International Women’s Day 2025

This International Women’s Day (8 March), we honour the strength, resilience, and achievements of women. But we must also confront an urgent health crisis: Australia now leads the world in young-onset colorectal (bowel) cancer, with women facing unique challenges from diagnosis through survivorship.

– by Dr Prasad Cooray, Medical Oncologist (Epworth Eastern, Knox Private and Ringwood Private Hospitals), Clinical Lecturer (University of Melbourne Department of Surgery, Austin Health), Advisory Group member (VICS Optimal Care Summits colorectal cancer consultation 2024–25)

While the rate of CRC colorectal cancer (CRC) in Australians over 50 has fallen consistently, incidence in younger people is rising, with a faster increase among women than men in Australia (Lancet Oncology, Jan. 2025). The risk of being diagnosed with CRC before the age of 40 has more than doubled since the year 2000 (Bowel Cancer Australia).

In Victoria, a recent VICS Optimal Care Summits consultation found rates of CRC in people aged 25-49 years have increased by 2.6% per year since 2005, and that patients diagnosed under 50 years of age are more often diagnosed with later-stage disease (compared Victorians diagnosed over 50).

For women in their 30s and 40s, a colorectal cancer diagnosis comes at a pivotal moment –balancing careers, raising children, and planning for the future. Yet, too often, they face delays, biases, and unnecessary barriers at every stage of their cancer journey.

Diagnosis delays

“You’re too young for bowel cancer.” Young, healthy-appearing women are often dismissed when reporting symptoms, leading to later-stage diagnoses and worse outcomes.

Australian research cited by Bowel Cancer Australia has found younger people may spend between 3 months and 5 years seeing multiple doctors before diagnosis, making 10 or more visits to GPs. Time to diagnosis is up to 60% longer for younger people, who are more likely to be diagnosed in later stages of the disease.

CRC symptoms (fatigue, bloating, constipation) in women who are pregnant can also be mistaken for normal pregnancy changes, delaying critical treatment.

Challenges during treatment

Women who push for answers are frequently labelled as ‘difficult’ or ‘hostile’, despite research showing that self-advocacy leads to better health outcomes.

Many women report feeling excluded from key decisions about their own treatment, with elevated psychological distress linked to lower involvement and a mismatch between their preferred and actual role in decision-making.

The struggles of survivorship

Women are often primary caregivers, and that doesn’t change after cancer. The emotional and physical toll of managing a household while still having treatment or healing is immense.

Many women pause their careers for treatment, only to face job insecurity, financial strain, and difficulties re-entering the workforce.

Ongoing symptoms like fatigue, infertility, and bowel dysfunction often go unheard and unaddressed, due to gender biases.

What needs to change?

We must do better for women facing colorectal cancer. We need healthcare systems that listen to women, take their symptoms seriously, and provide equitable care.

That means:

• earlier screening and faster diagnosis for young women at risk
• ending gender biases in symptom assessment and treatment decisions
• empowering patient-centred care that supports women beyond survival – through recovery, caregiving, and career reintegration.

We can do better to bridge this gap. We need to establish care models around cancer treatments that empower patient-partnered, shared decision-making collaborations, recognising, acknowledging, and being especially mindful of disparities faced by women in a health crisis.

Clinical practice guidelines for early-onset bowel cancer and a 19-hour continuing professional development (CPD) series are available for free online from Bowel Cancer Australia.

Further ways to address the later stage of disease at diagnosis seen in early-onset CRC were discussed at a VICS Optimal Care Summit on 26 February 2025, by more than 100 experts from across Victoria. The VICS will shortly publish an ‘action register’ of proposals to improve these and other unwarranted variations in CRC care and outcomes.

Women should not have to fight for recognition of their symptoms or navigate an unfair burden of advocacy while battling cancer. This International Women’s Day, let’s commit to closing the gap in cancer care for women. Because their lives depend on it.