Sarah Nersesian explains the need to change how we understand ovarian cancer in light of the fact that not everyone who can get ovarian cancer identifies as a woman.
I will preface this entire commentary by acknowledging that I have referred to ovarian cancer as a women’s cancer in the past. I have since become aware of the ways in which this terminology fails to reflect the wider spectrum of gender identity, and can actually perpetuate harm against people with ovarian cancer who do not identify as cis women.
What “type” of cancer is ovarian cancer?
If we must label ovarian cancer as a “type”, it should be classified as cancer that can develop in anyone with fallopian tubes or ovaries. While this patient demographic includes cisgender women, it can also include transgender men, non-binary, agender, genderqueer, or other gender-nonconforming people and also people with differences in sex development (who may or may not identify as male, female, or intersex).
Historically, ovarian cancer research has been conducted on biological samples from cisgender women – not because cisgender women are the only ones who experience ovarian cancer, but because transgender and other gender-nonconforming people with ovaries are rarely specified as an inclusion group during trial recruiting. Transgender individuals also face social barriers around accessing healthcare that may cause them to forgo cancer screening procedures altogether, which again constrains their eligibility for clinical trials. While lack of trans-inclusive education for medical practitioners is partially responsible, this is compounded by the pervasive use of the term “women” by the scientific community, as publications, conference talks, and medical textbooks continue to unintentionally yet undeniably exclude a significant part of the population that is equally at-risk for ovarian and other gynecological cancers.
The immense power of language to both guide research and inform clinical practice cannot be understated. As an example, numerous reports suggest that progesterone-based contraceptives are associated with decreased ovarian cancer risk. However, individuals who have ovaries but do not identify as women are less likely to take hormonal contraceptives and might not even have them prescribed for them in the first place if they visibly “pass” as a different gender. Furthermore, transgender individuals may be more susceptible to ovarian cancer due to off-target effects of gender-affirming hormone treatment. Without accessible, trauma-informed, trans-inclusive gynecological care, transgender ovarian cancer patients may be diagnosed later than cisgender female patients, leading to an even poorer prognosis.
In the field of cancer immunotherapy, physical sex is a crucial variable to consider. Endogenous factors such as sex hormones and hormone-responsive genes heavily influence the immune system. For example, females tend to experience much higher levels of autoimmunity when compared to males. These differences are also observed in cancers outside reproductive tissues, where males are at almost two-fold more significant risk. In addition, response to immunotherapies or cancer treatments is influenced by sex, including anti-checkpoint therapies that seem to be more effective in those females with melanoma.
Still unsure about how these experiences matter in research and clinical care settings?
Going forward, I’ll continue to choose inclusive language to frame my reproductive health research and I hope that others will do the same in their domains of study.
Sarah Nersesian (she/her) is in the Department of Microbiology & Immunology at Dalhousie University. @NersesianSarah
The author notes that this commentary has also been reviewed by:
Gillian Carleton (they/them), in the Department of Biochemistry at The University of Victoria, @gilliancarleton
Edan Foley, at the University of Alberta, @EdanFoley