What is a 'feminist approach' to cancer care?

 Female doctor talking to female cancer patient while examining x-ray in doctor's office.
Female doctor talking to female cancer patient while examining x-ray in doctor's office.

A "feminist approach" to cancer care could save the lives of tens of thousands of women each year in the UK alone, according to a new global study.

Gender inequality and discrimination are having "resounding negative impacts" on how women experience cancer prevention and treatment, said the landmark report, published in The Lancet. The research found that 2.3 million women are dying prematurely of cancer each year, as gender inequality reduces the chance of avoiding risk factors and impedes timely diagnosis and access to quality care.

The "patriarchy dominates cancer care, research and policy-making", concluded the researchers. They called for "the immediate introduction of a feminist approach to cancer".

What did the report find?

The Lancet Commission on Women, Power and Cancer brought together global experts in gender, human rights, law, cancer epidemiology and treatment to analyse women's experience of cancer in 185 countries.

The study underpinning the commission, published in The Lancet Global Health, found that 1.5 million deaths a year could be "averted through primary prevention or early detection". Another 800,000 deaths could be prevented altogether, "if all women everywhere could access optimal cancer care".

About 24,000 women in the UK aged 30 to 69 are dying unnecessarily every year, it said. Six out of 10 of those deaths could be averted through earlier diagnosis, and the other four in 10 could be prevented with improved access to timely treatment. Women are dying in "the prime of life", said Sky News, with more than 5,000 children orphaned in the UK in 2020 due to cancer.

"The impact of a patriarchal society on women's experiences of cancer has gone largely unrecognised," said Dr Ophira Ginsburg, co-chair of the commission and senior adviser for clinical research at the National Cancer Institute's centre for global health.

About 1.3 million women died in 2020 due to four known cancer risk factors: tobacco, alcohol, infections and obesity. But those factors were "widely underrecognised". Only 19% of women attending breast cancer screening in the UK were aware that alcohol was a major risk factor, the study found.

What causes the gender health gap in cancer?

Cancer is one of the biggest killers of women, said The Guardian, ranking "in their top three causes of premature deaths in almost every country on every continent". But the disease is "often deprioritised", said the newly published report.

Women in the global cancer workforce also reported frequent and severe gender-based discrimination, the report said, including sexual harassment. Around the world, that discrimination was "ubiquitous".

The UK has been facing a medical "MeToo" moment, after a separate study found that one in three women working in surgery claimed to have been sexual assaulted by a male colleague at work. A report published in the British Journal of Surgery earlier this month warned that the "misogynistic culture" rife in hospitals posed a "significant risk to patient safety".

This conclusion was backed up by the Lancet report, which said that a "myriad of factors" can lower women's chances of avoiding cancer risks, or impede diagnosis and care. Women "interact with cancer in complex ways", as policymakers, doctors, patients and caregivers. In "all these domains", women are subject to "overlapping forms of discrimination" – age, race, ethnicity and socioeconomic background.

Of the 184 members of the Union for International Cancer Control (hospitals, treatment centres, or research institutes), only 16% are led by women.

Women were "often expected to prioritise the needs of their families at the expense of their own health", said co-author Professor Nirmala Bhoo-Pathy – and shouldered most of the unpaid caregiving work for cancer patients. The value of that ranged from 2% of Mexico's national health expenditure to nearly 4% in India.

The commission also criticised the "narrow" focus on "women's cancers" like breast and cervical forms of the disease – while leading causes of cancer deaths among women included lung and bowel cancer. Women's health is "often focused on reproductive and maternal health", said Ginsburg, "aligned with narrow anti-feminist definitions of women's value and roles in society".

A study published in Nature in August looked at the US gender disparity of lung cancer incidence, and found that the female-to-male ratio had "continuously increased" from 2001 to 2019.

What would a 'feminist approach' to cancer look like?

The Lancet commission recommended that sex and gender should be considered in policies and guidelines, with data on sex routinely collected in health statistics.

That would involve "accessible and responsive health systems that provide respectful, quality cancer care for women".

It also called for "fair, equitable and inclusive" pay standards for all cancer caregivers, and policies that reduce exposure to known cancer risks for women and girls.