The diagnosis of cancer is never neutral. This is a reality that many women with cancer ignore. And it is not because their enemy is men, but rather a social system that generates power asymmetries, in terms of information, control of resources and decision making, which decreases women’s opportunities to understand their risks, take measures to prevent cancer, find resources for initial detection when cancers are detectable early, and arrive at optimal treatment, when available. Faced with this system, every day more health professionals and citizens demand a fairer approach to cancer care to eliminate gender inequality, both for women who suffer from cancer and for those who care for those who suffer from it.
while I was writing When the world stops. Cancer: from myth to hope, reviewing the stories of many breast cancer patients, to whom I dedicate the book, and the reflections of activists and feminists such as Audre Lorde, Anne Boyer and Susan Sontag on their own tumors, I understood, again, that women are more likely to of dying from a female-specific cancer than men are from dying from a male-specific cancer. And although there is a vaccine against the human papillomavirus, which produces tumors of the uterus, in many countries of the world the political and administrative measures are not established to vaccinate girls and adolescents, nor is the early diagnosis of this cancer promoted, that still 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 cancerpublished a few weeks ago in The Lancethas collected testimonies from women from 185 countries around the world in which cancer is one of the three leading causes of premature mortality (deaths before the age of 70) and, based on this data, points directly to patriarchy as a system social that makes prevention, diagnosis and treatment of cancer patients difficult.
In oncology, without research there is no progress. The dynamics of patriarchy are responsible for the underrepresentation of women in cancer research. If we examine the International Union for Cancer Control, based in Geneva, an organization that brings together 185 institutions including hospitals, other treatment centers and research institutes, we see that, in this leading organization in the cancer community, only the 16% of the entities are directed by women. That is, women would not participate directly in the decisions made in more than 80% of the institutions represented.
And that’s not all, cancer research scientists have to publish to communicate advances in research and also to defend their jobs and promote themselves in their professional career, but less than 20% of the top 100 cancer research journals They have an 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 by a system so ignorant of the true value of female scientists?
And it is worth asking, if the asymmetry between the decision-making power of men and women were not so marked, would we have made more progress in the treatment of tumors that mainly affect women, such as breast and ovarian cancer? And then there are the 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. And the prognosis worsens even more if the patient belongs to a low socioeconomic level.
In some countries, patriarchy creates family units where women do not have access to knowledge, therefore, they do not participate in decisions about their illnesses, and they do not control income, so they cannot decide on treatment. Many times they go to the doctor with advanced cancer, 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 this year’s Nobel Peace Prize winner, Narges Mohammadi, or countries where old cancer stigmas predominate. The asymmetry is also obvious in developed countries. It is an anomalous and universal power dynamic that has global effects.
If cancer is an epidemic, only prevention, not treatment of individuals, could stop it. There are many funds for breast cancer research. But most of the money is focused on treatment. And 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 to do more research on prevention, because 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 be an alarm signal that is impossible to ignore. 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, as healthy or sick people they participate in multiple activities: cancer prevention and detection, caregivers of family and friends, activists in foundations, health workers and professionals, researchers in laboratories and policy makers in cancer matters. In all of these areas, women experience gender bias and are subject to overlapping forms of discrimination, such as those due to age, race, ethnicity, socioeconomic status, sexual orientation and gender identity, that combine and overlap to marginalize them structurally. 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.
It is clear that the prognosis of cancer is not only influenced by the genetics of the patients and the cellular and molecular characteristics of the tumor: a multitude of socioeconomic and political factors influence their prognosis. And one of the most frequent causes of premature deaths in women with cancer according to the conclusions of a study by Lancet It is not related to a clinical phenomenon, but to patriarchy, whose pernicious logic permeates the behavior and decisions of both men and women, because, let us not forget, both are responsible for its maintenance and activity. For all these reasons, the diagnosis of cancer is never neutral.
Juan Fueyo is a cancer researcher, Fellow of the American Academy of Neurology, and Fellow of the American Association for the Advancement of Science.
You can follow EL PAÍS Health and Wellbeing in Facebook, x and instagram.
#Cancer #patriarchy