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.
Madan
A K
AK
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Aliabadi-Wahle
S
S
Beech
D J
DJ
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