Does Oncology Have a Glass Ceiling?

Linda Brookes, MSc

Disclosures

November 02, 2015

Across Europe, women make up nearly 40% of the oncology workforce, but the proportion of women in leadership roles in academia, clinical practice, and professional organizations is significantly lower, according to data presented at the European Cancer Congress (ECC).[1]

In a special session at ECC, Solange Peters, MD, PhD, professor of medicine at the University of Lausanne, in Lausanne, Switzerland, and chair of the European Society for Medical Oncology (ESMO) Women for Oncology Task Force, outlined the current status of women oncologists in Europe.

At the end of 2014, 38.6% of ESMO members were women compared with 20.2% in 2000.[2] This increase is largely represented by younger women, who now make up 52% of oncologists aged 40 years and younger (as compared with 31% of the older age group). On the basis of these data, Dr Peters predicted that ESMO will have a majority of female members in a few years' time. Despite the increasing numbers of women oncologists, their roles in leadership positions are not increasing at a comparable rate. An exploratory study first reported in 2013[3] found that although most working oncology teams (57.6%) are composed of a majority of women (compared with 31.6% of teams with a majority of men), the managers of the teams are more often men (60.1%) than women (39.9%).

In an online questionnaire distributed to European women oncologists, respondents identified two main challenges to career progression: work-family balance (identified by 58.7% of survey respondents) and society's perceptions of men as natural leaders while women are perceived as team members and supporters (50.5%).[3] Other challenges included cultural gender prejudices (38.7%) and difficulty in spending time abroad for research fellowships (30.1%).

The women surveyed identified programs that ESMO could implement to support their professional career development. Almost 6 out of 10 respondents (57.4%) thought it would be helpful to have access to flexible education/fellowship programs. They also identified the importance of implementing mentorship programs (41.5%) and making professional career development tools available online (40%).

The survey was an undertaking of ESMO's Women for Oncology (sometimes referred to as W4O) initiative, launched in 2013, with the creation of the Women for Oncology Task Force. In 2014, ESMO announced a Women for Oncology Award,[4] and Enriqueta Felip, MD, PhD, a medical oncologist from Barcelona, Spain, was named its first recipient for her work in bringing international attention to the underrepresentation of women oncologists in leadership roles.[5]

Leadership Roles in Europe vs the United States

New data reported by Dr Peters reveal that the degree of underrepresentation of women as officers of professional oncology organizations and as speakers at international congresses varies between Europe and the United States.[1] In 2014, women made up 22% of speakers at the ESMO Congress—"a strong minority," commented Dr Peters. However, at the same year's annual meeting of the American Society of Clinical Oncology (ASCO), women made up 34% of the speakers. At 2014 meetings of the European Association for Cancer Research and the American Association for Cancer Research (AACR), about 28% of speakers were women.

No major change in the proportion of women speakers at European and American meetings over the past 10 years.

"Unfortunately, there has been no major change in the proportion of women speakers at European and American meetings over the past 10 years," Dr Peters noted, with women making up 22% of speakers at the 2004 annual congresses of ESMO and European Cancer Organisation (ECCO) and 28% of speakers at ASCO. "Very often we hear that this will change over time, but we have not progressed in the past 10 years, so can we expect it to change in the next 10 years if we don't make any effort? I don't think so," Dr Peters stated. Proportions of female speakers at national oncology congresses in Europe (Spain, Italy, German, Austria, and Switzerland) are about 20%-25%, also increasing, although not dramatically, she added.

