COMMENTARY

A Call for More Women Oncologists at the Podium

Solange Peters, MD; Enriqueta E. Felip, MD, PhD; Susana Banerjee, MRCP, PhD

Disclosures

October 13, 2015

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Solange Peters, MD, PhD: Hello. I am Solange Peters, chair of the Thoracic Clinic at the University Hospital of Lausanne in Switzerland. I am also chair of the European Society for Medical Oncology (ESMO) Women for Oncology Task Force, and I am an ESMO Executive Board member. I would like to welcome you all to this edition of Medscape Oncology Insights, coming to you from the 2015 European Cancer Congress in Vienna, Austria.

Today we are talking about a topic that is critical to the practice of oncology, which is the importance of supporting women oncologists and encouraging them to take leadership roles. I am honored and pleased to welcome two of my colleagues, whose research and leadership roles are admirable examples for other women in oncology.

To start, I am here with Dr Enriqueta Felip, associate professor of medicine at the Autonomous University of Barcelona School of Medicine and head of the Thoracic Cancer Unit at Vall d'Hebron University Hospital in Barcelona, Spain. She is also the first recipient of the ESMO Women for Oncology Award.[1]

Enriqueta E. Felip, MD, PhD: Thank you so much.

Dr Peters: I also welcome Dr Susana Banerjee, consultant and research lead in gynecology cancers at the Royal Marsden Hospital in London. She is also a guiding force of the ESMO Young Oncologists Committee. Welcome, Enriqueta and Susana.

Few Women Speakers at International Congresses

Yesterday, we had a new session called Women for Oncology.[2] We talked about the main problems that female oncologists might face when trying to get into the professional life and, subsequently, into a leadership position. This survey effort was started in 2013,[3] but it looks like it's not an easy task and not easy to progress in terms of numbers. We were able to show yesterday at the session ESMO data about international congresses. In Europe, 20%-25% of the oncology speakers are women. In the United States, it's a little bit better; 35% of the speakers are women.

Since 2004, there has been some improvement, but it's not significant. Both of you are speakers in all of these congresses. Do you have any explanation as to why these programs have fewer women speakers? Is it because we are less present on the scene? Or do you think it's a biased selection?

Dr Felip: I don't have a clear explanation, but this is the reality. You mentioned the statistics. In Spain, only 20% of speakers are women. Why is that? I don't know, but we have to change this. I think speakers are rarely women, and these numbers should change. We should encourage women to present in these meetings and to interact because the same few are presenting in Spain, in Europe. This is not the way to work.

Dr Peters: Very importantly, in ESMO—it is not the case now, but very soon—the majority of ESMO members will be female. We know this because if you look at the ESMO members who are under 40 years of age, women are already the majority. So, it will be the case one day that most of our members are females. It would be very nice if some of the speakers are also women.

What about in your community of young oncologists? Is this something that you speak about? Is it a concern, and do you try to find some initiatives in order to change this imbalance?

Susana Banerjee, MD: It is a very important topic for young oncologists. As you pointed out, the number of women who are studying oncology is increasing. This is true internationally and certainly in Europe and in the United Kingdom. It is very important that we support women through training and the early years of their careers as specialists and to carry this through going forward. I anticipate that the problems are not only for trainees or young oncologists, but, unfortunately, it may carry through to more senior individuals who are women.

We are going to have more women, and we currently provide training in oncology. But what are really important are the actual leadership roles: being on the podium, presenting data, and being chief investigators and principal investigators of trials. We need to be better represented. I'm not sure why that's not necessarily the case. What I very much hope is that as there are increasing numbers of women oncologists, I hope that they are given those opportunities and that they embrace those opportunities. Even though there may be more women, we might still be in a situation where the people in charge are men. We need to work together as a community of women, working with men, to see how we can address this.

Survey: Male Oncologists Make Most of the Decisions

Dr Peters: There is very clearly a discrepancy. In a 2013 ESMO survey,[3] women oncologists were asked about the composition of their work force environment. They all said that the majority of their collaborators in oncology are women. But, when they were asked who makes the decisions about strategy, treatment, and so on, almost all of them answered that it is a man. Maybe it's the same situation with speakers.

