Analysis Finds Women Underrepresented as NCCN Guideline Chairs

The National Comprehensive Cancer Network (NCCN) Guidelines shape cancer care in the United States and beyond, informing treatment decisions as well as insurance coverage. A study presented at the 2026 European Society for Medical Oncology (ESMO) Congress examined who writes those guidelines and found that, although women make up 40.5% of NCCN guideline authors, they hold only about 1 in 6 guideline chair positions, with wide variation in representation across cancer types.¹

“There are disparities in the representation among the guideline chairs, so that reinforces what previous studies have shown that there’s underrepresentation of women in leadership roles in oncology,” said David Benjamin, MD, in an interview with Targeted Oncology^TM during the congress.

Though the guidelines are designed for treatment in the United States, over 2.2 million registered online NCCN users reported living outside the US, and the NCCN offers international adaptations for Brazil, China, Middle East and North Africa, Poland, Spain, Sub-Saharan Africa, and Vietnam, giving them significance worldwide.²

Benjamin, a medical oncologist at Hoag Family Cancer Institute in Newport Beach, California, discussed how he and his colleagues evaluated the gender of 2231 authors across 61 NCCN Guidelines, why female representation ranged from 16% in genitourinary (GU) cancers to 72% in breast cancer, and what further research is needed to determine whether these differences reflect the oncology workforce. He also shared why he is looking forward to results from the phase 3 VOLGA trial (NCT04960709) in muscle-invasive bladder cancer, after the FDA granted priority review to perioperative durvalumab plus enfortumab vedotin for patients who are ineligible for or decline cisplatin.

Targeted Oncology: What was the background for your research on female representation among authors of the NCCN Guidelines?

David Benjamin, MD: Our study looked specifically at cancer guidelines. The most commonly used, not just in the US but I would contend worldwide, are the NCCN Guidelines. These are a little over 60 guidelines for the treatment of adult solid tumors and hematologic malignancies, and they are updated periodically to provide guidance to patients and physicians, but also to other parties, like insurance companies for drug coverage. They’re a very important publication in the field of oncology and hematology.

We wanted to look at female representation among the authors because many studies over the last few years have shown gender disparities, specifically the underrepresentation of women, whether it’s in leadership positions at cancer centers, in conference speaker roles, in leading clinical trials, or in the publication of those studies. Given how often these guidelines are cited and used every day globally, we wanted to see whether that is true in these guidelines as well.

How did you approach measuring representation in the guidelines?

We went through the 61 guidelines for the treatment of adult solid tumors and hematologic malignancies. The data were collected in the spring of 2026. Each guideline is updated at different times, so we used whatever was the most recent version as of April 2026. We looked at all the authors listed for each guideline, and then we looked at their academic profiles to see which gender they are associated with.

We identified a total of 2231 authors across the 61 guidelines and found that women made up 40.5% and men made up 59.5% of the authors. We also looked at the guideline chairs, because there is a chair and a vice chair for each guideline, and we found that women represented only 16.4% of the guideline chairs, only 10 out of the 61.¹

What were the key takeaways from how representation broke down across the guidelines?

What was striking was the low proportion of women among the guideline chairs. We also found differences in female author representation depending on the cancer type. For example, breast cancer had the highest representation of female authors at 72%, and gynecologic cancer was at 70%. As you work your way down the cancer types, female authors represented 34% of the authors in gastrointestinal [GI] cancers, and GU cancers had the lowest proportion: only 16% of the authors were female.

That brings up a couple of questions. No. 1, is this difference in female representation among the tumor types reflective of the workforce? My colleagues and I previously did a study of the workforce for GU medical oncologists, and we found that there are generally more men than women.³ Anecdotally, from my own experience, that could be the reason we see the difference between tumor types, but more research could be done to see whether there is a discrepancy there.

No. 2, there are disparities in the representation among the guideline chairs, so that reinforces what previous studies have shown: there is underrepresentation of women in leadership roles in oncology.

