A cancer diagnosis is never neutral for women. They face a social system full of inequalities in terms of information, control of resources and decision-making, which decreases their opportunities to understand their risks, take measures to prevent cancer, find resources for early detection and receive optimal treatment. Faced with this system, every day more health professionals and citizens are demanding a fairer approach to cancer care to eliminate gender inequality.
Women are more likely to die from a female-specific cancer than men are to die from a male-specific cancer. Although there is a vaccine against the human papillomavirus, which produces uterine tumors, in many countries, political and administrative measures to vaccinate girls and adolescents do not exist, and the cancer is not diagnosed early. It continues to take many lives, including, recently, that of Sherika de Armas, former Miss Uruguay, who was only 26 years old.
A report titled Women, Power and Cancer, published a few weeks ago in The Lancet, collected testimonies from women in 185 countries around the world. Cancer is one of the three leading causes of premature mortality (deaths before the age of 70). The data demonstrates how patriarchy makes prevention, diagnosis and treatment of cancer patients difficult.
In oncology, there is no progress without research. The dynamics of patriarchy are responsible for the underrepresentation of women in cancer research. At the International Union for Cancer Control, based in Geneva, an organization that brings together 185 institutions including hospitals, other treatment centers and research institutes, only 16% of the entities are directed by women. In other words, women do not participate directly in the decisions made in more than 80% of the institutions represented.
Cancer research scientists have to publish about advances in research to advance their careers. But less than 20% of the top 100 cancer research journals have a female editor-in-chief. Obviously, many capable women still lack leadership opportunities due to gender bias, lack of support or mentoring and harassment in the workplace. Let’s not forget here that this year’s Nobel Prize in Medicine, Katalin Karikó, was demoted several times and even forced into early retirement. How many male Nobel Prize winners in Medicine have suffered this same treatment?
It is worth asking whether we would have made more progress in the treatment of tumors that mainly affect women, such as breast and ovarian cancer, if there were less inequality. There are other discrimination factors: according to the American Cancer Society, the incidence of cancer in Black women is lower than that of white women, yet the death rate is 40% higher in Black patients. The cancer prognosis of a mother in a single-parent family is worse than that of a married woman. The prognosis worsens even more if the patient has a low socioeconomic status.
In some countries, the patriarchy creates family units where women do not have access to knowledge and therefore do not participate in decisions about their illnesses. They do not have an income, so they cannot decide on their treatment. They often go to the doctor once their cancer is advanced, simply because they had no other choice. These are not just countries where women are violently marginalized and imprisoned for demanding their rights, such as Iran, the home of this year’s Nobel Peace Prize winner, Narges Mohammadi, or from countries where old stigmas of cancer predominate. The asymmetry is also evident in developed countries. It is a universal power dynamic with global effects.
If cancer is an epidemic, only prevention, not treating individuals, can stop it. There are many funds for breast cancer research, but most of the money is focused on treatment. We still don’t understand much about what the risk factors are for this cancer, one of the most common tumors in the world. We need more prevention research. We do not sufficiently understand emerging risks, such as hygiene products and cosmetics that are marketed almost exclusively to women, sometimes based on patriarchal and racist notions of beauty. What effects do these products have on women’s health in the long term? The example of talcum powder, which women used for intimate hygiene and which has been correlated with ovarian cancer, should sound alarm bells. After decades of hormonal treatments for women, we are now seeing the slow emergence of contraceptive products aimed at men.
Women interact with cancer in complex ways. In addition to being cancer patients, they participate in cancer prevention and detection; they are caregivers, activists, health workers, researchers and policymakers. In all of these areas, women experience gender bias and are subject to overlapping forms of discrimination due to age, race, ethnicity, socioeconomic status, sexual orientation and gender identity. At the same time, these factors serve to unfairly overburden and perpetuate an unpaid workforce of cancer caregivers that is predominantly female, and hinder the career advancement of women as leaders in oncology research, practice and cancer policymaking.
A cancer prognosis is not only influenced by the patient’s genetics and the tumor’s cellular and molecular characteristics, but also by a multitude of socioeconomic and political factors. One of the most frequent causes of premature deaths of women with cancer, according to the conclusions of The Lancet study, is not due to a clinical phenomenon: it is patriarchy, whose pernicious logic permeates the behavior and decisions of both men and women. For all these reasons, the diagnosis of cancer is never neutral.
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