It is very important to help women become leaders who are considered equal to male leaders. The leadership roles are still a bit lacking in representation from women.

We have leadership programs in ESMO. We are starting a very specific one, trying to identify the leaders of tomorrow. Fifteen young oncologists or caregivers or researchers per year are brought in to be trained as leaders. We want half of the people in that program to be women. But is that enough? Do you think doing that will be enough, or do you think we should also educate these leaders about this gender question? What do you think?

Dr Banerjee: I think that we as women need to do more for ourselves as a community. But we also need to educate men about these gender issues and potentially address them. It's important to educate the men as well as the women.

I think that many of us women need to be more confident and feel that we can do these tasks and do them very well, at least equally if not better. That's what we need to do. We also need to include men in these leadership programs and sessions, acknowledging the problems, issues, or challenges that women have.

The obvious challenge is having children and taking some time out, however short or long it is. Hopefully, it doesn't mean that your career ends or stalls significantly. The key is having support from your peers, both male and female, for those who wish to carry on at the same pace as well as those who want to take a break for some time but not to end their careers that way.

Dr Peters: Yes. That's what our women at ESMO answered. When we asked them what the main difficulties are that they encountered in terms of career, the first thing was trying to reconcile family and work life. The second, interestingly, was the perception that men are natural leaders. It's about education from the very beginning that we could also be considered as being natural leaders.

Mentoring: A Way to Cultivate Future Leaders in Oncology

Dr Peters: You were awarded the very important Women for Oncology Award this year because you have an incredible career. But I also know that you have a family. You have a real and complete family life, and I'm sure you also had experiences of not being immediately considered as a natural leader, being a woman. And you're quite a shy person. How did you become so successful?

Dr Felip: I'm extremely honored to receive the award. My personal experience is that I had the opportunity to work with ESMO, and I think that is very important for young people. You know this history very well. The American Society of Clinical Oncology (ASCO) invited me to give a talk in 2013 about women in cancer and the keys to success.[4,5] I think this invitation was due to the fact that I was working in a European society of medical oncology that is very well known.

I asked a number of key physicians, such as you and Martine Piccart, and, together, we identified some of the aspects involved in becoming successful in medical oncology: You have to be active, you have to be respectful, and you have to find a good mentor. It is important for women to have somebody who can help you, give you advice, and help you in your career. I think this is not very well organized in Europe—not only for women but also for men.

Dr Peters: Did you have a mentor?

Dr Felip: No, not exactly a mentor, but I was very lucky to work in a big hospital with very big names who helped me. It's not exactly a mentor, but yes, I had the opportunity to interact with very important and active medical oncologists in the field.

Dr Peters: Supporting your career.

Dr Felip: Exactly. Supporting my career.

Dr Peters: That's very important.

Dr Felip: Yes, this is important.

Dr Peters: And you, Susana, do you feel that in the United Kingdom, if a woman is trying to make a career, she will be supported sufficiently? Will she find a mentor? Is it easy to do in London?

Dr Banerjee: I think it depends on individuals and the institutions. I was very lucky at the Royal Marsden Hospital where I was mentored throughout my training. My mentor was Professor Ian Smith, a professor of breast cancer. I don't think you necessarily need a female mentor. It's about having somebody take an interest in your career. I actually found it very helpful to not have a female mentor but someone who recognized the issues and was supportive of women.

Even though I finished training and I've been a consultant for 4 years, I still regard him as a mentor. It is having that consistency. I think what is also important is having people who inspire you—they can be men or women—and to learn from them and to see the ways they practice and behave that you like and would like to emulate. But you must also learn from them the negatives and what not to take on board. I think it's very important. I am a mentor to younger oncologists who are training, and I happen to be currently mentoring women.

