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How gender and race deepen the cancer care divide

In 2023, roughly 2 million people will have been diagnosed with some form of cancer, and while cancer can affect everyone, it does not affect everyone equally. Women – especially women of color and women with lower socioeconomic standing – often face significant hurdles when it comes to accessing the health care they need to prevent, treat, and survive cancer.

The downstream effect

Although there have been significant efforts to address gender disparities in cancer care, structural sexism, the unequal distribution of resources and power, remains a challenge in oncology, which negatively affects both female physicians and patients. A 2019 study around federal funding and gender found that female scientists receive fewer grants, and as much as 38 percent less in funding, than their male counterparts. Female researchers tend to prioritize studies around female-specific health problems – including cancers that disproportionately affect women. When these physicians and scientists don’t receive adequate funding, it affects the amount of research being done on women’s cancers, as well as the ability to correctly diagnose and treat these cancers. Moreover, long-held systemic biases within the medical field have resulted in fewer women being awarded National Institutes of Health grants or being promoted to department chairs in radiation and medical oncology.

This gender gap has followed women out of academia and into their daily practices. A recent study of gynecologic oncologists found that the median salary for women was $380,000 and $500,000 for men in that same profession. In oncology specifically, nearly one in four oncologists report burnout, with self-identified female and lesbian/gay/bisexual faculty at the highest risk.

This combination of underrepresentation in leadership positions, lack of equitable funding, and higher rates of burnout in the workplace for female oncologists trickles down from an institutional level and ultimately impacts the quality of care received by female cancer patients.

Disparities in female cancer care

In general, survival after a cancer diagnosis is shorter for people of all races who have a lower socioeconomic status (SES) and who live in a more rural area compared to those with higher SES and in or near a metropolitan area. However, women – regardless of race or SES – overwhelmingly report significant barriers to receiving care. These include having their symptoms dismissed, being denied testing, and constantly being “referred out” to a myriad of specialists who are often unable to provide solutions or diagnoses to alleviate their symptoms. There are few peer-reviewed journals regarding women’s health, and much of the focus of women’s health is on obstetrics and reproductive health, while female-specific diseases often fall by the wayside. Of the five main types of gynecologic cancers, only cervical cancer has screening tests for early detection, when treatment is often most effective. Because symptoms for gynecological cancers tend to be vague and can be attributed to other health issues, women regularly face hurdles to getting tested for these cancers and oftentimes must make multiple visits to various specialists before their complaints are taken seriously.

Additionally, women are still underrepresented in clinical trials, even in cancers that have a higher prevalence in women. Compared to men, women are 50 to 75 percent more likely to experience an adverse drug reaction, making their inclusion in clinical trials imperative to understanding the full scope of a drug’s potential adverse side effects and ensuring the correct dosage is properly administered based on an individual’s physiological characteristics.

While researchers have made many advances in treating a variety of cancers, people of color, those with lower SES, and individuals living in rural areas have not benefited equitably from these advances in cancer care. Across the board, Black people have a higher cancer burden and face greater obstacles to cancer prevention, detection, treatment, and survival. Black people have the highest death rate and shortest survival of any racial/ethnic group for most cancers in the U.S., with Black women 40 percent more likely to die of breast cancer than White women and twice as likely to die if they are over the age of 50.

Incidentally, Black women have reported experiencing significant discrimination in the medical setting. For cervical cancer, specifically, where Black women have the second highest incidence rate and the highest mortality rate, many women have reported not having their pain or symptoms taken seriously, leading to a general sense of distrust among the Black community when it comes to the medical field. This anticipation around potential discrimination coupled with the notion that their grievances will not be heard or believed by practitioners has led to Black women delaying seeking out medical treatment or skipping preventative appointments altogether, which ultimately leads to cancers being diagnosed at later stages with less optimal prognoses.

Addressing gender disparities

To bridge the gap in care experienced by female patients – especially those of color or lower SES ─ there must be a collaborative effort to prioritize women’s health, particularly as it relates to cancer. This begins with increased funding and improved visibility of the specific health issues women face. Prioritizing funding for women’s health research can lead to the creation of more diagnostic and screening tests tied to improved preventative care and increased potential for catching diseases, such as cancer, at earlier stages.

Additionally, women must be seen and treated as equals to their male peers – both within academia and while practicing. Ensuring women are paid equally for equal work, are included in leadership positions, and feel safe and comfortable within their working environment can lead to better overall outcomes as it pertains to women’s health. Additionally, practitioners must strive to improve the quality of care received across racial and socioeconomic statuses to eradicate the prevalent mistrust often associated with the medical field. Women are a diverse and complex group of patients in the medical system, and they must be treated as such to truly abolish the gender disparities in health care.

Meera Ravindranathan is a hematologist-oncologist.

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