Tuesday, February 05, 2008
Surgeons and Sex
Well, here's a new one: it's reported that women who have lumpectomy for breast cancer are more likely to have radiation therapy afterwards if their surgeon is female. Once again, I'm stumped. As a surgeon of the scrotumnal sort, I'm trying to figure it out. In the article, you'd see the differences weren't huge; and that there were other independent characteristics which seemed to matter at about the same level: that the surgeon was an MD, and that s/he was US-trained. (Chauvinistic in ways other than sexual, I'm not surprised by those two.)
It's hard to imagine any properly-trained surgeon who doesn't know of the need for adjunctive breast irradiation after lumpectomy. As always, there's room for some judgment: from a few very elderly and frail women I've removed a cancerous lump under local anesthesia and elected -- fully consulting with patient and family about options -- simply to follow along with no other treatment except, for some, hormone therapy. But the study is said to have controlled for age and other factors. So what can it mean? Are female surgeons more interested in saving the lives of their patients than males? Is it that we males prefer the feel and look of uncooked and unbrowned breasts (truth be told, I've heard it said more than a few times that the irradiated breast is preferred by its owner, because of youthful firmness)? After a night of carousing and piggish behavior, did the menfolk sleep through the lecture on complete breast treatment?
Maybe it's patient self-direction: women who don't want "all that fuss" (ie, radiation) gravitate toward male surgeons. It could even be, I suppose, that males are more open to modifying treatment for the frail and very elderly to whom I referred above. Or maybe it's about the age of surgeons: could older ones not be up to date? I doubt it; but if it's true, there are a lot more old male surgeons than female ones, since the demographics have only somewhat recently shifted toward the ovarian model.
At the end of the article it's stated that more work is needed to figure it all out. Meanwhile, it has me mystified. In most ways I think women are more admirable than males. Still, I'd hate to have to hang my nuts on a nail to practice my craft.