In 2023, The Lancet published Women, Power and Cancer – a Lancet Commission, which found that unequal power dynamics were having a profoundly negative impact on women globally, impeding their ability for timely and accurate cancer diagnoses.
The comprehensive study, led by Dr Ophira Ginsburg, Centre for Global Health, National Cancer Institute (US), also found gender inequalities were 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.
For International Women’s Day 2024, we asked three preeminent Australian women in the cancer sector for their observations on these findings. How does this play out in an Australian context, what are their personal experiences and what can be done to change the status quo?
Here’s what they had to say.
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Prof Long, AO says she has observed gender inequalities hindering women’s professional advancement in all walks of life, not just the cancer sector. She believes it is a societal issue that is ingrained from the very early stages of childhood development, and the solution will need to involve everyone - regardless of gender - to make a change.
“Cancer offers a lens to view how society values women,” says Prof Long, who, as a leading medical oncologist in melanoma, says she works within a system with a history of conscious and unconscious bias against women. “There will be hurdles in all lives, but discrimination, often systematic and both conscious and unconscious, based on sex or gender is unacceptable.”
“Our society needs to change so that women and men are equally able to identify and build a life they truly want. Across the world, disproportionately, women end up with caring responsibilities, fewer opportunities in their careers, and delays in access to healthcare due to entrenched sexism in medical and clinical research.”
“Cancer research and medicine are sectors that thrive on archetypes of genius and creativity, which women are less likely to self-identify with than men. Most women are born and socialised to believe that they are different from men, and that there are differences in their abilities and the spaces they can or should occupy, particularly in areas of leadership and innovation.
“When I’m mentoring people, I find women attribute success to having needed to work hard, rather than innate attributes, skills, or ‘deservedness’, which is quite different to the men I mentor.
“We need to remember that men are born and socialised in this same environment, so sexism is not a ‘women’s issue’; it’s a sociocultural and historical problem that is deeply embedded within society, to the detriment of society, and will self-perpetuate as long as it remains unaddressed.
“To make change, therefore, we need the engagement of both men and women at all levels of society and all generations – within the home, the education system, and the workplace.
“These are big and important asks, but not all of us have time to wait for a world without sex- and gender-related barriers. So what can the women who are making decisions today do, in their lives, health, and career, given the reality of the culture and systems they’re facing?
“Something individual women can do is to check in with their self-talk and core beliefs about their abilities. What factors are holding them back from saying yes to opportunities, to championing their own worth, and seeing themselves as having equal right and equal responsibility to enter and enrich all domain of life and society?”
Aboriginal and Torres Strait Islander people face additional barriers in cancer care than other populations, and these additional hurdles further impact Aboriginal and Torres Strait Islander women and the way they receive care, says Professor Garvey.
“There are very few Aboriginal and Torres Strait Islander people working in the cancer setting. That is an issue in regard to appropriately supporting Aboriginal and Torres Strait Islander cancer patients. Unless we have an inclusive workforce, we’re not going to be able to provide culturally safe cancer services.
“We know if we have Aboriginal and Torres Strait Islander people in the workforce then Aboriginal and Torres Strait Islander people are more likely to come and get medical care.
“If you're an Aboriginal woman and you have breast or cervical cancer, or something that is more women's business, if you had an Aboriginal person to speak with or to support you through that, then there might be different engagement with cancer care and very different cancer outcomes for our women.
“In Australia we have a few First Nations cancer care coordinators but to my knowledge we don't have a First Nations oncologist or radiation oncologists.
“Here in Brisbane we’ve employed a First Nation's cancer nurse coordinator in the past month and in the coming month we should have another two positions filled – one in Brisbane and one in Cairns. So there are some strategies being implemented but there's no systematic strategy to address the health workforce issues, particularly for women, in cancer care.
“The Australian Cancer Plan has a focus on addressing inequities for Aboriginal or Torres Strait Islander people including workforce issues, but these are in the very early stages of development.
“In Victoria, VACCHO in collaboration with other organisations developed a culturally designed screening shawl for women to use when going in for a mammogram. These shawls provided safe and empowering breast screening experiences for Aboriginal and Torres Strait Islander women. Other jurisdictions and services are now developing similar strategies.
