COMMENTARY

ESMO Data Clarify Differences in Pay, Mentorship, and Professional Opportunities for Women in Oncology

Solange Peters, MD, PhD; Eva Thalmann, PhD; Giuseppe Curigliano, MD, PhD

Disclosures

January 31, 2018

Solange Peters, MD, PhD: Hello. I am Solange Peters, ESMO Women for Oncology Committee chair and the head of medical oncology at Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. Welcome to Medscape Oncology Insights, coming to you from the 2017 Congress of the European Society for Medical Oncology (ESMO).

Today we will be discussing some of the unique challenges women oncologists face in their professional careers. Joining me is Giuseppe Curigliano, a member of the ESMO Women for Oncology Committee and chair of the division of medical oncology at the European Institute of Oncology and the University of Milan, in Italy. Also joining me is Eva Thalmann, also a member of the ESMO Women for Oncology Committee, and head of external scientific relations at Janssen Pharmaceuticals, a Johnson & Johnson company.

The Women for Oncology Committee is not a new initiative. We began discussing this initiative in 2013, but now this has become a top priority for ESMO. In 2015, we established the committee and we now have many initiatives that have to grow and be practically applied to change the paradigms of women's careers in the oncology field. I believe that in every ESMO Perspectives, our digital magazine, when we decide to set our strategy, it is very important first to be sure that we clearly and concretely describe the situation for women professionals in oncology in general, and to be very objective in the way we address the challenges. We have been doing it so that we can define a strategic plan for the ESMO society, the ESMO board, and the ESMO "deciders." The first step of this strategic plan was to describe the reality.

To do that, we have performed two studies. One was a study of numbers; numbers are very good surrogates to describe the reality. These numbers are about how many women speakers are to be found in our meetings and also in meetings abroad—the American Society of Clinical Oncology (ASCO), European Association for Cancer Research (EACR), American Association for Cancer Research (AACR), and so on. How many board members are women? How many presidents of societies are women? How has this evolved over time? How many members of ESMO are women? All of these numbers allowed us to describe the reality.

The other initiative to set the scene was a survey that was distributed to all of our members, men and women; one fourth of the responders of the survey were men. This survey asked about perceptions on this initiative and about the oncology gender gap in general.

I want to discuss these two studies in order to try to explain the starting point of all our initiatives and our plans for the field. Eva, you are the lead author of the manuscript that will be published describing these numbers, which showed the variable participation of women in the activities of our professional societies. Is it true that a gender gap affects our activities in ESMO and beyond?

Eva Thalmann, PhD: Thank you, Solange. This is a very interesting question. One remarkable number is the ESMO membership. ESMO constantly is getting more female members and especially women under age 40. Already, 50% of ESMO members are women. That is a very constant development over the past few years. But we also looked at how many women are on the boards of the different societies. We see differences between Europe and the United States, but also between the clinical societies such as ESMO and ASCO, and the research societies such as AACR and EACR.

If we look at faculty members, we also see a gap. At the moment, women are not represented; the number of female faculty does not increase in proportion to the number of female members. ESMO is lagging behind in that case. One analysis showed that the more women you have on a board, the more female faculty members you will have in the scientific programs. That is definitely something to think about.

Dr Peters: What is your opinion on the numbers, Giuseppe? The proportion of members who are women is growing, but we have included a high proportion of women for the past 10 years. But when you look at the speakers in 2004, 22% of speakers at the ESMO meeting were women. In 2017, 13 years later, 28% of the speakers were women. I agree: The number of women increased, but the disproportion related to faculty is not getting smaller. I am still finding that the gender gap is obvious in terms of who is part of the scene. What do you think about this? As a very active member of our committee and of ESMO, what are your thoughts about how we can actively promote the idea of female investigators and female scientists?

Giuseppe Curigliano, MD, PhD: When I joined the Women for Oncology Committee in 2015, I was one of the few men on the committee. I asked, "Why ask a man to join the Women for Oncology Committee?" But I learned that this was the only way I could understand that there really is an inequality in the access to a career between a man and a woman. Why is this? I strongly believe that there is a gap between mentoring and sponsoring. If we move from having 22% female faculty in 2004 to 28% in 2017, I do not believe that it is related to the numbers of organization executives that are men; it is related to the fact that women are not sponsored. Every one of us who is leading a group can mentor many people.

Mentoring means offering the opportunity to publish something, the opportunity to be in the spotlight at least one or more times. When you are in an executive board meeting and you have to decide who will lead the track for a cancer disease, who will take the lead role on the executive board, no one is sponsoring women—no one. No single man there will sponsor a woman. I do not know why this is the case. Perhaps also there is something related to women's perspective, because [many times when] you discuss a leadership role with them, they will say, "I have many commitments with my family, I have to manage my family and my job. If I would like to do a fellowship, I have to consider that I have two children." There are many gaps.

