By Eileen Parkes, MD, PhD
I remember the first international cancer research conference I attended. I was in awe—absorbing incredible translational science and exciting early-phase trials. I was enjoying every minute.
On the second day, one of the keynote speakers took the stage. Up until this point, I hadn’t noticed that nearly every speaker, every panel member, every chair had been male. This time was different. Her intelligent, engaging presentation held the attention of the room; she dealt with the questions with thoughtful, considered answers. While the other speakers had informed me, none had inspired me or motivated me in quite the same way. For the first time, someone like me, someone I could see myself being in the future, was up there on stage—a woman.
From that point on, the all-male panels felt a bit, well, jarring. Now we have a name for this phenomenon—“manels.” We now also know about the “maper”—an all-male authorship paper—and all male-conferences, “manferences” and “him-posiums.” Even the “mantor”—the mentor who has only male mentees.1
Why does this matter? When women aren’t represented in leadership, in oncology research, we limit our progress against cancer at every stage. A diverse team with many perspectives on the same issue can comprehensively address and solve that issue.2 Women in medicine earn less, are poorly represented in leadership positions, are awarded less research funding, included on fewer publications, and nominated for fewer awards.3-7 These issues place additional barriers and burdens on women in oncology, leading to a struggle for recognition and promotion, and making those leadership positions seem, at times, unattainable. Having women in leadership positions leads to improvement of the wider culture, ensuring inclusion and addressing gender bias.
Without visible women leaders, and loud voices, we won’t be heard and we won’t make a difference.
So what can we all do to make women’s voices heard in oncology? This is when I turn to myself: what can I do, in my small sphere, to make a difference?
Some people advocate the idea of doing one thing a day that scares you—I’m not in that camp. But I do examine my reasons for not stepping up. If I’m asked to do something, or if someone is looking for a volunteer, and my gut reaction is “That’s not for me, I’m not qualified/good enough,” then I pause and think: there has to be a way of escaping the clutches of imposter syndrome. Do I want this opportunity? Yes, of course I do. I’ve made myself email organisers and potential collaborators. I’ve applied for grants, for awards that I thought were way beyond my reach. I’ve spoken to the podium speakers, asked for advice, mentorship.
I’m less confident than I’d like to appear—this has been a conscious effort to step up, to signal to my female peers that it is possible. But I look at the next generation coming up, the medical students, the PhD students in my lab. And I want them to accept as unquestioned that women have equal opportunities to advance. I want them to see women in leadership. I want them to have role models. And if that means I need to step up, to start being a role model, as much as I’m terrified to do that, then that’s what I ask of myself.
Say yes… sometimes
It’s easy to get carried away with all this saying yes to things. I was given excellent advice I wish I had learned even earlier in my career: say yes to things that get you on a publication, on a platform, or on a national committee. It’s well recognised that female academic physicians take on the bulk of uncompensated work in academia and also take on a greater proportion of teaching commitments than their male counterparts.8,9 Part of this is proportionality—there are fewer women around, and to have representation on committees, on panels, women end up being asked to take more of this on. It’s hard to say no. One strategy I’ve found useful is to talk about the things I am already actively doing, and how I would love to be involved (and I really would, most of the time) but I’m already fully committed. We all need to practice identifying when we need to say no, and how we’re going to say it. Taking on yet more uncompensated and unrecognised work will not further the cause of women in medicine.
When you do get that grant, when you do get on that committee—I heard comments like, “Oh, they need to make sure they’re balanced for gender,” or “It all makes sense now—you know such-and-such”, implying that I didn’t get there on my own merit. In one memorable incident, as the only woman in the room, I was told my ideas were “crazy” in front of a funder. From being stung and questioning myself and my own achievements, the perspective of valued mentors helped me see these remarks for the sexist takes they were. Instead, when women are successful, we can champion each other. We can amplify each other. Social media platforms are great for celebrating women’s success in achieving awards or positions of leadership. The journalist Ed Yong writes about recognising and addressing his imbalance in quoting female experts.10 We can do the same: cite women-led papers, share and follow women’s voices, share and celebrate our fellow female oncologists’ successes.
