Women's Health Matters: Challenges to Colorectal Screening — International Women's Day 2025 #AccelerateAction

Vol. 30, Issue 1 (March 2025)

Lubna Kamani, MD, FCPS, MRCP, FRCP
Professor of Gastroenterology
Liaquat National Hospital
Consultant, Aga Khan University Hospital
Karachi, Pakistan
 

Anjaleen Maryam Agrawalla
Medical Student
Aga Khan University
Karachi, Pakistan

 

Majidah Abdulfattah Bukhari, MD, FASGE, FRCPC, ABIM, MCRP (GI)
Adjunct Assistant Professor
University of Sharjah
Sharjah, United Arab Emirates

 

Every year we eagerly anticipate celebrating the month of March for its dual significance, International Women’s Day and Colorectal Cancer Awareness Month. It is a time to honor the incredible contributions of women worldwide while raising awareness about colorectal cancer prevention. The arrival of 2025 brings with it a powerful theme, “Accelerate Action,” which acknowledges the forging of women’s equality. It’s important to recognize that we must implement #AccelerateAction to all aspects of life, especially our health. A life-threatening disease like colorectal cancer can be lethal if not treated at the right time, and to do so, it’s imperative that it get diagnosed early on. As we march forward, it’s crucial that we do so united, and to make this vision a reality, we must ensure that every woman feels safe, empowered, and above all, healthy in every environment she inhabits. Because when women thrive, the world moves forward.

Medicine is a constantly evolving field, with new discoveries emerging all the time. As medical professionals, it is our responsibility not only to stay at the forefront of these advancements but also to ensure they reach and resonate equally with both genders, empowering women with the knowledge to make informed health decisions with freedom. Colorectal cancer is the third most common cancer worldwide and is largely preventable with timely screening. It has been documented from time to time that women face unique challenges and barriers for colorectal screening that transcends borders. Previous studies showed that what was once perceived as a cancer predominantly occurring in males, also occurs quite commonly in females. However, the women of the South Asian population do not consider it a threat as they still believe colon cancer primarily occurs in the older male population.¹ Moving forward, it is imperative that we reach out to our female population, educate them on colon cancer, and emphasize the need for screening. The mainstay screening tool used for colon cancer diagnosis is colonoscopy, which a lot of women are hesitant to get done. This is due to several reasons, a few of which are the lack of same gender endoscopists, feelings of shame or embarrassment, religious and cultural beliefs, accessibility and cost, the fear of the bowel preparation before colonoscopy, and the procedure itself.

In South Asia, it is common for female patients to prefer same gender doctors for various medical issues. For Muslim women, same gender preference is commonly noted, especially for invasive procedures like colonoscopies. Studies show that approximately 75% of Muslim women prefer female endoscopists due to religious values, family pressures, and personal comfort.²

In lower middle-income countries like Pakistan, a significant number resides in the rural areas where screening programs are often inaccessible. Due to the distance, patients are required to travel to equipped facilities along with bearing the cost of various diagnostic tests in the absence of government sponsored screening programs. Thus, CRC screening in women remains low, ultimately leading to late or missed diagnosis.

In any setting, there must be a balance between supply and demand, and unfortunately there is sparsity of female endoscopists worldwide. This leads to a lack of screening opportunities and increased wait time for the female population.

These challenges are not only significant from the patient’s perspective but also from the practitioner’s. The scarcity of female endoscopists leads to increased workloads, poor ergonomics, burnout, and work-life imbalance.

A 2022 survey revealed that 50% of gastroenterologists experience burnout, significantly affecting their personal lives. In extreme cases, stress can lead to early retirement, depression, substance abuse, and even suicide. Factors contributing to burnout include high workload, lack of breaks, limited vacation days, and familial responsibilities, with female gastroenterologists and younger practitioners being particularly affected.³

Globally, women make up less than 20% of endoscopists, a statistic influenced by factors like underrepresentation, workplace discrimination, family planning challenges, pregnancy, and ergonomic issues. Endoscopists face a high risk of ergonomic injuries due to the strain caused by the repeated performance of the procedure. The increasing number of colonoscopies, along with longer procedure durations and insufficient breaks, has led to a rise in muskuloskeletal injuries such as lower back, leg, wrist, hand, and neck pain. These injuries are noted to be more prevalent among women and can be attributed to the fact that women have smaller builds as compared to men, weaker grip strength, and reduced finger strength, requiring them to exert more force during procedures. A study found that 61% of female endoscopists suffered from ergonomic injuries as compared to 39% in males.⁴

Furthermore, performing colonoscopies on female patients has its own set of challenges. Women generally have longer colons, including a longer transverse section, and may have altered anatomy due to previous pelvic surgeries, making the procedure more complex.⁵

As we aim to march forward this year, we must increase awareness of colorectal cancer prevalence among women and make them more comfortable with the screening process to help reduce the morbidity and mortality. We must recruit more female endoscopists to not only help the increasing number of female patients but also reduce the burden on the currently practicing doctors. Bridging the gap between female practitioners and their patients is key to enhancing patient satisfaction and improving the well-being of our healthcare professionals. This year let’s #AccelerateAction for women’s equality by investing in equitable healthcare access to create a more sustainable and inclusive world.

References

1. Ivey SL, Mukherjea A, Patel A, et al. Colorectal Cancer Screening Among South Asians: Focus Group Findings on Attitudes, Knowledge, Barriers and Facilitators. J Health Care Poor Underserved. 2018;29(4):1416-1437. doi:10.1353/HPU.2018.0104
2. Kamani L, Butt N, Taufiq F, de Paredes AG, Rajan E. Unique perspective of Muslim patients on gender preference for GI endoscopists: a multicenter survey. Gastrointest Endosc. 2021;94(6):1110- 1115. doi:10.1016/J. GIE.2021.06.030
3. Practice Management. Am J Gastroenterol. 2017;112(S1):S593- S645. doi:10.1038/AJG.2017.308
4. Kamani L, Kalwar H. Ergonomic Injuries in Endoscopists and Their Risk Factors. Clin Endosc. 2021;54(3):356-362. doi:10.5946/CE.2020.200
5. Saunders BP, Fukumoto M, Halligan S, et al. Why is colonoscopy more difficult in women? Gastrointest Endosc. 1996;43(2 Pt 1):124-126. doi:10.1016/S0016- 5107(06)80113-6