“I tried every diet under the sun. I didn’t eat bread or pasta for two years, I tried some wacky shake diets, I exercised on the elliptical every morning and went for a walk every night after work. I think she just didn’t believe me.”

The fact that Piper’s doctor was a woman is not remarkable in the growing literature on medical misogyny, which attributes many of the issues to systemic and historic biases rather than laying it at the feet of individual clinicians.

In June 2022, after an unrelated operation to treat varicose veins, thoracic specialists overlooked a chance finding in a CT scan report of a three-centimetre suspected adrenal adenoma – a type of benign tumour.

The radiologist noted the mass “would be more accurately assessed with a non-contrast scan”, but Piper’s treating clinicians did not read that part of the report, only the conclusion, according to a formal assessment by the Health Care Complaints Commission.

Eighteen months later, Piper’s new GP was worried and sent her for another CT scan. The tumour had grown to seven centimetres. It was cancerous and had spread to her liver. That’s when Piper herself found the old CT scan report and the reference to a suspected tumour.

As Piper had suspected, her weight gain had been a symptom, not the cause, of her health problems.

She had Cushing’s syndrome, a rare hormonal disorder caused by prolonged exposure to high levels of cortisol that are often due to tumours on the pituitary or adrenal glands that can become cancerous if left untreated, as happened in Piper’s case.

Seventy per cent of Cushing’s syndrome patients are women. The side effects include unremitting weight gain, excess facial hair, inexplicable bruising, chronic fatigue and muscle weakness.

Last month, Piper stopped cancer treatment in favour of spending time with her husband, Bruce, daughters Sarah and Anna, son Ben and her two grandchildren in her home in north Sydney.

“Most GPs have probably never seen a case in their life,” Piper said. “But I had been telling her for years that something was wrong with me … and she didn’t bother sending me to a specialist. She just didn’t take me seriously.”

A landmark report in 2023 commissioned by prestigious medical journal The Lancet, “Women, cancer and power”, found equitable access to care, improvements in diagnosis and primary prevention strategies could prevent 2.3 million cancer deaths in women each year.

This masthead’s survey attracted a handful of derisory submissions stating that medical misogyny did not exist. The most common justification was the incorrect claim that female doctors outnumbered male doctors in Australia.

Dr Ophira Ginsburg, medical oncologist and project lead on The Lancet Commission “Women, power and cancer”, said people often misunderstood medical misogyny or gender-based discrimination as “men doing bad things to women”.

“So much of the time, terrible discrimination, not being believed, being under-treated or turned away from the emergency room, the people responsible are women, [which] speaks to the patriarchal system [and] implicit, unconscious bias,” Ginsburg said.

“When I trained as a medical oncologist 20 years ago, we were under the impression women were just smaller men.”

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Historically in medicine and medical research, the male (usually Caucasian) body is the standard, rendering the female body the deviant.

Associate Professor Nada Hamad, also a clinical researcher with a focus on women with cancer, said it was not unusual for women’s symptoms to be dismissed as a normal part of their physiology.

“By definition, cancer diagnoses involve a normal metabolism change,” Hamad said. Normal physiological female changes – premenstrual stress, pregnancy, perimenopause, menopause – all of those things mimic so many of cancer’s symptoms,” she said.

“The fact that female bodies change over time – from prepubescence, pubescence, pregnancy planning, pregnancy, postpartum, perimenopause and menopause – is not taken into account in anything we do.”

Studies comparing how men and women describe pain found that women’s answers were longer and used more emotional, graphic language and words such as “scary”, “unbearable” and “disgusting”. Men were more likely to be specific and use sensory language like “stabbing”.

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“The way doctors ask questions is designed to elicit responses from men. The questions we were trained to ask are not suited for [women’s] form of language and description,” Hamad said.

The consequences can permeate through generations.

“It’s not uncommon that I’ll have women come to me and say ‘My mum had something and nobody believed her and I’m worried that this is happening to me now,’” she said.

The Australian Health Practitioner Regulation Agency review will gather intelligence about incidents and trends linked to gender bias in healthcare, which it says is a systemic issue similar to racism, and it will then consider possible system-wide responses to gender bias in healthcare, including “what rapid response actions might be needed”.

Natasha Lanza is one of eight women who contacted this masthead reporting having received a delayed breast cancer diagnosis after their symptoms were misdiagnosed or dismissed.

