Several misconceptions around sex- and gender-sensitive medicine still limit its application in cancer research and care
For those working in the area, the definition of gender medicine - more precisely, sex- and gender-sensitive medicine - is well established: it is a transversal discipline that considers both biological sex differences (i.e hormones and sex chromosomes) and the sociocultural influences of gender (i.e behaviour, lifestyle) on disease risk, presentation and treatment, with the ultimate goal of improving health outcomes for all patients with cancer.
Yet despite its growing relevance, particularly in the context of current political debates on diversity, equity, and inclusion, misunderstandings about what gender medicine actually encompasses have become increasingly visible.
Confusion is widespread, not only in society at large but even among healthcare professionals. Gender medicine is often mistaken for women’s health, associated with LGBTQI advocacy, or linked to topics such as promoting the career of female professionals, reproductive health or work-life balance. Why do these misunderstandings persist despite awareness of this topic is rising?
One important driver of the misconception that gender medicine is synonymous with women’s health is the persistent sex and gender data gap, which disproportionately affects women. Historically, women were excluded from many clinical trials. While initially aimed at protecting women from potential drug-related pregnancy risks, this approach resulted in establishing men’s physiology as the standard. Even after regulatory authorities mandated greater female representation, the inclusion of women in oncology trials has remained unchanged over the last two decades, with a female to male ratio of 60:40 in most disease entities (JAMA Oncol. 2021 Oct 1;7(10):1569-1570 ). Together with the lack of reporting of clinical trials segregated by sex, as requested by the Sex and Gender Equity Research (SAGER) guidelines, this results in insufficient understanding of disease biology, symptom presentation, and balance of treatment efficacy versus toxicity in women (Lancet. 2024 Jan 20;403(10423):226-228). As a result of this well-recognised disadvantage for the female patient population, gender medicine is often perceived as an effort to “fix” women’s underrepresentation rather than a holistic approach aimed at improving outcomes for all patients, regardless of sex or gender.
Another factor contributing to misunderstandings about gender medicine is that this area of research was founded and has been historically guided by female physicians and scholars, and it continues to be so today: large-scale bibliometric analyses have shown that women scientists are significantly more likely than their male colleagues to incorporate sex and gender considerations into study design and reporting (Nat Hum Behav. 2017 Nov;1(11):791-796 ). While the female-only leadership of the field is a strength because it helps counteract the long-standing underrepresentation of women in research, it has also led to distorted perceptions of this discipline – i.e. it is sometimes mistaken as being primarily about supporting women in science or promoting their careers.
Finally, gender medicine is sometimes mistaken for LGBTQI advocacy because the term gender is commonly associated with gender identity and sexual orientation in everyday discourse. In biomedical context, instead, gender refers to the psychosocial and cultural factors that influence disease risk and outcomes. Reducing this scientific approach to mere advocacy oversimplifies its purpose and blurs its central aim: delivering more precise and equitable healthcare for everyone.
All these misconceptions can be overcome by a clear communication about the purpose of gender medicine to all oncology stakeholders. Patients, the public, peers, funding bodies, regulatory agencies and the pharmaceutical industry must be aware of the vast amount of data on sex and gender differences in cancer susceptibility and survival, and that disparities must be investigated systematically to tailor patient care. It is well documented how sex influences drug metabolism, treatment response and toxicity while gender roles affect access to care, adherence to therapy and survivorship (J Clin Oncol. 2018 Sep 10;36(26):2680-2683 ). Despite this, clinical trials are still not designed or statistically powered to examine treatment effects by sex. This omission perpetuates a substantial evidence gap that disproportionately affects women. For instance, clinical trials in the adjuvant and neoadjuvant setting of immune checkpoint inhibitor often enroll far more men than women, with a typical male-to-female ratio of roughly 70:30 (unpublished data).
Not only must we close this data gap, but we also need to move beyond examining to sex- and gender- related factors in isolation and instead study their intersections with other determinants of health such as age, ethnicity, socio-economic status, sexual orientation and identity. The message is simple: gender medicine is not an add-on for select groups, but the foundation of precision oncology for everyone.
