Understanding relationships between science, society, gender inequality and cancer

When calling out and taking action to eradicate inequality between genders a key area to look to is women’s health. Specifically, factors that limit “women’s opportunity to avoid cancer risks and capability to receive a timely diagnosis and optimal care” (The Lancet Commission 2023: 2114).

For the purposes of this blog, women will refer to women assigned female at birth. The previous blog in this series on equitable cancer care for the LGBTQIA+ community by Dr Alison Berner looks at how health inequalities can adversely affect trans and non-binary people, and LGBTQIA+ communities.

Many of the underlying dynamics that contribute to gender inequality in cancer have been discussed in a recent report published in The Lancet. Its findings offer a clear entry point into the role of medical anthropology, which takes a holistic, comparative, and fieldwork-based approach, to understand how beliefs, values and practices of people and communities shape and are shaped by wider societies’ socio-cultural and political dimensions. The Society for Medical Anthropology provides a more detailed definition of what medical anthropology is.

Indeed, within and beyond the subfield of medical anthropology we are indebted to scholars, whose work in healthcare settings illuminate historical and cultural contexts shaping experiences of care, and how these dynamics, underscore, amongst other things, questions of gender (inequality), race, power, culture, and politics Rapp 2000; Murphy 2012 Puig de la Bellacasa 2017).

For example, medical anthropologist Jessica Gregg’s book (2003) offers insight into the complex relationship between cultural constructions of female sexuality and cervical cancer in low-income areas of Brazil. Whilst other scholarship offers important understanding of transformations around breast cancer activism as scientific progress on breast cancer genetics, societal hope, economic investment, and gendered knowledge making intersect in novel ways (Gibbon, 2007).

The societal values and gendered dynamics that govern our everyday life become rooted and reinforced through our medical structures and embedded in people’s experience of care. Inequalities that we know exist within society commonly show up in our medical systems and vice versa.

As scholars Kerr et al. note, some clinical teams they worked alongside during a study across NHS cancer care and research “reflected gendered hierarchies” as there were fewer female consultants within, for example, lung cancer teams.

Meanwhile, the nurturing qualities of women were reflected by the fact that “the majority of nurses and clinical trial assistants were women” (Kerr et al. 2021, 227). This gender split in role types aligns with gender dynamics within society that see women disproportionately in care giving roles.

Whilst not every example above speaks directly to gender inequality in cancer care, there are several reflections that can be taken from these stories:

1. Their stories illuminate the importance of listening to women’s voices, in all their diversity in order to understand how wider socio-cultural and political dynamics intersect with gender (inequality) in relation to the care experience of cancer prevention, diagnosis and treatment.

2. Their narratives reveal how, as women (and men) sought to carve out a “good life”, their lived experience evoked a deep sense of reflexivity and ethical practice related to the values, interests and challenges they confront and were confronted with, prior to, within and beyond their care pathway (Mattingly, 2014, 09).

3. These women’s narratives reflect a willingness to leverage their own embodied gendered knowledge and experience to speak out and question practices of care.

Thus, alongside wider conversations about how to achieve gender equality, in my mind, these examples underline why a feminist ethics approach helps identify and dismantle unequal power relations both within and beyond cancer research and care.

Dr Clara Fabian-Therond is a medical anthropologist who completed her Economic and Social Research Council funded PhD at University College London (UCL).

Clara’s research focused on understanding the social, ethical, political, and cultural aspects of molecular profiling technologies and associated personalised medicine therapeutics within late-stage cancer treatment settings, in the NHS. The themes in her PhD research reflect a number of anthropological themes, including the relationality of care; identity; subjectivity and experiences of bodily trauma, suffering, and intensities of hope.

Clara’s research is also interested in understanding how care pathways are changing as a consequence of personalised medicine. Specifically, she examines how pathways become socio-material and affective sites in which complexity, possibility, hope, suffering, uncertainty, and expectation intersect in particular ways to produce new kinds of ethical and moral practice.