In August 2022, her GP didn’t bother examining the hard lump under her right breast that barely budged when she pushed it, said Lanza, a 36-year-old single mother.

“[He said] ‘You look healthy and fine’, and just kind of shrugged me off like it was nothing,” she said.

After returning for a second consultation and insisting on testing, the GP then failed to pass on an ultrasound report recommending a biopsy of two lesions in her right breast, Lanza said.

Lanza saw another GP, who immediately recommended a biopsy. It had been about five months since that initial appointment. By then, one of the lumps had grown to more than seven centimetres. Lanza had aggressive breast cancer. She needed a mastectomy, chemotherapy and 30 rounds of radiation.

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Lanza believes that had she been a man presenting with a lump on his penis, it would have been seen immediately.

“I just felt like I wasn’t heard. I was kind of just dismissed.”

Fran Boyle, a professor of medical oncology at the University of Sydney and a leading breast cancer specialist, said young women frequently draw attention to a lump on their breast and have their concerns dismissed by their doctors.

“Then they turn up a year or a few years later with nasty, large, widespread breast cancer, having not been investigated when it was at an early stage when it would have been easier to manage,” Boyle said.

“I think it comes down to ignorance,” Boyle said. “They think these women under 40 are too young to have breast cancer because they aren’t in the breast screening age group.”

Professor Caroline Ford, who leads the Gynaecological Cancer Research Group at the University of NSW, recalls attending tumour board meetings at a major tertiary hospital where multidisciplinary teams discuss patient history and treatment.

She was shocked by the number of women whose endometrial cancer was diagnosed after months or years of abnormal post-menopausal bleeding.

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“This is the main and very obvious symptom of endometrial cancer,” Ford said.

She suspects this is due to a lack of awareness of endometrial cancer and the stigma around menstruation, menopause and pelvic pain.

“I haven’t seen a massive improvement when I go to these meetings now, which worries me,” Ford said. “It’s Australia’s fifth most common cancer and pretty much our only cancer that is increasing in rates.”

Decades of underfunding have led to gynaecological cancer having the lowest survival outcomes among all cancers, and diagnoses are expected to rise by 21 per cent over the next 10 years, found a new report by the Gynaecological Cancer Transformation Initiative – a coalition of leading gynaecological cancer organisations.

“The survival rates for gynaecological cancers have barely changed in decades,” said Robin Penty, chief executive of the Ovarian Cancer Research Foundation.

For ovarian cancer, the most deadly cancer for Australian women, the survival rate of 49 per cent has not changed in 50 years, according to the report.

“We know that the answers are there – they lie in research and better understanding of women’s bodies and women’s pain [and to] reveal them we need appropriate and proportionate investment,” Penty said.

More males are diagnosed and die of cancers that affect both sexes, but more women die of cancers specific to women than men die of cancers specific to men, The Lancet Commission reported. Moreover, cancers that predominantly affect females are less preventable.

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“If you removed tobacco and alcohol from planet earth, you would see a far greater drop in the numbers of men developing and dying of cancer compared to women.” Ginsburg said.

We know very little about the causes of cancers that predominantly affect women, Ginsburg said, including two-thirds of breast cancers, and most gynaecological cancers.

“So, we must ask, who is making the decisions regarding what gets studied and funded, what grants are developed, and what research questions are prioritised?” she said.

The report found 16 per cent of hospitals, treatment centres and research institutes in the Union of International Cancer Control are led by women globally. Men are also overrepresented among editors in chief of cancer research journals and lead authors of cancer research papers.

The scientific research that underpins medical practice has long been skewed towards males (usually Caucasian) and has largely failed to consider the fundamental impacts of sex and gender in disease prevention, diagnosis and treatment. Many sex and gender differences are yet to be recognised.

Roughly 76 per cent of cell lines are male or not reported, 75 per cent of mouse models are male, and 67 per cent of human trials are male, yet 51 per cent of the human population is female.

“Because the research is mostly done in men, male symptoms are what clinicians are looking for, and we often see the same thing in cancer,” said Megan Varlow, director of cancer control policy at Cancer Council Australia.

