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Women Underrepresented as Authors in Prestigious Cancer Trials

June 14, 2022

Mid-July 2022

Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, is a freelance medical and science writer based in Bloomington, Indiana.

Although strides have been made toward gender parity for women in medicine – and specifically in academic oncology – female oncologists still face many challenges, including a lack of mentors, work-life balance pressures, lower compensation, cultural gender bias, and even outright discrimination and harassment.1

About 36% of faculty in oncology programs are women, which is consistent with the percentage in other physician groups and in academia at large. However, women make up only 24% of leadership positions in oncology, and only 16% of chair positions are filled by women (with higher percentages in medical oncology and comparatively lower percentages in surgical oncology).2 Women have entered medical school in roughly equal numbers to men for the past several decades, suggesting that women drop out of the pathway to leadership and academic attainment as a result of gender-specific challenges.2

Research presented by Lynne O. Chapman, MD, of Baylor College of Medicine in Houston, at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting shed light on one aspect of this with respect to women’s authorship on key clinical trials in oncology.3 Authorship of peer-reviewed scientific papers serves as a key marker for demonstrating scientific contributions and expertise, and affects promotion and tenure prospects.4 This is especially the case for premier authorship positions: first, corresponding, or senior author. Decreased authorship among women, especially in premier authorship positions, may be one factor leading to decreased representation of women in leadership positions in oncology.

Previous work has demonstrated a higher number of male authors in surgical journals, radiation oncology journals, and papers devoted to specific oncologic areas (including gynecologic, prostate, and lung cancers). Men are also more likely to achieve authorship in high-impact journals and collaborative cancer trials, more likely to be senior authors, and more likely to be asked to present at oncology conferences, although the percentage of female first and senior authors has increased over time.4,5

Dr. Chapman and colleagues sought to add to this literature by analyzing the authorship in 227 pivotal oncology and hematology trials that resulted in drug approvals by the U.S. Food and Drug Administration from July 2008 to June 2018. Of the 4,664 authors included in the analysis, 1,287 (27.6%) were women. Authorship among women was higher in breast and gynecologic oncology at 41.3% compared to other cancers at 26.0% (p<0.001). Additional results of the analysis showed that female authorship was significantly higher in non-randomized versus randomized trials (30.4% vs. 26.5%; p=0.007), phase I/II trials compared to phase III trials (29.9% vs. 26.3%; p=0.009), and in trials with fewer patients (≤100 compared to >500; p<0.001), all indicating slightly less prestigious trials.

Additionally, women were proportionately less likely than men to hold premier authorship positions (9.2% vs. 18.2%; odds ratio [OR] = 0.46), including the following: 3.2% versus 6.3% of first authors (OR=0.49), 3.3% versus 6.0% of senior authors (OR=0.54), and 2.5% versus 5.8% of corresponding authors (OR=0.42).

The researchers concluded, “The under-representation of women in premier authorship positions in pivotal clinical trials, demonstrated in our study, serves as a barometer of a biased academic infrastructure.” They argued their data only make it more critical to support efforts to remove barriers that limit the full inclusion of women in oncology.

Any conflicts of interest declared by the authors can be found in the original abstract.

References                                                                                                                                       

  1. Butkus R, Serchen J, Moyer DV, Bornstein SS, et al. Achieving gender equity in physician compensation and career advancement: A position paper of the American College of Physicians. Ann Intern Med. 2018 May 15;168(10):721-723.
  2. Gharzai LA, Jagsi R. Ongoing gender inequity in leadership positions of academic oncology programs: The broken pipeline. JAMA Netw Open. 2020 Mar 2;3(3):e200691.
  3. Chapman LO, Loree JM, Anand S, et al. Gender disparity in authorship of clinical trials leading to cancer drug approvals between 2008 and 2018: The glass ceiling of academic oncology. Abstract 11048. Presented at the 2022 American Society of Clinical Oncology Annual Meeting; Chicago, Illinois.
  4. Dalal NH, Chino F, Williamson H, Beasley GM, Salama AKS, Palta M. Mind the gap: Gendered publication trends in oncology. Cancer. 2020 Jun 15;126(12):2859-2865.
  5. Mah SJ, Makkar M, Huang K, Anpalagan T, Reade CJ, Nguyen JMV. Gender imbalance in gynecologic oncology authorship and impact of COVID-19 pandemic. Int J Gynecol Cancer. 2022 May 3;32(5):583-589.

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