Health experts are calling for a “feminist approach” to cancer to eliminate inequalities, as research reveals 800,000 women worldwide are dying needlessly every year because they are denied optimal care.
Cancer is one of the biggest killers of women and ranks in their top three causes of premature deaths in almost every country on every continent.
But gender inequality and discrimination are reducing women’s opportunities to avoid cancer risks and impeding their ability to get a timely diagnosis and quality care, according to a report published in the Lancet.
The largest report of its kind, which studied women and cancer in 185 countries, found unequal power dynamics across society globally were having “resounding negative impacts” on how women experience cancer prevention and treatment.
There was particular focus on “women’s cancers” – including breast and cervical – despite lung and colorectal cancer being among the top three causes of deaths from the disease, researchers said.
Gender inequalities are also hindering women’s professional advancement as leaders in cancer research, practice and policymaking, which in turn perpetuates the lack of women-centred cancer prevention and care, the report adds.
The commission brought together a multidisciplinary and diverse team from around the globe. It included experts in gender studies, human rights, law, economics, social sciences, cancer epidemiology, prevention, and treatment, as well as patient advocates, to analyse how women around the world experience cancer.
It is calling for a new feminist agenda for cancer care to eliminate gender inequality.
“The impact of a patriarchal society on women’s experiences of cancer has gone largely unrecognised,” said Dr Ophira Ginsburg, a senior adviser for clinical research at the National Cancer Institute’s Centre for Global Health and a co-chair of the commission.
“Globally, women’s health is often focused on reproductive and maternal health, aligned with narrow anti-feminist definitions of women’s value and roles in society, while cancer remains wholly underrepresented.
“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.”
A second study published in the Lancet Global Health suggests 1.5m premature cancer deaths in women under 70 in 2020 could have been prevented with the elimination of exposures to key risk factors or via early detection and diagnosis.
The research analysed premature deaths from cancer among women aged 30 to 69 and found a further 800,000 lives could be saved each year if all women had access to optimal cancer care.
About 1.3 million women of all ages died in 2020 due to four of the major risk factors for cancer: tobacco, alcohol, obesity, and infections. But the burden of cancer in women caused by these four risk factors is “widely underrecognised”, the report says.
For example, a study from 2019 found only 19% of women attending breast cancer screening in the UK were aware that alcohol is a major risk factor for breast cancer.
“Discussions about cancer in women often focus on ‘women’s cancers’, such as breast and cervical cancer,” said Dr Isabelle Soerjomataram, a co-chair of the commission. “But 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.
“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.”
Greater scrutiny of the causes and risk factors for cancer in women is also needed as they are less well understood compared with cancer risk factors for men.
“Of the 3 million adults diagnosed with cancer under the age of 50 in 2020, two out of three were women,” said Dr Verna Vanderpuye, a co-chair of the commission.
“Cancer is a leading cause of mortality in women and many die in their prime of life, leaving behind an estimated 1 million children in 2020 alone. There are important factors specific to women which contribute to this substantial global burden – by addressing these through a feminist approach we believe this will reduce the impact of cancer for all.”
To counter the negative impact of gender inequality and transform the ways women interact with the cancer health system, the commission argues for sex and gender to be included in all cancer-related policies and guidelines.
It also calls for strategies targeted at increasing women’s awareness of cancer risk factors and symptoms, along with increasing equitable access to early detection, diagnosis and treatment of cancer.
Writing in a linked comment, Dr Monica Bertagnolli, the director of the National Cancer Institute, who was not involved in the commission, said the recommendations must be acted on.
“Achieving gender equality in the context of cancer research and care will require broad implementation of the recommendations in the Lancet Commission on women, power, and cancer, 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.
“This is something that we can and should all support. Improved outcomes for women translate into benefits for households, communities, societies, and the world.”