Ultimately, the reason for identifying these disparities is that these guidelines have a significant role in patient care, because they are adopted not just in the US but globally. Patients are diverse and have different backgrounds. Some cancers tend to affect one gender more than the other. What effect these disparities may have, we don’t fully understand right now. All we can say is that there are disparities in the authorship, and they could have potential downstream effects.

Were you able to compare representation in the NCCN vs the oncology workforce?

The only oncology workforce study I’ve seen is [our study] specific to GU cancers. For the other types, we don’t fully know, but I think that would be an interesting avenue to explore. Whether it’s GI cancers, which stood out at 34%, or even hematologic malignancies at 39%, it’s not clear whether that necessarily represents the workforce or even the patient population.

What conclusions can be drawn, and what are the next steps?

The key takeaway is that there are differences in female representation in these cancer guidelines. In some, like breast cancer and gynecologic cancer, there is actually a greater proportion of female authors than male authors, and in others, like GI and GU cancers, we see a disparity. The first step is understanding whether this is simply representative of the workforce, or whether it is truly a disparity that may reflect neither the workforce nor the patient population. These guidelines affect patient care, and that’s why they include patient representatives. It’s not strictly physicians, and having individuals who represent the patient population may benefit patient care.

There are also studies, not in oncology but in medicine generally, suggesting that some patients may connect better with a physician who has a similar background. We don’t know exactly how that translates to a leadership role or to writing the guidelines, but it implies there could be some connection with patient care.

As a next step, we’re thinking about looking at the ESMO guidelines to see whether there is a difference between US and European cancer guidelines and hopefully submitting that for publication.

What do you see as the most exciting news from ESMO this year?

As a GU oncologist, one study I’m interested in is the VOLGA trial (NCT04960709). That’s a phase 3 trial in muscle-invasive bladder cancer studying enfortumab vedotin [Padcev] plus durvalumab [Imfinzi] with or without tremelimumab [Imjudo].² The management of muscle-invasive bladder cancer has changed a lot. Even 3 or 4 years ago, we were talking about using cisplatin chemotherapy, and now the standard of care in the US is enfortumab vedotin plus pembrolizumab [Keytruda]. A lot of us in the field have been anticipating these results for some time.

What could an approval of durvalumab plus enfortumab vedotin mean for this setting?

Depending on the regulatory decision, if it is approved, I think it will provide another option for patients with muscle-invasive bladder cancer. We know it is a very aggressive cancer, and it’s a balance between helping our patients get cured and not causing long-term toxicity. My interest is not just in the efficacy and clinical outcomes, but also in the toxicities and tolerability of this combination. That will help oncologists and patients decide on the best approach for them.

What do you appreciate most about attending ESMO as a US-based oncologist?

I’ve attended ESMO for the last 5 years. It’s a great opportunity to talk with colleagues from Europe, Asia, and pretty much every continent. At each congress, it’s striking that many treatments we have in the US are not necessarily available or approved in other countries, whether because of regulatory approval or cost. We all learn from each other, especially those of us in the US learning from colleagues outside the US about how they approach the management of GU cancers or other malignancies.

REFERENCES

1. Benjamin DJ, Moyers JT, Stern A, Kalebasty AR. Female representation among authors of US cancer guidelines. Presented at: 2026 European Society for Medical Oncology Congress; October 23-27; Madrid, Spain. Abstract 3362P.

2. National Comprehensive Cancer Network. Global Program. Accessed October 22, 2026. https://www.nccn.org/global/global-program

3. Benjamin DJ, Kalebasty AR. The genitourinary medical oncology workforce in the United States. Urology. 2025;203:11-14. doi:10.1016/j.urology.2025.02.026

4. Powles TB, Grande E, Simone G, et al. Perioperative durvalumab with or without tremelimumab plus neoadjuvant enfortumab vedotin in muscle-invasive bladder cancer: Results from the phase 3 VOLGA trial. Presented at: 2026 European Society for Medical Oncology Congress; October 23-27; Madrid, Spain. Abstract LBA2.