What we have to do is provide women with the same career opportunities as men. I believe that the future will be pink. Why? Because almost 70% of the under-age-40 members are female in the ESMO society. In the future, I am quite sure that many of the executive positions will be acquired by women. I am thinking about you, Solange, our chair of the Women for Oncology Committee, who will be the next president of ESMO. In 2020, we will have a woman president of ESMO. This is quite important because in our society, in 44 years of history, we have had just two women serving as president. This is a strong message—only two women in 44 years.

Dr Peters: You are one of three men on my committee. Part of our plan is, as you say, to try to implement sponsorship and mentoring of women in oncology. This is difficult; it is a long-term aim because you have to identify people who are committed to doing that at a national, regional, and international level, and you have to make sure that it is being done efficiently.

If we actively promote women in this way, how will the community perceive this effort? Yesterday, in another meeting, I heard that it could also create some kind of, I would not say jealousy, but some feeling of unfairness for men if we prepare programs dedicated to women.

Do you believe that it is unfair to specifically promote women? My other question is a bit provocative: Should we aim for specific numbers? Should we say that we want 35% of the speakers and 40% of the board members to be women, or will this be perceived to be even more unfair or undue?

Dr Curigliano: This is not a matter of fairness; this is a matter of gender inequality. We should provide equal access. It is not a matter of male or female, men or women. We need to give the same opportunities of leadership to men as to women.

I believe that as a committee, as the Women for Oncology Committee, we should increase the self-awareness of women. When you ask a woman if she would like to lead a project, the first question often is, "Are you sure I can do this?" We must increase self-awareness [and confidence]. We need a new generation of leaders, and in the context of this leadership, we need women. They bring a different perspective.

I do not believe that we should consider the perception of men, because I am quite sure that there would be a difference in the way men approach the same problem.

Increase self-awareness of young women. Let us begin with the ESMO leadership generation program. It is a program at ESMO in which we invite very young people to get to know the society, to understand what the leaders of the society are doing every day to increase their self-awareness, and to foster the dream that they could become president, as you did, Solange. This is very difficult but you did it.

Young women need to be encouraged to step up, lean in, and take over responsibilities.

Dr Thalmann: Giuseppe is absolutely right. I believe that women, young women, need to be encouraged to step up, lean in, and take over responsibilities. But women are a bit more hesitant than men, and for this, they need our encouragement. I believe that sponsorship also means to encourage and help them to know that they can step up and think bigger.

Dr Peters: In that case, a society such as ESMO has to make sure that they offer the opportunities for these women who have found the courage and have the skills, of course, to be part of the scene. That is very important. You both have raised a very important point.

Let us move on to the survey, which focused more on the perception of why the gender gap exists. When you look at this survey, there are clear differences in the way that men and women perceive the gender gap. Men tend to agree that it exists but believe that it has little practical impact on each individual career. Men believe that it exists but is a minor factor, and they believe that it improves over time. Women believe that it is a major factor in how they can develop themselves, now and previously, and that it does not evolve positively over time. Women also said that they do not live in an environment where there is equal pay for equal work, right?

Dr Curigliano: This is true.

Dr Peters: It is interesting to see the difference between men and women. The only point where they join, where men and women completely agree, is about why the gender gap exists. They agree that the first factor affecting the inequality is the work-life balance. ESMO cannot, as a society, do much to change this. We cannot change the law in every country.

But the three other factors identified by men and women are interesting. First is the unconscious bias among managers. Second is the lack of professional self-esteem among women. Third is social pressure. If you cannot change the world tomorrow, you can begin to try to change perceptions. Do you both also believe that women, in general, still suffer from some social pressure and lack of self-esteem, like being blocked in a space where it is difficult to move?

Dr Thalmann: This is very interesting. I was talking to school teachers, and they say that girls do not jump up to answer when there is a question, but boys do. Even from a very young age, we women do not go for the same opportunities at the same speed. Another point in the survey that was very interesting to me is that [most respondents] actually think men are natural leaders, which may also explain why women do not come forward when there is an opportunity. Encouraging self-esteem is quite important. I believe that the problem of work-life balance is also a reality; if you are away from your professional life for 3 or 4 years because of your children, when you return, you may need to find the self-esteem again. This is when your boss and your environment can help. How is this seen in your department, Giuseppe?

Dr Curigliano: I work in a team at my institution, and my team is made up of all women, finally. I manage many of these problems. Women will stop working because they are pregnant and they decide to commit their time to children; and older women who are very committed to their careers will delay the decision to get pregnant. This is another problem to be addressed.

Another issue is that there is a gap in salaries—this is reality.

Many women today still do not have the opportunity to take a special track to a specific career because no one sponsored them.

Why is this? Because in most of the cases, they do not get top-level positions. Look at the scenario at my institution, the largest institute in Italy for medical oncology. We have 14 division chiefs and only two of these are women. It is quite clear that there is something like discrimination. I just believe that many women today still do not really have the opportunity to take a special track to a specific career because no one sponsored them. This is my personal perception.

