IWD 2020: My passion for global oncology - a journey around the world

As part of a series of blogs celebrating International Women's Day 2020, Dr Susannah Stanway discusses her journey to medicine, her passion for global oncology and what she wants for the future. 

I knew from a young age that I wanted to be a doctor. I was interested in science but was also creative, so medicine seemed to be the best option to combine both things. During my sixth form years I regularly volunteered in a local hospice and realised I’d like to work in oncology as most of the patients in the hospice had cancer.

When my mother, a doctor, attended medical school, women made up a little more than 10% of the intake, whereas when I trained at Bristol University there were almost equal numbers of male and female students. My elective, in 1997, was spent in the Solomon Islands working with an orthopaedic surgeon. I witnessed the challenges of working in a resource constrained setting and it was interesting to see the different type of injuries and the impact of a different culture on presentation and management (compared with what I was used to in England). I particularly remember the injuries caused by climbing up coconut trees, or being hit by coconuts, and the wider use of external fixators for limb fractures.

It wasn’t until I cared for a young patient with incurable cancer from a low income country in sub-Saharan Africa that I saw how I could combine my interest in oncology with that of healthcare in resource-constrained settings. I completed oncology training at The Royal Marsden NHS Foundation Trust and carved out time to devote to global oncology.

The majority of global cancer deaths occur in low-and middle- income countries (LMICs) where epidemiological transitions are occurring that increase cancer incidence. The infrastructure to manage the cancer care continuum in these countries is often not as well developed as in more affluent countries. The growing field of global oncology is a fascinating area, incorporating a range of disciplines including many branches of clinical medicine and nursing, politics, policy, anthropology, epidemiology, religion, global health and academia.

It wasn’t until I cared for a young patient with incurable cancer from a low income country in sub-Saharan Africa that I saw how I could combine my interest in oncology with that of healthcare in resource-constrained settings.

Dr Susannah Stanway

As a consultant my interest in global oncology has grown and resulted in teaching and sharing my knowledge in the UK. Some of my work has involved researching collaboratively with colleagues in LMICs; working with the RCP in East Africa; advocating for cancer care in LMICs as co-organiser of London Global Cancer Week 2019; and co-leading the setting up of a multidisciplinary national network to lead research and education on this area in 2020.

I have recently had the privilege to teach oncology to doctors in Tanzania and Kenya, alongside the local faculty there, as well as working with cancer researchers in Ghanaand Tanzania on breast cancer survivorship; and developing palliative care services with colleagues in the Democratic Republic of the Congo.

I’ve seen first-hand and heard many accounts of the challenges some women with cancer in these countries face, yet cancer survival shouldn’t be dependent on country of birth. Late presentation, a lengthy diagnostic pathway, challenging access to treatment and palliation (often for multifactorial reasons) all contribute to this. Cervical cancer, which has been a preventable cancer for many years, is still affecting women in disproportionately larger numbers in poorer countries – where access to HPV vaccination and screening still needs to be improved. Women with breast cancer are similarly more likely to present at a later stage and to be less able to access treatment in poorer settings.

I have been fortunate to have had really great role models in medicine, including my mother. She was a doctor during a time when it was harder for women to enter and progress in medicine. Today, doctors are lucky to be able to train and practise part-time if we choose to do so, and this has enabled me to spend more time with my four children. However, there is still a lot more work to be done within medicine to facilitate less-than-full-time and flexible working.

Being a physician has been a wonderful career so far. I am happy to be able to say that my gender has never impaired me realising my ambitions in medicine. I am grateful to The Royal Marsden and the Institute of Cancer Research for the opportunity to work part-time and to have encouraged and supported my research and education endeavours. I hope that during the rest of my working years I can continue to work with colleagues to deliver care I am proud of, and contribute to improving the global inequity in cancer survival.