Author:

Elisa Manacorda

Introduction

Despite significant efforts by the European medical and scientific community in recent decades, more must be done to recognize and support the role of women in oncology. Achieving gender equity in this field remains a fundamental goal.

One way to approach the issue is by spotlighting the women who have chosen oncology as their field of research. Who are they? What challenges have they faced—and continue to face—in establishing themselves in a discipline that has historically been male-dominated? While the number of women entering oncology is steadily increasing, the road to these achievements has been long and fraught with obstacles. Current data show that even today, women remain underrepresented in decision-making roles and as lead authors in high-impact scientific journals.

This underrepresentation is striking, given that the history of oncology is rich with outstanding female researchers who have profoundly shaped the prevention, diagnosis, and treatment of cancer. Many of these pioneers not only made groundbreaking contributions to medicine as a whole, but also focused specifically on women’s health—particularly in researching, diagnosing, and treating cancers such as breast, ovarian, and cervical cancer. More recently, it has often been women who, recognizing the lack of sex-specific data, were the first to advocate for and conduct research on gender-related aspects of cancer, pushing for more inclusive clinical trials and more personalized therapeutic approaches.

In this article, we will explore the historical roots of gender bias in oncology, examine how these inequalities persist in certain specialties even today, and consider how this plays out within the broader European context. We will also highlight current initiatives aimed at promoting gender balance and empowering women as leaders in oncology—from academia to hospital governance to public health policy.

19th Century: an hurdle course

Throughout the 19th century, advancements in cancer research remained predominantly male-dominated, even though women began entering the field primarily as nurses, midwives, or research assistants. However, it is essential to recognize that it was often women who paid particular attention to female physiology and the diseases affecting women—including cancers. These early contributions laid the foundation for a gender-informed approach to cancer research and care (Chin, 2020). A notable example is Miranda Barry, a pioneering figure who, in 1812, became the first woman to earn a degree in Medicine and Surgery at the University of Edinburgh. Her determination and skill saved hundreds of lives, particularly through her work on cesarean sections, at a time when surgical procedures on women were both controversial and underdeveloped (Petrocelli, 2010).

Women also owe much to Elizabeth Blackwell, the first woman officially awarded a medical degree in 1849. Born in England and later working in the United States, she went on to found the London School of Medicine for Women in 1857, eventually becoming a professor of gynecology in 1875. Her groundbreaking career not only paved the way for women in medicine but also expanded access to healthcare for female patients, helping to reduce the gender gap in medical treatment (National Library of Medicine, 2021).

Equally important is Mary Putnam Jacobi (1842–1907), an English-American physician, scientist, teacher, writer, and suffragist. She was the first woman admitted to study medicine at the University of Paris and conducted pioneering research on women's health, including gynecological cancers. Jacobi also advocated for evidence-based medicine and used scientific methods to challenge sexist myths—for example, disproving the belief that menstruation made women mentally and physically unfit for intellectual work. These early female pioneers did more than simply enter a male-dominated profession—they reshaped medical knowledge through a gender-sensitive lens. They not only contributed to early cancer research, especially concerning women’s cancers, but also fought for institutional change that would eventually allow more women to pursue medical careers.

20th Century: breaking barriers

In the late 19th and early 20th centuries, women increasingly gained access to medical education across Europe, paving the way for their future contributions to fields like oncology. Switzerland played a pioneering role in this movement; by 1906, the number of female medical students in Swiss universities surpassed that of male students, attracting women from around the world (Fauvel, 2021).

In the United Kingdom, the London School of Medicine for Women, established in 1874, became the first British institution to train women as doctors. By 1914, the school had expanded significantly, enrolling over 300 students and becoming the largest women's university college in Britain at the time. Additionally, during World War I, St Mary's Hospital Medical School in London admitted female students between 1916 and 1925, marking a significant shift in medical education policies (Garner, 1998).

Among the key figures of this period, Marie Curie stands out as a pioneering physicist and chemist. She was awarded her second Nobel Prize in Chemistry in 1911 for her discovery of the elements radium and polonium, further solidifying her role in the development of cancer treatment methods (ONS, 2022).

Her groundbreaking work in radioactivity laid the foundation for modern oncology practices. The isolation of radium led to the development of radium therapy, an early form of radiation treatment for cancer. Beyond her research, Marie Curie also inspired the creation of the Radium Institute in Paris (now the Curie Institute) and the Radium Institute in Warsaw (now the Maria Skłodowska-Curie National Research Institute of Oncology), both of which became leading centers for cancer research and treatment (Kułakowski, 2011).

