2023-09-26 22:30:00
Cancer affects men and women differently. But these differences are not always reflected in their research and treatment. A report published in the scientific journal The Lancet urges an intersectional gender approach when it comes to this disease. The commission responsible for the report, made up of an international team, proposes a set of ten actions, with the general recommendation that sex and gender be included in all cancer-related policies and guidelines.
“This commission was created to investigate the intersection between social inequalities, the status of women in society and cancer,” explains Karla Unger, researcher in Health Systems at the National Cancer Institute of Mexico and one of the authors, by email. of the study. “Those in positions of power decide what is prioritized, financed and studied,” she denounces, referring to a highly masculinized sector. Although she recognizes recent advances, she denounces that women with cancer continue to experience “various forms of discrimination” that must be eradicated.
The study has been carried out in countries with very different realities, but Unger believes that this does not detract from its value, but rather reinforces his thesis. The expert repeats in many of her statements that these are situations that occur “also in high-income countries” to highlight the global nature of the problem. The report highlights that, “regardless of geographic region or economic resources,” women are more likely than men to lack the knowledge and power to make informed health care decisions.
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Access to accurate health information and quality health services would be at the center of the analysis. The report notes that 1.5 million women’s deaths might be avoided through primary prevention or early detection strategies, and another 800,000 if all women had access to optimal cancer care. Does not specify data regarding men.
It also analyzes the role of women in health and care related to cancer, reaching the conclusion that they are, for the most part, the ones who become unpaid caregivers when a family member suffers from cancer. And, conversely, they are significantly underrepresented as leaders in research and policy organizations.
Incomplete studies
When talking regarding cancer and women, the debate generally focuses on those that specifically affect them, such as breast and uterine cancer. “Breast cancer is the most common and cervical cancer is the only cancer that is completely preventable,” says the expert. It is normal that they have so much media focus. But other types of cancer that affect both sexes have been included in this commission, with the intention of identifying social differences between them. “There are studies that report that women are diagnosed at more advanced stages than men in colorectal cancer, bladder cancer and urinary tract cancer,” she explains. “Longer times between presentation to the doctor and final diagnosis have also been reported for women compared to men for various types of cancer: lung, colorectal, bladder, pancreas and urothelial. [de vejiga]”.
The report emphasizes the need to differentiate between gender and sex, something that is not always done. Sex refers to biological attributes such as chromosomes, gene expression, or reproductive anatomy. Gender, on the other hand, is a social construction that encompasses the roles and behaviors that are considered socially appropriate for women or men. “These terms are not interchangeable,” Unger clarifies. “But in the research work we did, most of the data available used sex and gender interchangeably, usually in a binary way: male or female. One of the main recommendations we make at the Commission is to ensure the routine collection of data disaggregated by sex, gender, and other sociodemographic factors in health statistics.”
Dr. Elena Élez is an oncologist at the Vall d’Hebron University Hospital and head of the Colorectal Cancer Group at the Vall d’Hebron Institute of Oncology. She has not participated in this study, but her team has made reports along the same lines and strongly agrees with her conclusions. She highlights the breadth of the report and the fact that it takes into account all stages, from investigation to treatment with the patient. Élez gives two concrete examples of how differentiating between men and women when we talk regarding cancer can help. “For example, when we do studies and in the models we use little mice,” she points out in a telephone conversation. “Many times the authors do not pay attention to something as simple as specifying whether they are little mice or little mice. And this has a very important impact. “There are differences in how each drug affects depending on sex.”
“On the other hand, in medications, data on side effects included is usually given. Maybe we should differentiate between men and women and see the impact this has,” he adds. There is scientific literature that supports this idea. An American study published in the Journal Of Clinical Oncology reveals that, following receiving cancer treatment, women have a 34% higher risk of developing serious symptomatic adverse effects than men. Above all, if the treatment is immunotherapy: before drugs such as cisplatin or pembrolizumab were approved, women had a 49% higher risk of sequelae than men.
“There is a clear male bias in the way we look at the world,” says Ana Porroche Escudero, anthropologist and researcher in the Health Research Division at Lancaster University. “That is why I am pleased that the article mentions the importance of investigating environmental and occupational factors in the incidence of cancer.” When understanding how cancer affects men and women, biological differences must be taken into account, but also environmental differences. Family burdens, the way of responding to pain, following medical prescriptions, the frequency with which check-ups are done.
Porroche misses “greater emphasis on denouncing the role of the social determinants of health in the incidence,” but celebrates that studies like this one focus on the intersection between power, cancer and women, a debate that, he believes, has not been addressed. finished addressing in biomedical environments. “Patriarchy dominates cancer research and policymaking,” she says. “Leadership positions are dominated by men and by male thinking, this applies to the management of health services as well as research teams, committees in charge of subsidizing research and editing scientific journals,” she laments.
Dr. Élez is less critical. “By her luck, at least in our context [el español]”We have a healthcare system that always tries to do the best for the patient, that works at a level of evidence, and applies the best possible treatment to the patient,” he points out. “But we have to understand how we approach this, even the way we talk has to change.” Élez also encompasses these conclusions in the need to individualize the treatment of patients, “the way of approaching cancer is very different depending on the patient, whether they are male or female, young or old.” In short, we must go towards individualized and specific treatment.
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