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John Yang:

According to the Setters for Disease Control and Prevention, cancer has been one of the two top leading causes of death in the United States for 75 years. And women with cancer can face unique challenges that make it harder to overcome the disease. Ali Rogin’s part of our ongoing series Unequal Treatment.

Ali Rogin:

Each year, 2.3 million women around the world die prematurely from cancer. Those deaths could be prevented by early detection, timely diagnosis, and increased access to optimal treatment. But experts say it doesn’t just stop there. A recent global study outlines why systemic changes in healthcare, health policy and cancer research are all necessary to eliminate the gender based barriers women fighting cancer face.

Dr. Ophira Ginsburg is a senior advisor for Clinical Research at the National Cancer Institute’s Center for Global Health. She’s also one of the co-authors of the study. Dr. Ginsburg, thank you so much for joining us.

This report compiles testimonies from women from 185 countries around the world. What were some of the common themes and experiences that you and your co-authors picked up on?

Dr. Ophira Ginsburg, National Cancer Institute:

One of the key themes that we uncovered, it was kind of hiding in plain sight, was that many people, women included, don’t realize what a huge problem cancer is in every country.

In fact, cancer ranks in the top three causes of premature mortality that’s death under the age of 70 in all but two countries. Our overall effort really uncovered that there are power, asymmetries in terms of knowledge, decision making, and economics, that influence women’s opportunities to understand their risks, to take action, to prevent cancer for themselves, to find resources for early detection when cancers are early detectable, and to make it through the care pathway even if quality treatment is available.

Ali Rogin:

It’s interesting to me because one of the most prevalent causes of these disparities is not related to a clinical phenomenon, but rather is about the word patriarchy. What does that power imbalance mean in terms of medical encounters and cancer outcomes?

Dr. Ophira Ginsburg:

First of all, the enemy of, let’s say feminism isn’t men, right? It’s patriarchy. This is a system. This has to do with structural power imbalances that impact people wherever they are, and also particularly women who are disadvantaged for other reasons, whether it’s because of race, ethnicity, migration status, income, et cetera.

So we’re talking about overlapping forms of discrimination that compound what’s already a problem in terms of patriarchal notions of a woman’s role in society. And when you think about caregiving, how many people out there are providing care for family members in their homes? Most of the people providing that caregiving are women, and that’s largely unpaid.

So what is the value of that to society? What would it mean if we actually took a more feminist economics case for cancer? There’s a lot that could be achieved if we just looked at things through a gendered lens that would be for the benefit of all people men, women, and children, for that matter.

Ali Rogin:

One of the findings in the study was that women are more likely to undergo financial hardships following a diagnosis than men. Why does cancer seem to have an undue economic burden on women?

Dr. Ophira Ginsburg:

We looked at women after one year of a diagnosis of cancer and found that three in four had suffered financial catastrophe that refers to 30 percent of their annual household income spent just on cancer related health expenses. That doesn’t even include the indirect costs such as transportation, childcare, the fact that women who are in the paid workforce have to leave those jobs in order to seek care.

And most of the work at home is performed by women. And so we see in this particular study of eight Asian countries, which included upper middle income and low income countries, we see that women tend to face greater financial risks than men do.

Ali Rogin:

This report also looks at women’s underrepresentation in the research that goes on to inform cancer conclusions. How does that inequality impact cancer care?

Dr. Ophira Ginsburg:

Even though we are women leaders, were surprised when we looked at a few things. Number one, the union for international cancer control, which is based in Geneva, is an umbrella civil society organization of 185 member organizations that were classified as hospitals, treatment centers, and research institutes, only 16 percent were led by women.

And another important data point of the 100 top cancer research journals, the top 100 had only 16 percent female editors in chief. So what does that mean? Right? Let’s just take breast cancer, for example. There’s a lot of research in breast cancer. There’s a lot of research funding. We know there’s a lot of important breakthroughs and treatments, but nonetheless, we only know about one third of the causes of breast cancer.

Even here in the U.S. if you change John to Jill on a grant application, there’s research from other countries showing that the chances of that person getting the grant are greater if it’s a man who wrote the grant.

Ali Rogin:

Dr. Ophira Ginsburg with the national Cancer Institute’s Center for Global Health. Thank you so much for your time.

Dr. Ophira Ginsburg:

Thank you.