Another woman without whose research oncology would not have reached its modern achievements is Rosalind Franklin. A British chemist, her work significantly advanced our understanding of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) (Glynn, 2012). In the early 1950s, while working at King’s College London with her doctoral student Raymond Gosling, she began taking x-ray diffraction photographs—one of which, the famous “Photograph 51,” provided the decisive evidence needed to identify the double helix structure of DNA. This discovery opened the way for identifying specific mutations responsible for the onset of many cancers and laid the foundation for molecular genetics, which is now central to modern oncology, including the study of oncogenes, tumor suppressor genes, and the development of targeted therapies. After her pioneering work on DNA, Franklin turned her attention to RNA viruses, focusing in particular on plant viruses such as the tobacco mosaic virus (TMV). Although she was not directly studying cancer, Franklin's pioneering work in structural virology helped establish methodological foundations for the field, which would later contribute to understanding the structure of various viruses, including those with oncogenic properties.

More directly connected to the field of medical oncology is Eve Wiltshaw. After earning her medical degree from the University of Wales in the United Kingdom, she became a consultant physician at the Royal Marsden Hospital. There, she was actively involved in clinical trials and published numerous papers on various aspects of oncology. It was Wiltshaw’s team that first administered the drug cisplatin to patients in the UK. The promising results led to its widespread adoption, saving and prolonging countless lives. She also played a key role in establishing the hospital’s Sarcoma Unit, introducing a multidisciplinary team (MDT) approach to patient care. Wiltshaw went on to become the Royal Marsden’s first medical director—an exceptional achievement and a rarity for a woman at the time. In 1992, she was awarded the Order of the British Empire for her services to cancer care (Royal College of Physicians).

In this context, we must not forget that cancer care should also address psychological aspects. This is where the contribution of Elizabeth Kübler-Ross (1926–2004) becomes so important. A Swiss-born psychiatrist who later became a U.S. citizen, Kübler-Ross was a pioneer in the field of psycho-oncology. Working with terminally ill patients—many of them cancer patients—she introduced, in her groundbreaking 1969 book On Death and Dying, the most widely taught model for understanding the psychological response to imminent death. Based on interviews with terminally ill patients, the book described the now-famous five stages of dying: denial, anger, bargaining, depression, and acceptance (DABDA).

Her work was historically significant, marking a cultural shift in how society approaches conversations about death and dying. Before her research, death was often considered a taboo topic—avoided, minimized, or spoken of indirectly. Terminal patients were not always given a voice in their care and, in some cases, were not even informed of their diagnosis.

Kübler-Ross’s approach inspired new ways of supporting patients in the final phase of life, emphasizing the importance of truly listening to them and addressing their individual needs. She encouraged healthcare practitioners to help both patients and their families come to terms with the reality of impending death, fostering a more compassionate and human-centered approach to end-of-life care (Tyrrell 2023).

The focus on women’s cancers was further improved by the establishment of supranational organizations dedicated to coordinating research efforts beyond national borders. In 1962, the European Organisation for Research and Treatment of Cancer (EORTC) was founded, playing a pivotal role in coordinating clinical trials and standardizing chemotherapy protocols across Europe (Meunier, 2012).

In 1984 the European Society for Medical Oncology (ESMO) was founded. The election of the first woman president did not occur until 2013, when Belgian medical oncologist Martine Piccart assumed the role, marking a significant milestone in advancing the representation of women within European oncology leadership. Subsequently, Solange Peters, a Swiss oncologist specializing in thoracic malignancies, became the second woman to preside over ESMO, serving from 2020 to 2021.

21st Century: greater inclusion and achievements

In the new millennium, the issue of the underrepresentation of women in oncology finally gained the attention of the medical community. One of the pioneers of this movement was Dr. Martine Piccart, who brought to light the lack of female oncologists in leadership positions. Her vision and intuition led to the creation of the ESMO W4O initiative and, in 2015, the ESMO W4O Committee, which addresses the challenges female oncologists face in pursuing leadership roles throughout their careers.

The most well-known activity of W4O is an exploratory study published in 2016 on the challenges faced by female medical oncologists. The study was based on an online questionnaire distributed to female oncologists in August 2013.

In terms of representation, data shows an increase in female membership from 20.2% in 2000 to 36.1% in 2013, revealing that in 59.4% of clinical teams, women made up the majority of oncologists. Notably, among members under 40 years old, women accounted for 46.8%, indicating a growing presence of women in the younger oncology workforce (Banerjee, 2018).

The gender balance among ESMO members has continued to evolve, with female membership reaching 49.8% in 2022 and increasing further to 51% in 2024, with the highest proportion of female members in Europe (Marín-Hernández, 2024).

This notable increase in the number of female oncologists, researchers, and surgeons across European countries is challenging traditional gender barriers in medicine and enriching the field with diverse perspectives. Studies have shown that gender diversity in medical teams can improve communication, enhance patient satisfaction, and increase adherence to treatment plans, ultimately leading to better patient outcomes (Linardou, 2023).

