Understanding relationships between science, society, gender inequality and cancer
Throughout March, we’re sharing a series of guest blogs exploring gender inequality in healthcare, as part of our activity around International Women’s Day.
In this third article, Dr Clara Fabian‑Therond, Medical Anthropologist, looks at how science, society and gender intersect and what this means for cancer care.
Why gender inequality matters in cancer care
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” as highlighted in The Lancet Commission 2023: 2114.
For this blog, 'women' refers to women assigned female at birth. If you missed it, the previous blog in this series explored equitable cancer care for the LGBTQIA+ community. Dr Alison Berner looks at how health inequalities can adversely affect trans and non-binary people, and LGBTQIA+ communities in cancer care.
How medical anthropology helps us understand inequalities in healthcare
Many of the dynamics that contribute to gender inequality in cancer have been discussed in a report published in The Lancet. Its findings offer an insight 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 systems. The Society for Medical Anthropology provides a more detailed definition of what medical anthropology is.
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).
How society and medicine are linked
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.
Can we disentangle gender roles in medicine?
An article on gender inequality explored experiences of women at differing stages of their career in cancer research and care in order to pinpoint actions through which a feminist approach would tackle gender inequality.
Including:
- Increasing the numbers of female "mentors” to attract and help women feel a "sense of belonging”
- Challenging male-dominated decision-making spaces
- Encouraging women to feel confident and feel no need “to be apologetic for who we are”
- Calling out poor behaviour against women when it happens
These experiences encouraged me to return to my PhD research to explore what we could learn from women’s experience of care and how we can do more to amplify these experiences.
What women’s experience of care reveals
Throughout fieldwork undertaken in late-stage cancer treatment settings, there were poignant moments that captured how trust and a sense of being cared for was crafted through what I described as gendered care, most obviously seen in the ovarian cancer treatment setting between a female practitioner and patient (Fabian-Therond, 2024).
One ovarian cancer patient described how having a female surgeon “felt quite comforting … at least she knows what it’s like, she’s got them as well,” she told me. Although she clarified that male surgeons can be equally good, she said her surgeon “was a breath of fresh air in comparison and very good.”
This experience is something we see reflected in society more widely, highlighting the importance for women in seeing themselves represented in positions of power and influence.
Interestingly, many patient narratives seem to reflect how the lived experience of cancer care instilled in them a moral and ethical desire to speak up, especially when they felt care could and/or should have been better.
One ovarian cancer patient told me of her care experience and subsequent decision to write a letter of complaint to highlight how the protocol determining access to germline genetic testing for the BRCA genes, prior to a cancer diagnosis, could (unintentionally) work against women, such as those “who don’t know their family history.”
Another ovarian cancer patient told me about her experience just prior to her diagnosis and described the need to speak up: “It wasn’t an easy thing to be taken seriously, that was the worrying thing …”
“I’m really sorry but sometimes you have to dig your heels in and not give up and be far more persuasive than you usually would be in situations like this, and be very assertive.”
What can we learn?
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. Make space for 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. Lived experiences evoke a deep sense of reflexivity and ethical practice related to the values, interests and challenges within and beyond a care pathway (Mattingly, 2014, 09).
3. These women’s experiences show how their own lived understanding of being a woman helped them speak up and question aspects of their care when something didn’t feel right.
Together, these reflections show why a feminist ethics approach can help reveal and dismantle unequal power dynamics in cancer care and research.
If you’d like to keep exploring this theme, you can read the other blogs in our International Women’s Day series and sign up to our Professionals newsletter to stay updated with the latest insights.
About the author
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.
More blogs from our International Women's Day series
Dr Hannah Tharmalingam discusses the issues that impact women's healthcare and what this means for cancer care.
Dr Alison Berner discusses the barriers faced by the LGBTQIA+ community throughout the cancer pathway and what steps can be made to remove these barriers.
Chief Nursing Officer Dr Claire Taylor MBE and Macmillan Lead Cancer Nurse Fungi Motsi, discuss the challenges and experiences for women in leadership in healthcare.