This is the hardest one, for me anyway. Anger in women is not socially accepted. But we need to speak up. Speaking out results in more female representation at conferences, and is helped by including women on organising committees.11 Speaking out lets those women who have been overlooked or slighted know that this is noticed, this is seen, this is unacceptable. We can speak out about sexual harassment.12 We can share our experiences with our colleagues, both men and women. We can contact conference organisers with lists of female speakers we would like to see on stage, or to highlight the lack of diversity in the program. We’ve moved on a long way from the Surgeon’s Hall Riot of 1870, protesting the inclusion of seven female medical students, who were ignored, threatened, and ultimately forced to study elsewhere for their medical license.13 But we are still a long way from where we need to be, from equal representation of women in leadership, and female physicians being judged on equal terms.
A job for all
I’ve written this piece from my own perspective, as a fellow in oncology and early-career researcher. But here’s the danger: there’s a very real risk that we view amplifying women’s voices in oncology as something women need to address, not men. This is a problem that affects all of oncology, and something we all need to address. Men, continue to advocate for women in leadership positions, on the podium, as worthy prize winners. Refuse to take part in all-male panels (you can even take the pledge at genderavenger.com/pledge). Make diversity a priority when organising programs. If offered a great opportunity you have to turn down, think about suggesting a female colleague instead. Ensure you have male and female mentees, and treat them equally.14 Follow, share, and celebrate the achievements of your female colleagues. There’s no competition here, because we’re all in it to win against cancer—let’s do it together.
We can all make a difference in amplifying women’s voices, ensuring equality of representation, and encouraging the next generation of female leaders in oncology.
Dr. Parkes is a fellow in medical oncology at Northern Ireland Cancer Centre and Queen’s University Belfast. She serves on the ASCO Trainee Council and is the recipient of a 2018 Conquer Cancer Foundation Young Investigator Award.
- Choo EK (@choo_ek). Twitter. 7 Aug 2018. Available at: https://twitter.com/choo_ek/status/1027042240139386882.
- Editorial. Science benefits from diversity. Nature. 2018;558:5.
- Jagsi R, Griffith KA, Stewart A, et al. JAMA. 2012;307:2410-7.
- McCormick H. SCOPE. 22 Jun 2018. Available at: https://scopeblog.stanford.edu/2018/06/22/paving-the-way-for-more-women-in-medical-leadership-roles.
- Weale S, Barr C. The Guardian. 10 Aug 2018. Available at: https://www.theguardian.com/education/2018/aug/10/female-scientists-urge-research-grants-reform-tackle-gender-bias.
- Singh Chawla D. Nature. 2018;561:295-6.
- Silver JK. STAT. 19 Jul 2017. Available at: https://www.statnews.com/2017/07/19/women-excluded-medical-society-awards.
- “Female professors ‘pay price for academic citizenship’”. Time Higher Education. Available at: https://www.timeshighereducation.com/news/female-professors-pay-price-academic-citizenship#survey-answer.
- Wietsma AC. J Community Hosp Intern Med Perspect. 2014;4:10.3402/jchimp.v4.24665.
- Yong E. The Atlantic. 6 Feb 2018. Available at: https://www.theatlantic.com/science/archive/2018/02/i-spent-two-years-trying-to-fix-the-gender-imbalance-in-my-stories/552404.
- Klein RS, Voskuhl R, Segal BM, et al. Nature Immunology. 2017;18:475-8.
- Graff SL. The ASCO Post. 25 Sep 2018. Available at: http://www.ascopost.com/issues/september-25-2018/an-invitation-to-be-quiet-no-longer.
- Fuge L. Lateral Magazine. 26 Feb 2018. Available at: http://www.lateralmag.com/articles/issue-25/the-wake-of-the-edinburgh-seven.
- Soklaridis S, Zahn C, Kuper A, et al. N Engl J Med. 2018 Oct 3. doi: 10.1056/NEJMms1805743.