title: The care of older women with early-stage breast cancer: what is the role of surgeon gender?
abstract: BACKGROUND
  Over the past decade and a half, a substantial literature has documented age-dependent variations in breast cancer care. Accumulating evidence suggests that these variations impact the health outcomes of older women with breast cancer. Surgeon gender may be an important source of age-dependent variations in care.
  
  
  OBJECTIVE
  To examine the relationship between surgeon gender and primary tumor therapy and systemic adjuvant therapy among 303 older women with early-stage breast cancer cared for by 20 surgeons in Boston, Massachusetts.
  
  
  METHODS
  The research design was a cross-sectional observational study. The subjects were women at least 55 years of age with newly diagnosed Stage I or II breast cancer. The main outcome measure was definitive primary tumor therapy and systemic adjuvant therapy.
  
  
  RESULTS
  After adjustment for patient and tumor characteristics, patients of female surgeons were more likely to receive definitive treatment, with the strongest effect being observed for the receipt of both definitive primary tumor therapy and systemic adjuvant therapy (odds ratio 4.5; 95% confidence interval 2.7, 7.7).
  
  
  CONCLUSIONS
  Women with early-stage breast cancer cared for by female surgeons are more likely to receive standard therapies. Surgeons provide the initial care, both diagnostic and therapeutic, for all women with breast cancer. Their role in breast cancer care is pivotal and has a substantial impact on the nature of breast cancer care received.
authors.affiliation: Boston University Medical Center, Boston University School of Medicine, MA 02118, USA. rsillima@bu.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Silliman
authors.forename: S
authors.initials: S
authors.lastname: Demissie
authors.forename: S L
authors.initials: SL
authors.lastname: Troyan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001900:Boston; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D013502:General Surgery; D006299:Health Services for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010822:Physicians, Women / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D000078329:Workforce