by Mona Jhaveri - June 16, 2021

Women's Cancer: Trends, Disparities, and Workplace Treatment

Women of all ages, races, and ethnicities are diagnosed with cancer each year across the globe. Worldwide trends indicate that there is a growing incidence of women developing cancer, especially in low-income countries. In middle- and high-income countries, cancer is the second-leading cause of death, right after cardiovascular disease.

So too, disparities in cancer incidence and mortality rates are evident between males and females.

To make matters worse, many research studies found that women who develop cancer often experience discrimination at work because they are seen as less productive or valuable to employers. Many women share how challenging it is to balance life, work, and cancer treatment and remain optimistic about the prognosis.

This article will highlight some key findings from recent research and will explore how cancers affect women all across the globe.

Most Common Cancer Types in Females

Following the worldwide trends in women’s cancer, the five most common female cancer types are:

  • Breast cancer (47.8% of all female cancer diagnoses in one year)
  • Colorectal cancer (16.2%)
  • Lung cancer (14.6%)
  • Cervical cancer (Cervix uteri cancer) (13.3%)
  • Thyroid cancer (10.1%)

Alongside these, there are five primary gynecologic cancers or cancers of a woman’s reproductive organs. These include:

  • Cervix uteri cancer (Cervix uteri cancer)
  • Endometrial cancer (Corpus uteri cancer, uterine corpus cancer)
  • Ovarian cancer
  • Vulvar cancer
  • Vaginal cancer

Breast Cancer Trends

The incidence of breast cancer in western countries (Northern America and Central and Western Europe) rose between 1980 and the late 1990s before decreasing or stabilizing since the year 2000. This increase is attributable to improved awareness of breast cancer risk factors, such as age, family history, race, weight, and lifestyle choices, as well as improved screening, and the abandonment of hormone replacement therapy, typically used to treat menopause.

Despite the increase in the breast cancer incidence rate during the 1990s, mortality rates steadily declined as a direct result of improved treatment options and more frequent mammography screening.

Colorectal Cancer Trends

Colorectal cancer incidence rates in high-income countries are stable, decreasing, or increasing, depending on the country. For example, the number of new female colorectal cases in the United States has been on the decline largely due to improved lifestyle habits and the avoidance of physical inactivity and smoking. Additionally, screening for colon cancer in both men and women has gained wide acceptance in the U.S. over the last decade.

The same cannot be said for low- and middle-income countries, particularly in Latin America and Asia. Western lifestyles increasingly influence these regions. The consumption of red meats, processed foods, and alcoholic drinks has been on the rise, leading to higher incidence rates of colorectal cancer.

Lung Cancer Trends

Even though tobacco smoking is not the only risk factor for lung cancer, it is certainly considered a major risk factor for developing lung cancer. Populations that constitute regular smokers are subject to increases in lung cancer deaths 20 and 30 years later. The number of deaths reaches its peak in about 30-40 years after addiction becomes prevalent within an area.

While women generally start smoking at a later age than men, the lung cancer death rate has peaked in places where women started smoking at a younger age, such as the United States, United Kingdom, Australia, and Hong Kong. Tobacco control measures are the primary cause of this recent decreases in lung cancer incidence rates among women in developed nations.

Cervical Cancer Trends

The incidence of cervical cancer is declining in high-income countries. Some countries have witnessed an 80% decline in the past forty years. This drastic decrease can be primarily attributed to a rise in screening and improved socioeconomic conditions. These optimistic trends are also evident in certain low- and middle-income countries such as Colombia, India, and the Philippines.

Unfortunately, women in other parts of the world such as Uganda, Zimbabwe, and Eastern European countries report cervical cancer rates that are higher than the global average. Even high-income countries like China and Japan are experiencing an increased number of new cervical cancer cases. With the changing sexual practices of women, which might include more partners and an increase in HPV prevalence, inadequate screening is one cause for the recent increase in cervical cancer incidences.

Thyroid Cancer Trends

Thyroid cancer is increasing at alarming rates in Canada, Norway, Germany, Japan, the United States, and other high-income countries. Reasons for this are still unknown. Overdiagnosis of thyroid cancer due to more widespread healthcare is one possibility as to why this rare cancer is becoming more common. Interestingly, there is a decrease in the incidence of thyroid cancer rates in low-income countries, perhaps due to poorly accessible healthcare systems that have overlooked thyroid cancer diagnoses.

