagnosis could save approximately 1.5 million lives, the analysis suggested. Another 800,000 deaths could be avoided if all women had access to high-quality cancer care.

In 2020, approximately 5.3 million adults under the age of 70 died from cancer, with women accounting for 2.3 million of these deaths, the report said. In 2020, approximately 1.3 million women of all ages died as a result of four major cancer risk factors: Tobacco, alcohol, obesity and infections.

However, the impact of these four risk factors on cancer in women is widely underestimated. A 2019 study, for example, discovered that only 19 per cent of women undergoing breast cancer screening in the United Kingdom were aware that alcohol is a major risk factor for breast cancer.

Greater scrutiny of the causes and risk factors for cancer in women is also required, as they are less well understood than cancer risk factors in men, the Commission said.  There is mounting evidence linking commercial products primarily used by women, such as certain types of breast implants, skin lighteners and hair relaxers, to an increased risk of cancer.

Gender inequality and discrimination affect women’s rights and opportunities to avoid cancer risk factors, as well as their ability to seek and obtain timely diagnosis and quality cancer care, the Commission found.

Read more: Tobacco behind more than a quarter of India’s cancer cases

Women are also disadvantaged globally in terms of education and employment opportunities, and they are more likely to have fewer financial resources to assist them in dealing with cancer-related financial challenges.

Furthermore, gender inequality has resulted in a predominantly female unpaid caregiver workforce, the report found. This impedes women’s advancement as leaders in cancer research, practice and policymaking, perpetuating the lack of women-centered cancer prevention and care.

The value of women’s unpaid caregiving work for those with cancer ranges from two per cent of national health expenditure in Mexico to 3.7 per cent of national health expenditure in India, according to a new Commission analysis of five countries.

Sexism in healthcare systems, manifested as unconscious gender biases and discrimination, can result in women receiving subpar care, according to the report.  These gender biases can be exacerbated when the cancer patient is also a member of a marginalised ethnic or indigenous group, or has a diverse sexual orientation or gender identity, the Commission found.

Women are also underrepresented as leaders in research and policy organisations. In Asia, Africa, and Europe, their representation in leadership roles remains significantly lower. Only 16 per cent of the 184 UICC member organisations classified as hospitals, treatment centres, or research institutes in the world are led by women.

Read more: What are these ‘cancer vaccines’ I’m hearing about? And what similarities do they share with COVID vaccines?

“While men are at higher risk for most cancer types that develop in both sexes, women have approximately the same burden from all cancers combined, with 48 per cent of cancer cases and 44 per cent of cancer deaths worldwide occurring in women,” Verna Vanderpuye, senior consultant at the Korle Bu Teaching Hospital, Ghana and co-chair of the Commission, said in a statement.

The impact of a patriarchal society on women’s experiences of cancer has gone largely unrecognised, said Ophira Ginsburg, Senior Advisor for Clinical Research at the National Cancer Institute’s Center for Global Health and co-Chair of the Commission.

To counteract the negative impact of gender inequality and transform how women interact with the cancer health system, the Commission advocated for sex and gender to be included in all cancer-related policies and guidelines. These policies must also be responsive to the needs and aspirations of all women, whether they are patients, care providers or researchers.

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