Dr Peters: Do you believe that women need a special educational program focused on gaining self-esteem and confidence? Or do you believe that it is because they have few opportunities to be involved in the usual educational programs that nourish self-esteem and self-confidence? Should the Women for Oncology Committee build in special modules or training programs to support women?

Dr Curigliano: I believe that women are like men. We do not need a special niche program for women. I believe that we should give them the same opportunities. Practically speaking, the executive board of ESMO decides who will be the faculty for a track. Let's say that the track includes four talks. In my mind, I have one man, one man, one man, and maybe another man. But if you consider the curriculum vitae of these people and you think about a woman instead of a man, I am quite sure you will find a woman with the same opinion-leader position for that specific topic. We just have to change our minds and select a woman instead of a man in that specific situation, and put together a faculty that is half men and half women.

Dr Peters: We did that for the next ESMO meeting in 2018, trying to balance the track chairs. It is an effort because the same names always come up when you think about a leader in the field of whatever disease; spontaneously a man's name usually comes up. However, you simply have to make the effort to think about balance, and you find that it is not a difficult task when you keep it in mind.

[We would like to] replace the quotas, or the fixed seats, which we do not like, but it will require a continuous effort to keep [the gender balance] in mind. It took some years, but now I believe that the ESMO board members have this constantly in mind. Sometimes they make jokes about it. That is fine—jokes will lead, finally, to considering the problem.

About the equal pay, I heard a number yesterday that completely surprised me. Eva, can you describe this World Economic Forum number?

Dr Thalmann: This is quite astonishing for both of us. At the moment, it will take [217] years to close the pay gap, which is amazing.[1]

Dr Peters: That is so interesting, because we all think that if we perform equal work, we will get equal pay. To the contrary, it is improving slightly every year, but equal pay is definitely not the reality.

Dr Thalmann: We need to speed up equality in salaries. I am working in the pharmaceutical industry. We in the industry should work with ESMO and other professional organizations to make sure that we have a gender priority in our programs. We develop educational programs. We should work together to identify women thought leaders. You may know women whom we are not aware of, and we may know women whom you are not aware of. This must be a joint effort.

Dr Peters: In the strategic plan that we have been building, we have formulated three goals. The first is to create an observatory to monitor and describe the improvements in numbers of members and faculty that are women. This is fully supported by the society. We will monitor every year to see whether these things have evolved in ESMO and beyond.

The second goal involves creating equal access to education about the interesting improvements in the way women can be skilled in doing things in the future. These are easy to create.

The third goal may be more difficult, and we will need collaboration with industry, with private partners, with ASCO, and other partners. This goal involves creating the constant mentoring and sponsoring over time. It should allow people to move, to travel, and to be followed in their careers, because sometimes you cannot do whatever you want in your own country.

This is something on a larger scale. Is it feasible? What are your thoughts about this strategic plan, in terms of making it concrete?

Dr Curigliano: This is an ideal strategic plan because what we did at ESMO is first to assess, then after the first assessment we looked for a solution. And this is one of the solutions—to create specific programs to address the issues. Then we have to maintain and monitor, which is quite important. If we do not monitor, I am quite sure that the number of faculty members who are women will reach less than 30% at ESMO 2020.

Dr Thalmann: It is a mind change. If we could also talk about specific programs on a joint basis, I believe that this may help. All partners should be asked to shift their minds a bit and make sure we have a gender priority.

Dr Peters: Eva, I have a last question for you. The Women for Oncology Committee in ESMO is unique in that we have decided to have guests—not the usual physician guests, oncologists, radiation oncologists, and so on, but members of industry. The reason is that we have been seeing that the industry addressed the gender gap way before we did and in quite a successful manner. Before any academic society, [companies in the pharmaceutical industry] decided to consider that it is not acceptable that these kinds of inequities and gaps exist. You have been dealing with the gender gap for some years. What is your experience from the industry point of view? When did it start?

Dr Thalmann: It started towards the end of the 1990s, and it was a movement out of the United States. They did a big study with 40 pharmaceutical companies and found out that only 10% of the board members were women.[2] This triggered development of special women leadership programs in some of the companies. A more current number of companies globally sets the percentage at about 24% of board members who are women, so I would say that it is also moving very slowly in the industry.[3]

Industry may have very similar problems. We also did a survey of women in pharmaceutical companies, and it also showed [that the main problems involved] work-life balance, self-esteem, "can I do what my male colleague can do," and jumping on opportunities. We in the industry also have quite a gap to close, but what we see is that more and more female leaders are willing to execute these positions, and that, of course, is a very good leadership example for women who are starting out working in the companies.

Dr Peters: Giuseppe and Eva, thank you for joining me in this fascinating discussion. This is Solange Peters, speaking from ESMO 2017 in Madrid, Spain.

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