Assessing leadership roles among nine international oncology societies, only two (22.2%) currently have women presidents: ECCO and ASCO. Among 15 European national oncology societies, three (20%) currently have women presidents. Historically, Europe lags far behind the United States in this respect, Dr Peters noted. ASCO has had seven women presidents and the AACR 10, whereas ECCO and ESMO have each had one (and the same) woman president: Martine Piccart, MD, PhD, professor of oncology at the Université Libre de Bruxelles and director of medicine at the Jules Bordet Institute in Brussels, Belgium, was ESMO president in 2012-2013 and is the current ECCO president. On the committees and boards of these societies, female representation ranges from 47% (AACR) to 13% (ESMO)—"a real gender imbalance," Dr Peters commented. A similar picture is seen for European national medical oncology societies, ranging from 60% female representation in Hungary (Hungarian Society of Medical Oncology) down to 0% in Switzerland (Swiss Society of Medical Oncology) and Austria (Austrian Society for Haematology and Medical Oncology).

Women for Oncology Action Points

To support career development for women oncologists, Dr Peters announced that the Women for Oncology Task Force is seeking to ensure equal participation by women in the ESMO Leaders Generation Programme, which aims "to give qualified oncologists the managerial skills to take positions of higher responsibility and help advance the profession."[6] "We would like to complement this program by having a special ESMO educational module addressing the problem of gender imbalance," Dr Peters proposed.

The Task Force plans to continue its surveys of women oncology professionals, "because they are very useful in illustrating the problems," continued Dr Peters. An exploratory survey of expectations for career development programs in the oncology community will also be conducted.

"Women for Oncology will promote gender balance in ESMO scientific/educational committees and meeting faculties as much as possible and raise awareness among a wider audience," said Dr Peters.

We will move to promote more women to chair congress sessions and more female speakers in educational sessions.

"We have to be an example," Dr Peters told Medscape. "The Task Force has pointed out that women are underrepresented on ESMO committees, and ESMO is already working to change that. We are not in a position where fixed quotas are appropriate, but we will move to promote more women to chair congress sessions and more female speakers in educational sessions. We will actively bring women onto the scene over the next months and educate men not to forget about this situation in the future." National societies can take similar actions, Dr Peters noted. "We have done it in ESMO, and Greece,[7] Italy, and France are already moving on similar initiatives at the national level.

Taking Cues From American Colleagues

ESMO's Women for Oncology plans to take cues from other organizations such as ASCO. In the United States, the matter of gender imbalance came to the attention of the professional oncology community some time ago," Dr Peters commented to Medscape. "It is maybe just a question of time to catch up, but in Europe our numbers over the past 10 years haven't changed very much. Natural changes over time are probably present but slow and weak. We have heard from our American colleagues that they managed to make the difference by creating a mentoring, sponsoring culture, with programs for learning how to publish and how to be at the forefront of the scene. We have to mimic this a little, maybe do it faster and more efficiently."

We need to be proactive Julie Vose, MD, ASCO President

Current ASCO President Julie M. Vose, MD, is also committed to enhancing and supporting the role of women leaders in oncology.[8] "I used to say that we should be gender-neutral, but I came to change my mind. I now believe that we need to be proactive," Dr Vose told Medscape. "ASCO is fairly proactive in trying to get women involved in committees. I think that the biggest thing is being more proactive at a young age," commented Dr Vose. "Young oncologists have to really get out there and have confidence and be able to get into the mix of things. Some cultures don't teach you to do that if you are a woman."

AACR has a strong record of women leaders, which includes its current president-elect, Nancy E. Davidson, director of the University of Pittsburgh Cancer Institute, in Pittsburgh, Pennsylvania. Over 40% of its 35,000 members are women, said AACR Chief Executive Officer Margaret Foti, PhD—a number significantly higher than that of the nation as whole. Current data indicate that 30% of practicing oncologists in the United States are women.[9] Dr Foti added that AACR runs a Women in Cancer Research initiative,[10] open to men and women, which is "committed to recognizing women's scientific achievements and fostering career development and advancement in cancer research." Interestingly, she added, "Women members did not initially support this initiative. Women need to support each other, but not all of them do."

Dr Vose underscored the importance of a network of support for women oncologists. "Women oncologists must make sure that we support each other in every aspect of our lives. We have to be good mentors for young women; they are going to take our place and take us into the future."

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