Ageism in medical students' treatment recommendations: the example of breast-conserving procedures.
OBJECTIVE
Age bias may play a role in physicians' discussions of equivalent therapeutic options with patients, especially in respect to breast-conservation therapy. This study investigated bias based on age (ageism) among physicians-in-training in their treatment recommendations for breast-conserving procedures.


METHODS
Second-year medical students responded to a questionnaire concerning recommendations they would make for breast conservation or mastectomies with or without breast reconstruction for eight patients with similar-stage breast cancer. The patients differed by age (older were > or =59 years, younger < or =31 years), race, and marital status. A total of 116 students made 1,146 recommendations. Percentages of the students' recommendations for breast-conservation therapy (BCT) were calculated for the two patient age groups and for the recommendations for breast reconstruction after the patient had already chosen modified radical mastectomy (MRM). Chi-square tests were used for statistical analysis.


RESULTS
The students recommended BCT for a significantly higher percentage of younger patients than older patients (86% versus 66%; p<.001). They recommended MRM to 34% of older patients versus 14% of younger patients (p<.001). Furthermore, the students recommended breast reconstruction after MRM to a significantly higher percentage of younger patients than older patients (95% versus 65%; p<.001).


CONCLUSIONS
Medical students' recommendations of breast conservation and breast reconstruction showed age bias. Educational efforts should be instituted during the medical school to decrease ageism in students' treatment recommendations.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
A K
AK
Madan
S
S
Aliabadi-Wahle
D J
DJ
Beech
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008145:Louisiana; D016462:Mammaplasty; D017533:Marital Status; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009790:Occupations; D010342:Patient Acceptance of Health Care / Q000523:psychology; D018579:Patient Selection; D011287:Prejudice; D044469:Racial Groups; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires