The Gender of Your Surgeon May Matter
- From: J <nswex@nalid;non>
- Date: Thu, 31 Jan 2008 04:05:17 -0500
http://well.blogs.nytimes.com/2008/01/29/the-sex-of-your-surgeon-may-matter/
The Sex of Your Surgeon May Matter
January 29, 2008, 4:01 pm
The Sex of Your Surgeon May Matter
Whether a woman receives radiation treatment after breast cancer surgery
may be influenced by the gender of her surgeon, according to a new report
from The Journal of the National Cancer Institute.
female surgeonThe gender of your surgeon may impact your treatment. (Fred
Conrad/The New York Times)
The study, from researchers at Columbia University, set out to determine
why breast cancer treatment still varies among similar patients. In
particular, they looked at radiation treatment given to women after
lumpectomy. The treatment is considered a standard of quality cancer care
and has been shown to reduce breast cancer recurrence and mortality.
However, many women still don?t receive it.
Earlier studies have suggested that demographic characteristics influence
whether a woman receives postsurgical radiation. A patient?s race, age and
how far she lives from a radiation therapy facility all are factors that
affect her chance of receiving the treatment.
But the latest report looked at the doctors behind the decisions. The
researchers analyzed data on nearly 30,000 women aged 65 and older who
were diagnosed with breast cancer between 1991 and 2002 and who received
lumpectomy. They also analyzed data on the 4,453 surgeons who operated on
the women.
About one in four women were not treated with radiation after surgery.
Older women, black women, unmarried women and those living outside urban
areas were less likely to receive radiation. But after controlling for
those factors as well as characteristics of each woman?s cancer, the
Columbia researchers spotted other trends.
Women who received radiation were more likely to have a female surgeon.
Women who were treated by more experienced surgeons were also more likely
to receive radiation treatment, as were women treated by doctors trained
in the United States.
Dr. Dawn L. Hershman, co-director of the breast program at the Herbert
Irving Comprehensive Cancer Center at Columbia University, said it?s not
clear why women treated by female surgeons were more likely to receive
radiation. It may have to do with the nature of a woman?s relationship
with her doctor or the doctor?s communication style.
?It?s important to figure out all the factors that can contribute to
improving quality of care,?? said Dr. Hershman. ?There are many fantastic
male surgeons?.It shouldn?t be taken that every woman should be seen by a
woman, but there are some contributing factors to this difference that we
need to investigate further.'?
Some responses
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January 30th,
2008
6:05 am
Radiation therapy to the breast after lumpectomy is one of the standards
of care for early stage breast cancer. A simple mastectomy with lymph node
biopsy is another option, with or without breast reconstruction.
The application of radiation to the breast after lumpectomy has been shown
to reduce the risk of a recurrence of breast cancer within the breast.
Approximately three out of ten women may experience a recurrence of cancer
within the breast within ten years of a lumpectomy if they do not get
radiation o the breast compared with around one in ten who do get
radiation. Put a different way, seven out of ten women will not have a
local recurrence of their disease if they do not get radiation vs. nine in
ten who do get radiation.
While radiation in this situation is a standard of care, some patients may
choose not to take treatment for a variety of reasons?among others, she
may think that a seven out of ten chance of no local recurrence is a good
enough outcome for her. Most will choose to get radiation.
Careful education of the breast cancer patient by a team that would
include a radiation oncologist as well as surgeon and medical oncologist
about the rationale for the use of any modality in the treatment of her
breast cancer is important. Education about the options available and
empowerment to make choices is essential for the vulnerable patient.
? Posted by David Howell, MD
January 30th,
2008
8:50 am
Based on the abstract of the article, as well as the methods
(retrospective review of large database), it does not appear that they
controlled for the age of the surgeon at all, so I think you may be
incorrect, TPP. Also they did not control for who did a fellowship or not.
I cannot help but think that the experience of a surgeon (which is under
his or her control) matters far more than the sex of aeon surgeon (which
is not). The importance of the article is clearly that the care of
patients with breast cancer could and should be improved, not that the sex
of the surgeon matters for each individual patient
From TPP ? I was referring to the fact that there has been an increase infemale surgeons. According to Dr.Hershman the number of female surgeons in
the study group increased significantly over time. In the early 1990s,
less than 10 percent of surgeons were female but by 2002 close to 25% were
female. But if you look at the overall data set, there was a 13% increase
associated with female gender.
? Posted by Chet Morrison MD
January 30th,
2008
9:45 am
None of the respondents so far mention that the article says, ?? as were
women treated by doctors trained in the United States.?
I?ve just lost two family members to cancer, spent months with each one as
death approached, spent days and weeks in hospitals with them, gone to
countless doctor appointments at which I was in the examining rooms with
them. I watched many doctors do their work. Yes, doctors from a different
culture do seem to view death of elderly women differently than doctors
from this western culture. Sad, but that was very obvious as soon as we
went into these two situations. I was shocked because I had no warning
about this. These non-western doctors are good, intelligent, hard-working
and often even Christian (not that that matters to me, but it?s true).
They often pray with and for the patient and that is so much appreciated
by Christian patients. And yet, even then, there is a difference. One
doctor from India told us, ?In my country we take care of our elderly at
home.? He was indicating that she should not go to a nursing home or
should not stay in the hospital when she was dying. She wanted to be near
medical help and knew there was nobody in her family strong enough to care
for her at home. So she felt guilty no matter which choice she made
because he basically told her that to choose care outside the home meant
she was a ?westerner? who has no sense of family. Another doctor from
India told her in his examining room that she was costing him money - that
Medicaid was not paying him enough - and that she would need to pay his
office $100 every time she came in for radiation. He often made pointed
remarks to me that I should not try to influence her, that she should make
up her own mind, that she had at first opted not to be treated for the
cancer and then changed her mind due to my influence. I only told her that
she had a right to treatment if she wanted it. He had led her, early on,
to think that she was stupid if she did opt for treatment. Note, this was
a man who seemed to be a man of intelligence and dedication to his
profession and who was a practicing Christian. I mention that because it?s
a Western thing - not because I cared if he was or was not.
With the two experiences I?ve had and watched my family have in 2007 I
will do all I can to be sure my doctor, male or female, is from the same
culture that I am and therefore, hopefully, shares my values where my life
is concerned. And no, I don?t think ALL doctors from India have allowed
themselves to make constant comparisons between their ?home? culture and
that of the patients he or she sees here. But I simply will not be able to
trust a doctor from outside my culture anymore to treat me with dignity
concerning my values.
From TPP ? The issue in this study was not nationality. It was whether thedoctor was trained in the U.S. That?s an important distinction.
Personally, I think having doctors of many nationalities is good for the
U.S. healthcare system and good for patients. I also think patients and
doctors alike have much to learn from ?non-Western? cultures that take a
more holistic approach to medicine.
? Posted by Patsy
.
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