However, despite the growing number of women in the field, significant obstacles remain. The 2016 W4O survey already highlighted these disparities: among female respondents, 45.5% held a managerial or leadership role, compared to 65% of male respondents. Men were more likely to attain leadership positions, even in clinical teams where women outnumbered men. Furthermore, women were significantly more likely to feel that their gender had a major impact on their careers (35.9% vs. 20.9%). The biggest challenge to career progression for women was balancing work and family responsibilities (64.2%). Additionally, only 14.4% of female respondents believed there had been significant progress in closing the gender pay gap, compared to 39.3% of men. Alarmingly, 37.7% of female participants reported experiencing unwanted sexual comments from a superior or colleague (Banerjee, 2018).

The trend of women being concentrated in lower-ranking positions is further supported by a 2021 study conducted by the Spanish Society of Medical Oncology (SEOM), in which 71.5% of respondents were women. Despite this majority, only 12.4% of female oncologists held division or department head positions, highlighting the persistent underrepresentation of women in senior leadership roles (Elez, 2021).

Following the 2016 W4O data, a follow-up survey conducted in October 2021 confirmed that the path to achieving gender equity in oncology remained long and challenging. The survey revealed that between 2015 and 2019, female oncologists were significantly more likely to be first authors rather than last authors, and that invited speakers at international and national oncology congresses were significantly less likely to be women. Additionally, women were underrepresented as board members of international and national oncology societies. However, when a woman held a leadership position within a society, it was more likely that other women were also present on the board (Berghoff, 2021).

To examine the situation in detail is the Lancet Commission, which was established to explore the intersection of women, power, and cancer. Using an intersectional feminist lens, it aims to identify, expose, and challenge existing power imbalances across three key areas: decision-making, knowledge, and economics.

As part of its work, the Commission analysed gender representation in the leadership of 639 organisations belonging to the Union for International Cancer Control (UICC). The findings revealed notable geographic disparities: while organisations in North America, South America, and Oceania showed relatively balanced gender representation in oncology leadership, women remained markedly underrepresented in Asia, Africa, and Europe.

Examining results by type of organisation revealed further inequalities. Men dominated leadership positions in hospitals, treatment centres, and research institutes, whereas women were more often in charge of patient support groups, public charities, or advocacy organisations. Of the 184 UICC member institutions classified as hospitals, treatment centres, or research institutes, only 16% were led by women (Ginsburg, 2023).

Reasons behind the bias

The difficulties women face in advancing their careers in oncology stem from several key factors (Linardou, 2023). These include challenges in balancing family and professional life, unconscious biases, societal pressures, and a lack of confidence in their abilities—often due to the absence of training programs aimed at developing leadership skills.

One of the fields in oncology where women struggle the most to establish themselves is surgical oncology, as noted by Dr. Isabel Rubio, Director of Breast Surgery at Clínica Universidad de Navarra, Madrid (Crompton, 2020). But why are women so poorly represented in top surgical oncology roles? A survey from the European Union of Medical Specialists (UEMS) found that in most European countries, the proportion of female surgeons is between 30% and 40%, while in some countries, it is as low as 20%.

Given that the number of female surgical trainees in some European countries now equals that of men, there is hope that greater equality is on the horizon. However, not all of these women will choose to pursue a surgical career, explains breast surgeon Malin Sund, a professor of surgery at Umeå University, Sweden, who led the UEMS survey. While the percentage of trained female surgeons not actively working as surgeons is very low in Nordic countries, the UK, and the Netherlands, it is notably higher in Germany and reaches 25% in some southern European countries. The issue is further compounded by the fact that women who do remain in the profession face significantly more obstacles than men in reaching top surgical positions. "Equality in senior roles is still a long way off," Sund concludes (Crompton, 2020).

There’s more than that. Women working in cancer care—much like in other medical fields—frequently report experiencing serious gender-based discrimination, including bullying and sexual harassment, both during their medical and residency training and in their professional roles. Such harassment is most often perpetrated by male supervisors and colleagues, though it can also come from male patients and their relatives. These behaviours have been shown to harm women’s mental health, undermine their sense of safety in the workplace, reduce job satisfaction, and hinder career progression.

These unacceptable yet widespread practices persist in part because of entrenched, male-dominated hierarchies that normalise abusive behaviour as a supposed part of medical training and workplace culture, while failing to hold perpetrators accountable. Although most available studies documenting gender-based discrimination and harassment come from high-income countries, the problem is also widely—if quietly—acknowledged among women training or working in low- and middle-income settings (Ginsburg, 2023).

