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Addressing Gender Disparities in Urology and Genitourinary Cancer Research

Gender disparities –the underrepresentation of women and other gender minorities—have historically and continually plagued many fields of medicine and scientific research. The fields of urology, genitourinary (GU) oncology, and prostate cancer research have especially been male-dominated.1,2

Representation of women in science and medicine has increased over the past few decades, across all career levels, yet gender disparities persist. While women have achieved over 50% of representation among medical students and biomedical sciences graduate students, these numbers shrink progressively at advancing career stages.2-4  For instance, female representation among clinical faculty increased from 14.8% in 1977 to 43.3% in 2019.5 However, in 2019, only 27.1% of full professors, 17.8% of department chairs, and 18.3% of deans were women.5  

Women who are underrepresented minorities (URM), including Black, Hispanic, and Indigenous women, suffer even greater disparities at all career levels compared with their White counterparts. In 2019, URM women accounted for only 9.9% of clinical faculty, 6.5% of full professors, 9.5% of department chairs, and 11.1% of deans.5

In GU medicine and research fields, gender disparities remain especially apparent. While the representation of women among urology residents rose from 0.9% in 1978 to 34% by 2021, only 10.9% of practicing urologists are currently women, highlighting attrition following residency.1,6  Women also only comprise about 23% of GU medical oncologists, 29% of radiation oncologists, and 38% of medical oncologists, in academic faculty positions.2,7

Women are also underfunded, under-published, underpaid, and under-recognized, compared with men.8,9 For example, only 23.6% of NIH R01 awards on GU topics between 2018 and 2021 went to women.10 An analysis of academic journals featuring GU oncology research found that women comprised only 25.7% of first authors and 18.1% of senior authors.8

The impacts of inequities in gender and racial representation among clinicians and researchers have a further negative impact -- reinforcing health care disparities. Improving representation among providers improves patient trust, communication, treatment compliance, and ultimately health care outcomes in underrepresented populations.5,11

Barriers faced by women in science and medicine include microaggressions, greater levels of emotional labor, inappropriate comments about appearance, insinuations about performance, micro-coercion, tone-policing, and other forms of gender-based harassment contributing to burnout and decisions to leave or not pursue higher positions.12 Women also tend to have disproportionate childcare, elder care, meal-planning, and other home-life responsibilities than men.13,14  It remains critical to address and overcome these gender-based prejudices, to improve the well-being and retention of women in these critical fields of research and medicine.

This UroToday Women in Science Center of Excellence is dedicated to highlighting the career paths and research achievements of women in the fields of GU cancer research and clinical medicine. We hope that sharing stories of overcoming barriers and tips for advancing the careers of women in these fields will help to create a strong pipeline of women in the cancer research field, as well as inform male allies on how they can support efforts toward achieving gender equity across all fields of cancer research and medicine, and at all career levels, especially at senior leadership levels.



Written by: Andrea Miyahira, Ph.D. is the Senior Director of Global Research & Scientific Communications at the Prostate Cancer Foundation (PCF)

References:

  1. Halpern, J.A., et al., Women in Urology Residency, 1978-2013: A Critical Look at Gender Representation in Our Specialty. Urology, 2016. 92: p. 20-5.
  2. Graham, L.S., et al., Gender Differences in Faculty Rank and Subspecialty Choice among Academic Medical Oncologists. Cancer Investigation, 2021. 39(1): p. 21-24.
  3. Schaller, M.D., The Gender Gap Amongst Doctoral Students in the Biomedical Sciences. bioRxiv, 2022: p. 2022.10.18.512765.
  4. Lautenberger DM, D., Valerie M., The state of women in academic medicine 2018-2019. 2020.
  5. Kamran, S.C., et al., Intersectional Analysis of U.S. Medical Faculty Diversity over Four Decades. New England Journal of Medicine, 2022. 386(14): p. 1363-1371.
  6. Findlay, B.L., et al., Path to Parity: Trends in Female Representation Among Physicians, Trainees, and Applicants in Urology and Surgical Specialties. Urology, 2023. 172: p. 228-233.
  7. Kamran, S.C., et al., Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation and Medical Oncology Faculty Over 5 Decades. JAMA Oncology, 2022. 8(2): p. 221-229.
  8. Alexandrou, M., et al., Gender disparity trends in genitourinary oncology academic publishing over the past 3 decades: A bibliometric analysis. Urologic Oncology: Seminars and Original Investigations, 2023. 41(10): p. 432.e21-432.e27.
  9. Bendels, M.H.K., et al., Gendermetrics of cancer research: results from a global analysis on prostate cancer.Oncotarget, 2018. 9(28): p. 19640-19649.
  10. Farooq, M.Z., et al., Gender disparities in the National Institutes of Health funding for genitourinary oncology.Journal of Clinical Oncology, 2023. 41(6_suppl): p. 264-264.
  11. Acosta, D.A. Achieving excellence through equity, diversity, and inclusion. 2020; Available from:  https://www.aamc.org/news-insights/achieving-excellence-through-equity-diversity-and-inclusion.
  12. Bentley, A. and R. Garrett, Don't get mad, get equal: putting an end to misogyny in science. Nature, 2023. 619(7968): p. 209-211.
  13. Baptiste, D., et al., Gender differences in academic surgery, work-life balance, and satisfaction. J Surg Res, 2017. 218: p. 99-107.
  14. Lyubarova, R., L. Salman, and E. Rittenberg, Gender Differences in Physician Burnout: Driving Factors and Potential Solutions. Perm J, 2023. 27(2): p. 130-136.