For almost 30 years, women of reproductive age were excluded from clinical trials as a result of the thalidomide crisis in which a poorly researched and rushed-to-market medication for morning sickness was responsible for more than 10,000 babies being born with birth defects. The ban was not lifted until 1993 by US and UK regulators.

There are some signs of progress, with women increasingly included as clinical trial participants. Still, Australia is one of many countries that do not mandate the inclusion of females in medical research.

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As a consequence, women are prescribed treatments that are mainly tested in men, despite being disproportionately affected by certain cancer types, Varlow said.

“This means we don’t fully know how things will play out for women.”

Of the 10 prescription drugs banned by the US Food and Drug Administration between 1997 and 2000 due to severe adverse effects, eight caused greater health risks in women, and a ninth belonged to a class of drugs known to pose a greater health risk for women. Australia’s Therapeutic Goods Administration had cancelled the registrations for most of these drugs by November 2004.

Emerging research suggests women suffer more significant toxicity from chemotherapy and immunotherapy and report poor pain management, likely due to participants in clinical trials that test the safety and efficacy of treatments being largely male.

Australia’s National Health and Medical Research Council published a statement on sex, gender, variations of sex characteristics and sexual orientation in 2024 that “strongly encourages” all Australian government-funded medical research to consider these factors at all stages of the research project.

This includes study design and recruitment, analysis, reporting and translating into practice.

The statement aligns with 15-year-old Canadian guidelines and similar efforts in the US that the Trump administration is now dismantling.

“We would like to see them not to be strongly recommended but required,” Varlow said.

Women ‘more likely’ to face financial catastrophe due to cancer

There is also a gender gap when it comes to the funding of cancer-related tests in Australia.

Medicare covers 74.3 per cent of ultrasound services fees for women compared to 82.8 per cent for males, and 87.5 per cent of diagnostic radiology fees for female patients compared with 92 per cent for male patients.

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Professor Christobel Saunders, head of the department of surgery at the Royal Melbourne Hospital, said it was “extraordinarily difficult” to justify the out-of-pocket costs for imaging and biopsies to investigate suspected cancers.

“A woman [referred for] a private mammogram and ultrasound, perhaps an MRI, ultrasound-guided biopsy, the biopsy alone will be $800 out of pocket,” Saunders said. “That seems particularly unfair to me.”

Said Dr Ron Shnier, president of the Australian Diagnostic Imaging Association: “Breast imaging and O&G ultrasound are among the most underfunded radiology services under Medicare, despite being among the most complex and time-consuming services provided by radiologists and sonologists.”

The Lancet’s “Women, power and cancer” report found that “women are more likely than men to risk financial catastrophe due to cancer, with dire consequences for their families, even if quality cancer care is available”.

Rebecca Weale, 45, has been unable to shake the feeling that her gender played a role in her GP’s failure to realise the seriousness of her symptoms when she went to him with chest pain, strange rashes, coughing and fatigue so overwhelming that she would fall asleep for hours in the middle of the day.

It was autumn 2021, and she had just migrated to Melbourne’s inner city from the UK with her husband and toddler.

It took five visits to the GP over four months until he “begrudgingly” handed over a referral for an ultrasound that diagnosed a cancer so aggressive that she was immediately sent to the emergency department and didn’t leave the hospital for 13 days, Weale said.

The doctor had initially diagnosed her with eczema and asthma and prescribed an inhaler that made no difference to her debilitating symptoms, she said.

At the fifth appointment, Weale’s neck had become so swollen that she struggled to button up her shirt. When the doctor gave her the ultrasound referral, he told her that she didn’t have to rush to get the scan done, Weale recalled.

“His language to me was very dismissive. I’m furious that he didn’t rule out serious things before diagnosing me with this eczema and asthma nonsense, neither of which I have ever had.”

The ultrasound detected a 14-centimetre tumour caused by non-Hodgkin lymphoma (a type of blood cancer) that had grown from her chest into her neck and was pushing on one of her main arteries.

Weale needed to start chemotherapy immediately, leaving no time for an egg retrieval to help preserve her fertility. She believes the GP’s dismissive attitude toward her symptoms robbed her of the chance to have another biological child.

“I wanted another baby … I’m still going through this, and he probably has forgotten he ever met me,” she said. “I feel like casual sexism definitely played a role in his attitude towards me and my symptoms and his diagnosis of me.

“I felt it really strongly at the time, and I still feel it now.”

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