Women and Cancer: Improving Diagnosis and Access to Care Could Prevent Deaths

Equitable access to care as well as improvements in cancer diagnosis and primary prevention strategies could prevent more than 2 million cancer deaths in women each year, according to a report published in The Lancet.¹

Researchers studied premature cancer death in 2020 among women from 185 countries who had 36 cancer types.^1,2 Of the 2.3 million women who died prematurely, an estimated 1.5 million could have avoided premature death via primary prevention or early detection strategies, and the remaining 800,000 deaths could have been prevented if women had equitable access to cancer care, according to researchers.

“[B]eing a woman impacts timely cancer care, more than being a man,” said Lancet report author Karla Unger-Saldaña, MD, of the National Cancer Institute of Mexico in Mexico City.

“[T]here are many mechanisms behind this starting with different access to education, health literacy, cancer awareness, and gender roles that interfere with women’s ability to seek care,” she added.

Women Experience Delays in Cancer Diagnosis

“[W]omen tend to be disadvantaged from first access to care for cancer, even starting from diagnosis,” said Lancet report author Verna Vanderpuye, MD, of Korle Bu Teaching Hospital in Accra, Ghana.

Studies have suggested that several cancers tend to be diagnosed later in women than in men. Women tend to have longer times from first presentation to diagnosis for gastrointestinal, genitourinary, lung, hematologic, and other cancers.^3-7

For example, in a UK study of 18,618 patients, women had delayed diagnoses of lymphoma, bladder cancer, colorectal cancer, gastric cancer, head and neck cancer, and lung cancer.⁷

Studies have also shown that women are more likely than men to first present with cancer symptoms at emergency rooms, with the greatest disparities seen for lung and gastrointestinal cancers.^8,9

These delays in diagnosis can mean that women are diagnosed with cancer at later stages than men. Research has shown that women are diagnosed with colon, rectal, and bladder cancer at later stages than men.^10-14

Delays in diagnosis may be partly explained by a lack of screening. For example, researchers found that health care providers are less likely to have discussions about lung cancer screening with women than with men.¹⁵ In addition, although screening has been shown to reduce the incidence of cervical cancer, many countries have not implemented widespread screening.^16,17    

How Sexism Impacts Access to Cancer Care

Sexism has been shown to impact women’s access to any type of health care, and this includes cancer care.¹

“Disrespectful or even discriminatory health care resulting from health care providers’ gender biases and stereotypes” affects women’s ability to receive the care they need, Dr Unger-Saldaña noted.

Studies have shown that women’s health concerns are less likely to be taken seriously and managed appropriately than men’s.^18,19 Women’s symptoms are more likely to be perceived as psychosocial, women are more likely to receive non-specific diagnoses, and they are more likely to be given prescriptions for psychoactive drugs.

A cancer-specific example of overlooking women’s health concerns is how physicians have delayed the diagnosis of breast cancer by inappropriately reassuring patients that a palpable mass is benign without performing a biopsy.²⁰

Research has also suggested that women with cancer are more likely than their male counterparts to experience adverse events related to cancer treatment, to report inadequate pain management, and to have their sexual health concerns overlooked.^21-23

“[I]n the area of breast and gynecologic cancers, only very recently have people focused on sexual health and sexual side effects of cancer treatment,” said Gita Suneja, MD, of the University of Utah in Salt Lake City, who was not involved in the Lancet report. “These are life-altering treatments that affect sexual health profoundly, yet we have long neglected women’s health and well-being.”

“Patriarchal ideas about women and women’s complaints often manifest in prevalent mistreatment, disrespect, negligence, and abuse of female patients by medical staff,” the authors of the Lancet report wrote. “These types of experiences can damage patients’ trust in health care providers and influence the patients’ willingness to participate in cancer screening or seek care for cancer symptoms.”

Another potential cause of suboptimal cancer care for women is the fact that they have been underrepresented in research, so cancers in women may not be as well understood as cancers in men.^24,25 The causes of breast cancer, for example, are not well understood, despite the fact that breast cancer was the most commonly diagnosed cancer worldwide in 2020.^1,26

“I think one of the key takeaways from our work was the degree to which sex and gender have not been adequately considered in cancer research, practice, and policy making,” said Lancet report author Ophira Ginsburg, MD, of the National Cancer Institute in Bethesda, Maryland. “We underestimated the massive role that gender-based and intersectional power dynamics play in the interactions of women with the cancer health system.”

This article originally appeared on Cancer Therapy Advisor