Dr Peters: Now that we are discussing this point, do you think the mentoring process is especially important for women because they need to sort of catch up in terms of representation in the oncology community? Or do you think that the mentoring process is something that is more easily available to men? It looks to me like everybody needs a mentor to help efficiently identify priorities and so on. Do women have more difficulties getting access to this mentoring strategy?

Dr Banerjee: Certainly at the time that I was training, the majority of senior oncologists were male. In fact, throughout my training—I didn't work as a clinician—I wasn't trained by a woman, I was trained by men. In the laboratory during my work toward a PhD, one of the lab supervisors was a woman, and that was great.

I think it's about access to the right people. There are cultural issues as well. It's much easier for men to go out after work to network, to talk about football, or something like that. That's the reality. It's different for women. What's key is that as we are having more female oncologists, we have the opportunity to network outside work, at congresses like this. What I found really important yesterday—I was in a room with women who felt equally passionate about trying to make a difference. I don't think it was about ourselves. It included ourselves, but it was about our peers, the next generation, and our trainees that we wanted to help.

Dr Peters: We probably need to identify mentees and help them to be active—be they men or women—and work on this across countries, across institutions, and maybe help some programs to be built. It could be a systematic approach to helping young oncologists, women in particular.

Are you mentoring somebody, Enriqueta?

Dr Felip: Yes, in my institution.

Dr Peters: Men and women?

Dr Felip: Yes. Two men and one woman.

What Can Be Done to Change Gender Imbalances?

Dr Peters: Apart from raising awareness about gender imbalance (which we agree we don't like to speak too much about), what do you identify that could be done by an organization like ESMO, which has a diversity of countries, members' origins, and cultures? What else could ESMO do as a priority to help support women in their careers? What do you think? Should we impose a certain number of seats in the committees, in the sessions, or for speakers? Should we force an increase in those things? What do you think?

Dr Banerjee: I think that there is a risk if we do that. What we really want are the best people. I wouldn't want to risk somebody being up there because there is a quota. As a woman, I wouldn't want to be chosen just for that reason. I'd want to be recognized and be able to play in the same arena as my peers.

I think what we really need to do for trainees is to allow them the opportunities for research fellowships; for example, taking time out for a higher degree to do laboratory work. Often, it's at an age where many of us may be thinking about having a family, and that does have consequences with grants and the reality about funding and delivery of programs. I know we have not talked about this so far, but I think it's important to give women those opportunities as well.

Dr Peters: Flexibility in education and enabling careers to be built.

Dr Banerjee: Exactly. And it's about leaders in the laboratory. I'm thinking more of laboratory research and taking on women researchers, acknowledging that there may be some system changes, that there may be a time during that research program when they may take some time off. I'm not sure how to best address that.

Dr. Peters: Without losing too much.

Dr. Banerjee: Exactly.

Dr Peters: And what do you think? You were deeply involved in the committees of ESMO. Of course, there are women with great, incredible competency in every discipline of oncology. Should we at least pick committees, not speakers, and say that we need a third or 40% to be women? Because they exist. We know that.

Dr Felip: I don't know if imposing a percentage is the way to go. The information you gave us yesterday is important. I think the members of ESMO should know the number of women speakers and the number of women who are on the board of directors. Even for publications such as the Annals of Oncology, for example, we don't know what percentage of the first or senior authors are women or men. I think this information is important for people because there is no explanation for this difference in numbers between men and women. I think it's important to have these numbers.

ESMO could encourage people to present to the boards. I think it is important to encourage young people to be there as committee members. It is relevant to have the numbers.

Dr Peters: Self-confidence is important, also. Women would very often decline a position or an offer because they lack the same self-confidence that men have, right?

Dr Felip: Or perhaps you need to have somebody, a friend, who can tell you, "You can present this. You need to present this poster."

Dr Peters: We have lots of ideas. We will decide on our next award recipient for next year. It's important to say that for this award, we recognize our colleagues who support women's careers, those who are actively changing the environment in which we are working. It's going to be very interesting to see how this initiative can move and raise awareness of this problem that is shared by all of us.

I'd like to thank you for this discussion.

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