Closing remarks

Despite progress, gender remains a major barrier to career advancement in oncology. While some obstacles have been reduced since 2016, the gender gap is far from being closed (Linardou, 2023). A critical priority is the increased reporting of discrimination and inappropriate behavior in the workplace, which remains a significant concern.

References

Banerjee S, Dafni U, Allen T, Arnold D, Curigliano G MD, Garralda E, Garassino MC, Haanen J, Hofstädter-Thalmann E, Robert C, Sessa C, Tsourti Z, Zygoura P, Peters S. Gender-related challenges facing oncologists: the results of the ESMO Women for Oncology Committee survey. ESMO Open. 2018 Sep 21;3(6):e000422.

Berghoff AS, Sessa C, Yang JC, Tsourti Z, Tsang J, Tabernero J, Peters S, Linardou H, Letsch A, Haanen J, Garralda E, Garassino MC, Furness AJS, Felip E, Dimopoulou G, Dafni U, Choo SP, Banerjee S, Bajpai J, Adjei AA, Garrido P. Female leadership in oncology-has progress stalled? Data from the ESMO W4O authorship and monitoring studies. ESMO Open. 2021 Dec;6(6):100281.

Chin EL, Levy MS, Brown AD, Marr MC, Keni PM, Daram N, Chau CA, Rangwala N, Watson K. Women Physicians and the Suffrage Movement. Perm J. 2020 Sep;24:1-4.

Crompton S, Women make great surgeons, so why is the profession still dominated by men?, Cancerworld 2020, retrieved from https://cancerworld.net/women-make-great-surgeons-so-why-is-the-profession-still-dominated-by-men/

Elez E, Ayala F, Felip E, García Campelo R, García Carbonero R, García Donás J, González Del Alba A, González Flores E, Hidalgo J, Isla D, Majem M, Rodríguez Lescure Á, Safont MJ, Santaballa A, Villacampa G, Vera R, Garrido P. Gender influence on work satisfaction and leadership for medical oncologists: a survey of the Spanish Society of Medical Oncology (SEOM). ESMO Open. 2021 Apr;6(2):100048.

Fauvel A, Begert L, Demirbas I. Quand la Suisse était «féministe»:une petite histoire de la féminisation de la médecine à la Belle Époque [When Switzerland was "feminist": a short history of the feminisation of medicine during the Belle Époque]. Rev Med Suisse. 2021 Jun 30;17(744-2):1246-1249.

Garner JS. The great experiment: the admission of women students to St Mary's Hospital Medical School, 1916-1925. Medical History. 1998 Jan;42(1):68-88.

Ginsburg O et al., Women, power, and cancer: a Lancet Commission, The Lancet, Volume 402, Issue 10417, 2113 - 2166.

Glynn, J Remembering my sister Rosalind Franklin, The Lancet, Volume 379, Issue 9821, 1094 – 1095.

Kułakowski A, The contribution of Marie Skłodowska-Curie to the development of modern oncology. Anal Bioanal Chem. 2011 Jun;400(6):1583-6.

Linardou H, Adjei AA, Bajpai J, Banerjee S, Berghoff AS, Mathias CC, Choo SP, Dent R, Felip E, Furness AJS, Garassino MC, Garralda E, Konsoulova-Kirova A, Letsch A, Menzies AM, Mukherji D, Peters S, Sessa C, Tsang J, Yang JC, Garrido P. Challenges in oncology career: are we closing the gender gap? Results of the new ESMO Women for Oncology Committee survey. ESMO Open. 2023 Apr;8(2):100781.

Marín-Hernández D et al., European Society for Medical Oncology (ESMO) congress 2024, The Lancet Regional Health – Europe, Volume 46, 101087

Meunier F, Lawler M, Pinedo HM. Commentary: fifty years of the European Organisation for Research and Treatment Of Cancer (EORTC)--making the difference for the European oncology community. Oncologist. 2012;17(6):e6-7.

National Library of Medicine, Elizabeth Blackwell: “That Girl There Is Doctor In Medicine” Part I, retrieved from https://circulatingnow.nlm.nih.gov/2021/03/11/elizabeth-blackwell-that-girl-there-is-doctor-in-medicine-part-i/.

Oncology Nursing Society, The Life of Marie Curie and Her Contributions to Oncology, retrieved from https://www.ons.org/publications-research/voice/stories/11-2022/life-marie-curie-and-her-contributions-oncology.

Petrocelli C, La donna nella storia della medicina, in Periodico della Società italiana di Farmacologia, vol. 23, 2010, pp. 55-59.

Royal College of Physicians, retrieved from https://history.rcp.ac.uk/inspiring-physicians/eve-wiltshaw.

Tyrrell P, Harberger S, Schoo C, Siddiqui W. Kubler-Ross Stages of Dying and Subsequent Models of Grief. 2023 Feb 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29939662.