Women, power, and cancer: a Lancet Commission

Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention and screening activities, as individuals living with and beyond a cancer diagnosis, as caregivers for family members and friends, as patient advocates, as health workers and healthcare professionals, and as cancer researchers and policy makers. The topic of women and cancer spans broad terrain, beyond women’s cancers and the biomedical aspects of any type of cancer that women in all their diversities might experience. It is inclusive of the ways in which sex and gender influence exposures to cancer risk factors, interactions with the cancer health system, and specific challenges faced by health-care professionals, advocates, and caregivers. In all these domains, women experience gender bias, and are subject to overlapping forms of discrimination, such as due to age, race, ethnicity, socioeconomic status, sexual orientation, and gender identity, that render them structurally marginalised. These myriad factors can intersect and restrict a woman’s rights and opportunities to avoid modifiable cancer risks and impede their ability to seek and obtain a prompt diagnosis and quality cancer care. At the same time, they serve to unfairly burden and perpetuate an unpaid cancer caregiver workforce that is predominantly female, and hinder women’s professional advancement as leaders in cancer research, practice, and policy making. Howeve

Mentorship Experiences Are Not All the Same: A Survey Study of Oncology Trainees and Early-Career Faculty

Physician workforce diversity can be a driver of institutional excellence, improving innovation and reducing health disparities. However, the current diversity of the hematology/oncology (HO) workforce does not reflect that of the US population. We conducted a cross-sectional online survey of current trainees and faculty within 5 years of completing terminal training in oncology specialties. Of the 306 respondents, 64 (21%) were under-represented in medicine (URiM) and 161 (53%) identified as male. URiM participants were less likely to have a primary mentor (66%) than non-URiM participants (80%; = .015). Among those who had a primary mentor, URiMs met less frequently (once every 3-6 months or less) with their mentor (19% 7% non-URiM; = .003). Furthermore, URiMs were more likely to report having mentors outside their own institution (47% 40% non-URiM; = .002) and making compromises to gain access to mentorship (36% 23% non-URiM; ≤ 0.001). URiMs were also less likely to apply for grants (34% 42% non-URiM; = .035) and awards (28% 43% non-URiM; = .019). In multivariable models, URiM individuals were more likely to make compromises to gain access to mentors (odds ratio [OR], 1.96; 95% CI, 1.01 to 3.82) and this remained significant for females (OR, 2.17; 95% CI, 1.26 to 3.75). URiM individuals may be less likely to have effective mentorship and apply for awards and grant support. Understanding the challenges of URiM trainees can help shape training environments in academic medicine to ensure that they are grounded in diversity, inclusion, and retention

Disparities in Diagnosis, Treatment Access, and Time to Treatment Among Hispanic Men With Metastatic Prostate Cancer

Reporting racial/ethnic disparities in aggregate obscures within-group heterogeneity. We sought to identify disparities in diagnosis and treatment in Hispanic subpopulations with metastatic prostate cancer (mPCa). We disaggregated men with prostate adenocarcinoma from the National Cancer Database from 2004 to 2017 by racial subgroup and Hispanic background. We assessed (1) presenting with mPCa, (2) receiving any treatment, and (3) receiving delayed treatment beyond 90 days. Logistic regression and adjusted odds ratios (aOR) were reported. Hispanic men had greater odds of presenting with mPCa (aOR, 1.54; 95% CI, 1.50 to 1.58; < .001) compared with non-Hispanic White (NHW) men. All Hispanic racial subgroups were more likely to present with mPCa, with the highest risk in Hispanic Black (HB) men (aOR, 1.68; 95% CI, 1.46 to 1.93; < .01). Men from all Hispanic backgrounds had higher odds of presenting with mPCa, especially Mexican men (aOR, 1.99; 95% CI, 1.86 to 2.12; < .01). Hispanic men were less likely to receive any treatment (aOR, 0.60; 95% CI, 0.53 to 0.67; < .001), and this effect was particularly strong for Hispanic White patients (aOR, 0.58; 95% CI, 0.52 to 0.66; < .001) and Dominican men (aOR, 0.52; 95% CI, 0.28 to 0.98; = .044). Hispanic men were more likely to experience treatment delays compared with NHW men (aOR, 1.38; 95% CI, 1.26 to 1.52; < .001) and in particular HB (aOR, 1.83; 95% CI, 1.22 to 2.75; = .002) and South/Central American men (aOR, 1.48; 95% CI, 1.07 to 2.04; = .018). Differences exist in stage at presentation, treatment receipt, and delays in treatment on disaggregation by racial subgroup and Hispanic heritage. We need to study the potential mechanisms of the observed variations to help develop targeted interventions

Race/Ethnicity and Gender Representation in Hematology and Oncology Editorial Boards : What is the State of Diversity?

Introduction: Women and underrepresented groups in medicine hold few academic leadership positions in the field of hematology/oncology. In this study, we assessed gender and race/ethnicity representation in editorial board positions in hematology/oncology journals. Materials and Methods: Editorial leadership board members from 60 major journals in hematology and oncology were reviewed; 54 journals were included in the final analysis. Gender and race/ethnicity were determined based on publicly available data for Editor-in-Chief (EiC) and Second-in-Command (SiC) (including deputy, senior, or associate editors). Descriptive statistics and chi-squared were estimated. In the second phase of the study, editors were emailed a 4-item survey to self-identify their demographics. Results: Out of 793 editorial board members, 72.6% were men and 27.4% were women. Editorial leadership were non-Hispanic white (71.1%) with Asian editorial board members representing the second largest majority at 22.5%. Women comprised only 15.9% of the EiC positions (90% White and 10% Asian). Women were about half as likely to be in the EiC position compared with men [pOR 0.47 (95% CI, 0.23-0.95, P =. 03)]. Women represented 28.3% of SiC editorial positions. Surgical oncology had the lowest female representation at 2.3%. Conclusion: Women and minorities are significantly underrepresented in leadership roles on Editorial Boards in hematology/oncology journals. Importantly, the representation of minority women physicians in EiC positions is at an inexorable zero