By Atlal Abusanad, MD, MSc, FRCPC, CIP
A few years ago, I moved from the country where I got my training and initial job as a junior medical oncologist to my home country. At approximately the same time, after losing the 45th presidential election, Hillary Clinton gave her concession address where she stated that the glass ceiling could not be broken to elect a woman president. The phrase lingered in my head, but I didn't realize how painful it was at the time. A glass ceiling is a term often used to describe invisible or overlooked obstacles that prevent people from attaining their goals, despite their best efforts. The experience of breaking through the glass ceiling can only be understood if it has been lived through. Unlike Western societies, where several studies have investigated the challenges faced by women in oncology, the experience of female oncologists in my region has not been adequately articulated or investigated (1). In 2018, a survey was conducted in the Middle East for the first time to provide a female perspective on gender equality and gender influence in the field of medical oncology. Despite the small number of participants, who were mostly from Lebanon and Tunisia, the data presented in this study was very comparable to data from Western societies, concluding that there are fewer women in leadership positions and that many are challenged by balancing life and work where limited support is offered (2). Likewise, there is no research on gender distribution among oncology conference speakers in the regional oncology community, but the representation of male professionals is disproportionately favored. This can be verified by reviewing national and regional conferences over the years. Aside from the fact that balanced representation must consider the female to male ratio in the medical oncology workforce, women are still not represented in an equal proportion to their workforce share. Additionally, many industry-sponsored meetings were dominated by "manels," or panels made up primarily or entirely of men.
The underrepresentation of female oncologists as leaders, speakers, panelists, and members of organizing committees is due to a bias in valuing their capability and potential, rather than a lack of qualifications or expertise. Local culture might have also hampered scientific inclusion (3). Although some accomplished female physicians and scientists were able to overcome cultural barriers and match their male counterparts in other subspecialties (4), medical oncology has not reflected this progressive pattern yet. Unfortunately, many female oncologists remain silent about their desire to be treated equally to their male colleagues. This could be attributed to the small number of female doctors interested in joining oncology in the past, but this is changing now as more female trainees are choosing a career in medical oncology, and the once minority will soon become evenly equated, or perhaps a majority.
Burnout is another issue which can be either a cause or a result of the glass ceiling experience. Burnout is prevalent among female medical oncologists in the Middle East and North Africa (MENA), according to a recent survey (5). In this survey, the majority of female oncologists were young to middle-aged, with those under the age of 44 having a higher risk of burnout. This implies that female medical trainees are more interested in oncology as a subspecialty, but this is not matched by the adoption of physician wellbeing and burnout education and support programs, as two-thirds of the participants reported receiving no burnout support or education. A shatterproof glass ceiling might be created by the inability to acquire mentoring, as well as the lack of association with seasoned professionals. Thus, the sense of belonging—where acceptance, attention and support is given to a member in a group—is missing. Belongingness is essential to thrive and develop. Recognizing this need, the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO) both encouraged "women in oncology" and offered a platform for female oncologists to network and support one another. Even though such platforms are open to female oncologists from all over the world, the establishment of a local platform is necessary, owing to the issues that female oncologists from various countries and cultures confront. Without a doubt, the unusual circumstances of the COVID-19 pandemic have widened the gender gap and magnified an already existing problem (6). A similar situation is witnessed in our region but has not been investigated.
Many women in their early to mid-career years are eager to be given the same opportunities as their male counterparts. The following must be done to reduce barriers for women in oncology:
- Leadership must promote inclusiveness and empower promising women in oncology in their communities.
- Without feeling ashamed or embarrassed, female oncologists must advocate for better participation as speakers, panelists, and members of organizing committees.
- Experience-sharing among female oncology specialists and high-quality mentoring for new women entering the field should be encouraged and supported.
- The oncology pharmaceutical industry must recognize women oncologists equally to their male counterparts.
- An initiative for a dedicated platform within regional and local oncology societies to address gender-specific challenges is required.
Cancer incidence is rising worldwide, with a projected parallel regional and local trend and oncology workforce shortage (7). Overall, effective deployment of the current workforce is required, as are more engaging opportunities for the future workforce of both genders. The current efforts, which begins with raising awareness by voicing concerns and identifying the problem, will assist the region's future generation of female oncologists in overcoming these challenges.
Gender equity spans a spectrum and extends beyond physical inclusion. It must overcome antagonistic circumstances to engage and empower women to maximize their potential. Only through the combined efforts of oncology leaders, women in oncology, and third-party partners can the glass ceiling be shattered with the hope that no one will be harmed by shattered fragments!
- Banerjee S, Dafni U, Allen T, et al. Gender-related challenges facing oncologists: the results of the ESMO Women for Oncology Committee survey. ESMO Open. 2018 Sep 21;3(6):e000422. DOI: https://doi.org/10.1136/esmoopen-2018-000422
- Salem R, Haibe Y, Dagher C, et al. Female oncologists in the Middle East and North Africa: progress towards gender equality. ESMO Open. 2019 Jun 14;4(3):e000487. DOI: https://doi.org/10.1136/esmoopen-2019-000487
- World Bank. 2013. Opening Doors: Gender Equality and Development in the Middle East and North Africa. World Bank. License: Creative Commons Attribution CC BY 3.0. DOI: 10.1596/978-0-8213-9763-3
- Islam SI. Arab women in science, technology, engineering and mathematics fields: the way forward. World Journal of Education. 2017;7 10.5430/wje.v7n6p12. DOI: https://doi.org/10.5430/wje.v7n6p12
- Abusanad A, Bensalem A, Shash E, et al. Prevalence and risk factors of burnout among female oncology professionals from the Middle East and North Africa (MENA). Journal of Clinical Oncology. 2021;no. 15_suppl 11016-11016. DOI: https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.11016
- Garrido P, Adjei AA, Bajpai J, et al. Has COVID-19 had a greater impact on female than male oncologists? Results of the ESMO Women for Oncology (W4O) Survey. ESMO Open. 2021;6(3):100131. DOI: https://doi.org/10.1016/j.esmoop.2021.100131
- Estimated number of new cases from 2020 to 2040, Both sexes, age [0-85+]. https://gco.iarc.fr/tomorrow/en/dataviz/isotype. Accessed August 25, 2021.