Glass Ceiling Largely Broken in Breast Surgery

By Monica J. Smith

Women continue to constitute a minority at the bulk of surgical conferences, but one annual meeting suggests the glass ceiling is not unbreakable.

The proportion of women in surgery skyrocketed from 3.6% in 1980 to 25% in 2019, but they lag in leadership positions and research. Now the specialty of breast surgery, which shows a strong patient preference for female surgeons, is a bit different.

To investigate trends in female representation among breast surgeons, Jenny Chang, MD, a resident physician at Cleveland Clinic, Sharon Lum, MD, and their colleagues at Loma Linda University in California, reviewed materials from the annual meetings of the American Society of Breast Surgeons (ASBrS) from 2009 to 2019, looking at committee leadership, scientific presentations and other meeting sessions.

They found the proportion of female committee members and chairs increased significantly each year, by 3.2% (P=0.005) and 5.9% (P=0.03), respectively. Over the 10-year study period, women accounted for 44.8% of the society’s board of directors, nearly 55% of all committee memberships and 42% of the chairs of those committees.

“Furthermore, though a global study of 1.5 million medical papers found only 35% had women in authorship positions, women comprised a majority participation in all scientific presentations at the ASBrS meeting,” Dr. Chang said.

Among presenters, women made up 77% of oral presentations and 74% of quick shot presentations, and were first authors on 75% of oral, 75% of quick shot and 71% of poster abstracts. In addition, 70% of oral presentations, 67% of quick shot presentations and 60% of poster abstracts listed a woman as the senior author.

“Subsequent publication rate of materials presented at ASBrS fell annually from 51% in 2009 to 28% in 2019, but female senior authorship was associated with a higher manuscript publication rate than male senior authorship,” Dr. Chang said. Among the manuscripts that were published, 71% of first authors and 64% of senior authors were women.

Dr. Chang acknowledged a few limitations of the study. It did not analyze other manifestations of diversity, such as race and ethnicity, area of expertise or geography; it was limited to a binary classification of gender, which could leave out gender minorities and nonbinary individuals; and it was not always possible to identify the gender of the presenters.

“Nonetheless, this paper suggests that within the realm of general surgery, breast surgery has distinctively shattered the glass ceiling. The ASBrS should be an example for others to follow,” Dr. Chang said.

She noted that the ASBrS has intentionally and actively recruited women into leadership positions. “I think that has a very strong downstream effect on increasing participation rates of women and paving the way for young female trainees.”

Dr. Chang presented her research as part of the ASBrS’s Virtual Education Series, which was held online this year in lieu of the annual meeting.