Past research has documented higher cancer rates among female orthopedic surgeons than among women in the overall U.S. population. A multicenter team of researchers updated that earlier research and their work, โIncreased Prevalence of Breast and All-cause Cancer in Female Orthopaedic Surgeons,โ was published in the May 1, 2022 edition of The Journal of the American Academy of Orthopaedic Surgeons Global Research Reviews.
โI became interested in the prevalence of breast cancer and female orthopedic surgeons after first discussing this topic with Dr. Loretta Chou several years ago,โ stated co-author Lisa Cannada, M.D. to OTW.
Dr. Cannada, an orthopedic trauma surgeon at Novant Health Orthopedic Fracture Clinic in Charlotte, North Carolina, added, โAfter talking with Dr. Chou, I found the association between breast cancer and female orthopedic surgeons intriguing. Breast cancer is associated with advanced maternal age, which goes along with the known research on later age for childbearing in orthopedic surgeons.โ
โDr. Chou became interested in this topic when she took note of how many faculty she knew with breast cancer. She saw the common exposure they all had and thought it was likely more than a coincidence. This led to earlier studies, which I participated in with her, regarding radiation exposure as a risk factor, and we looked at fluoroscopy use amongst several orthopedic subspecialties. Concurrently, we were working on this survey, which is the basis for this article.โ
Between February 2019 and February 2020, the investigators reached out to 1,290 female orthopedic surgeons, asking them to complete a survey; they received 672 surveys in return (age range of 26-72). The team used a survey that emanated from prior studies and follows the principles for conducting surveys with orthopedic surgeons.1,2,3
The investigators sent surveys to the following organizations: the Ruth Jackson Orthopaedic Society, Pediatric Orthopaedic Society of North America, Musculoskeletal Tumor Society, Orthopaedic Trauma Association, American Association of Hip and Knee Surgeons Women in Arthroplasty Committee, American Orthopaedic Foot and Ankle Society, American Orthopaedic Society for Sports Medicine, and American Society for Surgery of the Hand.
The survey tool included questions regarding subspecialty, years in practice, use of fluoroscopy, poly- methylmethacrylate use, lead protection, dosimeter use, and training or education on radiation exposure risk. The researchers compared the distribution of breast cancer risk factors with that of women in the 2018 and 2009 California Health Interview Survey.
The Findings, the Future
โOut of 672 responses, 51 of the respondents reported a diagnosis of invasive cancer, and 20 reported breast cancer,โ said Dr. Cannada to OTW. This represented an increased incidence compared to the U.S. female population. We were surprised that with this survey, the results continue to show an increased risk of other cancers also compared to the U.S. female population.โ
Asked about precautions one could take, Dr. Cannada stated, โThere are protections that can be put into place for female (and male) orthopedic surgeonsโboth physical protections and education. First of all, many surgeons use the lead aprons that are meant for the entire OR staff, and those aprons can often be found hanging in rooms or in the hallways. The lead aprons that are available might not always be the best fitting, especially for medical students and residents, because faculty may get the first choice. In addition, sometimes the lead aprons are thrown over a chair or not cared for properly and that could lead to cracks.โ
โItโs very important that everyone gets a proper-fitting lead apron. In our study, we found a higher risk of breast cancer in those who were unprotected by lead aprons. Axillary shields which cover the armpit can improve protection. The use of thyroid shields to minimize the risk of thyroid cancer, and lead glasses to protect the eyes from cataracts are also important.โ
โEducation is also another form of protectionโeducation about the use of X-ray and fluoroscopy techniques and how to minimize exposure. I published a previous paper, which compared the use of fluoroscopy for a tibial nail in residents, both by level of experience and time of the year, wondering if there was more efficiency at the end of an academic year. There were significant differences found with more experienced residents resulting in less fluoroscopy exposure time.โ
โWe believe further work is needed on this topic, including education. We have lobbied for this to be considered for the ABOS [American Board of Orthopaedic Surgery] Web-Based Longitudinal Assessment Pathway, and we were fortunate enough for the American Academy of Orthopaedic Surgeons to support consideration for Orthopaedic In-Training Examination questions. It would be great to have it included in journal clubs for discussion.โ
โOur next steps are to survey male surgeons also, to really determine the prevalence of cancer amongst male and female orthopedic surgeons, and to develop appropriate education and prevention tips.โ ๏ด
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