Cancer Disparities

Disparities in cancer care are too often a function of race, ethnicity, age, disability, gender identity, national origin, sexual orientation, and socioeconomic status groups. While these health disparities exist across many areas of the world, a few examples can be highlighted:

  • In Canada, recent studies revealed that immigrant women with breast cancer were less likely than Canadian-born women to receive appropriate treatment.
  • When conducting a study examining cancer disparities in an urban population, researchers found that black women with breast cancer were less likely to have appropriate surgical treatment than white women.
  • In the United States, African Americans have the highest mortality rates for all cancers combined.

Disparities in cancer treatment can have grave consequences for patients—particularly those of low income or minority status who may not be able to afford proper care, but also disparities exist between genders where women are less likely to receive quality care and treatment for cancer.

Disparities in Incidence Rates

In the United States, cancer statistics suggest that males have higher incidence rates of these cancer types:

  • Liver and intrahepatic bile duct cancer
  • Bladder cancer
  • Laryngeal cancer
  • Esophageal cancer
  • Oral cavity and pharyngeal cancers

In contrast, females have higher incidence rates of these cancers:

  • Anal cancer
  • Biliary tract cancer
  • Thyroid cancer

Regarding other sex-nonspecific cancers, lung cancer is more prevalent in males. There is also a slight male predominance in the number of new cases of central nervous system and brain cancer types.

Disparities in Mortality Rates

Cancer death rates for males are higher than those for females. Male cancer mortality rates are also increasing faster than female cancer mortality rates – typically, men have worse survival outcomes than women. However, these trends aren’t true for every type of cancer. For example, lung cancer fatality rates are decreasing for men while increasing for women.

Biological Reasons for Cancer Disparities

Gender influences anatomy, physiology, the immune response to cancer, and the pharmacokinetics and pharmacodynamics of cancer treatment. Men and women are biologically predisposed to have similar but not identical responses to certain types of cancer. A common example of this is colorectal cancer. Females usually develop malignancies on the right side of their colon or rectum, while males tend to develop the disease on the left side. The root of this difference is not yet understood, but it might have something to do with different estrogen levels between men and women. Either way, left-sided colorectal cancer is linked to lower severity compared to right-sided colorectal cancer.

Different drugs can also impact men and women differently. Women tend to have many adverse reactions to chemotherapy drugs, such as alopecia (hair loss) or nausea. Drugs such as cisplatin and paclitaxel exhibit higher toxicity in women, while rituximab leads to better outcomes in women than in men.

Women in Cancer Clinical Trials

In 1977, the Food and Drug Administration (FDA) recommended excluding women of childbearing age from clinical trials in the early stages. Nothing prevented organizations from including women in the later studies when there was enough data on safety. Still, most decided to eliminate women from all types of clinical trials, including cancer studies. This event contributed to a significant disparity in clinical trial participation between males and females.

Later on, in 1993, new guidelines were issued by the FDA that allowed for the inclusion of all healthy volunteers and minors between ages 18-45 years old. This effectively reversed the decision from 1977, but the damage has already been done. Women are still severely underrepresented in clinical research not tied to biological sex.

Overall, lower participation rates of women in cancer trials hindered our true understanding of how safe and effective cancer drugs are in the female body. We lost insight into how treatment could be tailored to women, and what can be done to improve their mortality and incidence rates in the future.

Clinician Factors

Clinicians play a role in cancer treatment disparities between men and women.  One study concluded that female doctors are more likely to provide preventive care to their female patients, especially in breast and cervical cancer. This research study found that female physicians were more likely to “encourage frequent mammograms for their female patients” than male physicians. This is key because annual mammograms are considered a highly effective tool for breast cancer prevention.

The difference in the way that male and female clinicians provide care could be due to many factors. This includes a lack of education about cancer in women and how they differ from men’s, or it might simply come down to differences in attitudes towards caring for their female patients. Compared to their male counterparts, female physicians appear to show more sympathy and comfort for a patient during clinical care, such as during cervical and breast cancer screening (mammograms, breast examinations, and Pap smears).

Women with Cancer in the Workplace

Women with steady jobs and with a cancer diagnosis often face a host of work-related discriminatory challenges that ultimately impede their recovery. For working women battling cancer, it is important to reflect on the following:

  • What can be done if the employer (or coworkers) turns out to be discriminatory?
  • What type of workplace accommodations are required?
  • Can the employer refuse to accommodate a request?
  • What about special equipment needs due to disability-related limitations?
  • Is it possible to take time off work for doctor’s appointments and treatments?
  • How will the disease or therapy affect their physical health and their job?

