In 2022, the theme of World Cancer Day (close the care gap), is a cross-cutting concern, highlighted by the COVID 19 pandemic: the issue of inequality in cancer prevention, diagnosis and treatment. Indeed, geographic location, gender, income, education, ethnic origin, age, disability, sexual orientation, and lifestyle affect the possibility of receiving care and its quality. Your survival depends on who you are and where you live. This difference in equity does not only concern low-income countries. It concerns us all. It is why we have chosen to tackle the subject of women and cancer to understand how gender norms (i.e. Gender norms are ideas about how women and men should be and act according to their birth sex) influence the experience of illness and care.
In health matters, as in many other areas, women and men are not treated equally. The reasons are biological but are also related to the cultural, social, and economic environment. These inequalities have long been ignored. Today science is looking into the issue of access to medical care for women, even if many grey areas persist. In the United States, in Sweden or Germany, gender issues in health are already included in the caregivers' training. In France, it is not yet the case, but in 2020, the High Council for Equality between Men and Women submitted a report to the Ministry of Health with a list of recommendations to promote better care for women. Catherine Vidal, neurobiologist and honorary research director at the Institut Pasteur and member of the INSERM Ethics Committee where she co-directs the "Gender and Health Research group", recently gave us the report entitled "Taking sex and gender into account for better care: a public health issue". This study highlights it is a crucial and cross-cutting issue to take gender into account. It allows research to improve its questions, medicine to analyze pathologies more precisely and build new strategies for prevention and treatment.
The report addresses gender stereotypes, one "strong" and the other "weak", which still permeates mentalities and influences the diagnosis and treatment of these diseases. For example, there are the so-called "feminine" pathologies such as osteoporosis or the "masculine" afflictions, such as cardiovascular diseases. In the case of cancers specific to women, such as the cervix or breast cancer, prevention policies have improved but can sometimes remain insufficient and do not consider risk factors related to the environment and work. In addition, women at risk of cancer of the female reproductive organs are more often subject to mutilating preventive surgery. Several studies carried out between 2002 and 2009 also show that women learn to monitor their health and the health of others and that they use the healthcare system more regularly than men. However, care spaces – political, institutional – are subject to gender asymmetry. Public health policies and patient care systems (screening, disclosure of diagnosis, care pathway) are as gendered as the rest of society. This structural aspect is fundamental to understanding the transversality and omnipresence of the gender gap in our health system.
Men and women experience cancer according to their individuality but also according to their gender. Do we know, for example, whether the pain is equal between the sexes? For women, what is the impact of the disease on their daily life, their professional situation, their family life (such as the mental load or the household cores), their romantic life? A study (Monet 2017) on the prevention of cancer recurrence indicates that women are significantly more likely after a cancer diagnosis than men to report a change in their diet and increase their physical activity. A survey called VICAN published by the French National Cancer Institute on the life of people two years after their first diagnosis shows that men resort more than women to preserving their fertility (for example, by freezing sperm before treatments such as chemotherapy or radiation).
In contrast, women describe a negative impact of the disease on their parental project. Another aspect that this survey address is the disease's impact on professional life. We observe, for example, a greater prevalence of reduced income among women than among men. The social gaze is also very different between the two sexes. For instance, after aggressive chemotherapy causes alopecia, men and women will not be judged in the same way and will react differently. Women will more often hide from others and use hair prostheses.
Gender biases influence public health policies, education, medical practices, and patient behaviour. It leads to inequality and discrimination between the sexes in care and access to care. Cancer is no exception. Therefore, it is essential to be more vigilant and consider these inequalities to reduce the gender gap in the future, improve prevention and treatment strategies for people with cancer, and promote a more egalitarian medicine.