“There is growing attention to this including from The Lancet Commission on Women, Power and Cancer. I think there needs to be more research around this, particularly with a focus on the intersection of gender, Indigenous identity and cancer care.
“We have an additional cultural load that we carry every day in our respective jobs. There are expectations for me as a researcher who is female and Aboriginal, that are intertwined with experiences of discrimination and racism that I carry that other women researchers may not.”
Caitlin Delaney launched her own consumer advocacy and compassionate care training business, CareFully, in 2019. It came after a tumultuous series of events - her mother-in-law passed away suddenly in 2016, and Caitlin was diagnosed in 2017 with Stage 4 Clear Cell Ovarian Cancer, a rare and deadly form of ovarian cancer, when her daughters were aged just two and four. Both of these experiences motivated her to advocate for others in the healthcare system.
She had previously worked as a healthcare professional and team leader in fertility. Despite having a high degree of health literacy, she notes navigating a cancer diagnosis and treatment is extremely challenging. If she finds it difficult, what must it be like for others without this background? Here, she reflects on her observations of women’s experiences with cancer through the lens of someone with a gynaecological cancer, and as a consumer advocate who has heard many other women’s cancer stories.
“I often observe huge inequity in cancer care and I feel like a lot of money goes to the easier wins or more common cancers – it’s hard to attract the big brains and scientists to rarer cancers. But it is changing, there is some great stuff happening, and I’m very hopeful.
“There is something about gynaecological cancers that attracts less attention. I think a lot of it is to do with the fact that these cancers are often associated with post-menopausal women. Let’s face it, post-menopausal women can become invisible in society. There is still a lot of shame and secrecy associated with gynaecological cancers, just like there was with male cancers such as prostate or testicular cancers that can be hard for men to talk about.
“Also, if you are younger – pre-menopause – and facing gynaecological cancer issues, the medical profession is not looking for it. And often symptoms can be dismissed as 'women’s business’ or ‘that time of the month’. I found that really challenging because I’ve got no risk factors, no obvious cancers in my family… but I knew that something was not right with me. My female GP was onto it – she was sending me for brain scans because I was having monthly headaches. (My symptoms were not typical to gynaecological cancers).
“I think it’s hard for women to speak up in a doctor’s room. And I think men struggle with this too. But women aren’t supposed to be angry, women aren’t supposed to complain or be assertive, women are just supposed to listen.
“I’ve never been one to be afraid to speak out, but I have struggled at times to really stand up for myself as a woman, and a rare and advanced cancer patient. And this is even to female doctors, it’s not necessarily about male doctors. Because you feel that you are are not meant to challenge any medical professionals. I’ve been so angry and frustrated throughout my ‘journey’, and I’ve seen people behave the same and be penalised for it, or not speak out and die much sooner than they should. But as patients we are entitled to be angry, after all this is OUR life and the stakes are pretty high! There is this sense that you need to be the ‘good cancer patient’, be passive, do what the doctors tell you, take the treatment and don’t rock the boat. I’ve seen that a lot.
“I’m showing my young daughters that by making noise, and challenging the status quo, things can happen, and you can make a difference. And to be honest, it’s my self-advocacy and making noise that has enabled me to far outlive my prognosis and witness many family milestones. Despite still living with active disease since recurring four years ago, there have been so many times when if I had done what the doctor had suggested, I would be dead by now.
“Of course I’m not saying it’s because doctors don’t know what they are talking about – it’s because I’ve got such a rare cancer and am such a complex unique case, and I’ve had to really dig around and be creative. There is no evidence-based standard treatment for me anymore, so I am always looking for the next thing. I am even considered a pioneer of my cancer treatments with my data being shared around the world.
“If you don’t have project management or CEO skills when you come into something like this, I don’t know how people manage it. You’ve got to be the CEO of your own health. You’ve got to be assertive, listen to your body and to your own intuition. And doctors need to empower patient-partnered, shared decision-making. Of course, doctors are the experts, but you need to be able to include that patient voice.”