Many women decide to keep working even after their cancer diagnosis. The American Cancer Society revealed that 69% of cancer survivors cite their work routine as one of the primary things that helped them through recovery. On the other hand, some women may choose to stop working during cancer treatment. This decision is not necessarily a reflection of their strength or desire to fight cancer. Some women find that spending more time with loved ones, to physically and mentally recover from the disease, is beneficial to their healing.

For many women (and men) in this situation, an employer may provide different accommodations to ease their time in the workplace and help them cope with their health status better.

Workplace Accommodations

When a person is diagnosed with cancer, they may not need any workplace accommodations- or at least not right away. But certain allowances may help them handle complex and debilitating cancer treatment while tending to their full-time job. These allowances can include:

  • A flexible schedule
  • Adjusted workload
  • Taking an extended leave
  • The ability to work from home for some time
  • More frequent breaks
  • Temporary changes in duties or projects
  • Different technological equipment, such as voice recognition software
  • Offering rehabilitating or counseling services for better mental health and more

As long as reasonable accommodations do not pose an undue hardship on the employer, they are obligated to provide them. Women could benefit by researching their rights in the workplace and what can be done should they face any resistance or even discrimination because of their health status.

Workplace Discrimination

Employees with cancer often face workplace discrimination, including loss of opportunities to advance in their careers, or they may receive lower wages, or be denied promotions. A study by the National Institute for Occupational Safety and Health found that women with cancer are more than twice as likely to be fired from their jobs than men.

Women with cancer also have to deal with gender bias in the workplace. If they cannot fulfill their job duties because of treatment or disease, they are usually viewed as less committed than their male counterparts. This type of gender discrimination unduly justifies salary decreases and unfair treatment in the workplace relative to men.

However, there are many ways for women with cancer to protect themselves against discrimination and injustice if they encounter it at work. Consider these options and practices:

  • Keeping a journal of anything and everything that is out of place or unusual in the workplace. This can include any comments made to you, being excluded from meetings with co-workers, not receiving pay raises even if others have received them, etc.
  • Filing complaints with different organizations like the Equal Employment Opportunity Commission or the Department of Labor.
  • If you are in a workplace that has set up guidelines for employees with cancer, make sure to follow the rules so they can be used as evidence of your compliance.
  • Mentorship programs and support groups are excellent ways to network and gain support from women in similar situations.

New Discoveries in Female Cancer Treatment

Science is continually advancing ways to treat, screen, monitor, and prevent cancer. Here are some interesting breakthroughs over the last few years that will impact the way clinicians approach treatment for female cancers.

EPN3 Gene

A team of cancer researchers led by Dr. Sara Sigismund in Italy uncovered a gene that stimulates the growth and spread of certain types of breast cancer through the rest of the body. Named the EPN3 gene, this is now a prime candidate for targeted anticancer therapy in the future.

AI Mammography

Artificial intelligence (AI) is not yet at the stage to replace humans in interpreting mammography results. However, it is a great supplemental aid that will improve the accuracy of mammogram results over time.

Liquid Biopsy

Liquid biopsy is used to monitor the development and treatment response of various cancer types. It is less invasive than a traditional biopsy, as it only requires a blood sample from the patient. Through liquid biopsy, medical professionals can develop personalized treatment approaches for each patient and each cancer mutation.

Conclusion

Cancer is a challenging diagnosis for anyone, male or female. In this article, we presented a brief overview of women with cancer from all corners of the world. The incidence and mortality rates of specific cancers largely depend on the country’s economic development and how influenced it is by the traditional western lifestyle.

The five most common cancers for women are breast cancer, cervical cancer, colorectal cancer, lung cancer, and thyroid cancer.

Overall, women have higher incidence rates than men in anal, thyroid, and biliary tract cancer. In contrast, men have higher cancer mortality rates than women. Reasons for these disparities can be biological but also rooted in flawed clinician guidelines and personal biases of medical professionals. For example, women with female physicians are more likely to undergo regular breast and cervical cancer screening than those who are seeing a male health care provider.

Other disparities in women’s healthcare involve the workplace. Women with cancer in the workplace face a set of challenges that can be overcome with certain accommodations. Women are also more exposed to discrimination, reduced pay, and being passed over for better positions. To protect themselves against these injustices, women diagnosed with cancer should inform themselves of their rights and file complaints against coworkers or employers who violate them.

Lastly, some new discoveries in cancer research have opened doors to innovative treatment and diagnostic tools for different cancer types, including breast cancer.

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