Women's preference for female colonoscopists hinders colon cancer screening

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In a study conducted by researchers at the Division of Gastroenterology, University of Michigan, Ann Arbor, and published in the current (August) issue of Gastrointestinal Endoscopy (GIE) by the American Society for Gastrointestinal Endoscopy (ASGE), 43% of the women who were asked their preference of a male or female endoscopist said female, while only 1.4% said male and the rest had no preference.

When asked questions to further gauge how strongly those who preferred a woman physician felt, 87% of this group said they would be willing to wait 30 days for a female endoscopist and 14% would be willing to pay more (up to $200) to have the procedure done by a female endoscopist. Five percent stated that they would not undergo a colonoscopy unless they were guaranteed it was performed by a female endoscopist.

The research results were collected through a self-administered questionnaire given to 202 women who were awaiting primary care appointments at four outpatient facilities at the University of Michigan Health System in Ann Arbor. The female respondents were 40-70 years old, 85% Caucasian, 70% married, 99% high school graduates, 49% held college or advanced degrees, 57% were employed, 21% retired, and over half had a gross annual household income of greater than $60,000.

Having a female primary care physician (PCP) was a positive independent predictor for preferring a female endoscopist. Of the women who preferred a female endoscopist, 69% had a female PCP, 27% had a male PCP and 4% did not respond to the question.

According to Stacy Menees, MD, lead author of the study, the research shows that the primary reason listed for a female gender preference was that it would make the procedure less embarrassing (75%). Fifty percent also felt that the same gender was more empathetic, while 36% listed women as "better listeners" as a reason and 20% marked "technically better" as a reason to prefer a female physician to administer the colon cancer screening test.

While this study corroborates earlier studies in other specialties that women prefer female physicians, this is the first study to demonstrate female endoscopist preference among women in the primary care setting, as opposed to female patients awaiting endoscopy procedures, said Dr. Grace Elta of the study team.

"This study has important implications for future prevention and educational programs for colorectal cancer," the research team stated in the report. "Programs targeting the female population should consider concordant gender preference for an endoscopist as a barrier to screening. A choice in gender of the endoscopist may help to increase adherence to colonoscopy among women."

"The number of women enrolled in medical schools and residency programs in the U.S. has risen dramatically over the past several decades, with women making up more than 50% of enrolled medical students and 25% of practicing physicians," the report says.

However, the current number of female physicians practicing gastroenterology only represents approximately 8% of the total, based on membership in the ASGE. In addition, females only occupy 16% of the GI fellowship positions today, so it will present a dilemma for some time to those women who prefer having a female physician to conduct their cancer screening tests.

"Colon cancer has an equal incidence between men and women," stated Blair Lewis, MD, Clinical Professor of Medicine, The Mount Sinai Medical Center, New York, and an ASGE spokesperson. He explained that the total number of new colon cancer cases, according to the American Cancer Society's Annual Report, is 145,290, of which 73,470 (50%) are women. The total colon cancer deaths are 56,290, of which 27,750 (49%) are women. For breast cancer, new cases in women are 211,240 and annual deaths are 40,410 (19%).

"So while breast cancer is more than twice as prevalent, a higher percentage of women die of colon cancer each year," Dr. Lewis stated. "That is why colon cancer screening is so important for both men and women over 50 years old." Currently, only 43.4% of the population has had a lower gastrointestinal endoscopy within the last 10 years, according to The Behavioral Risk Factor Surveillance System (BRFSS).

Colorectal cancer is the third most commonly diagnosed cancer in men and women and the second leading cause of cancer-related deaths in the United States and Western Europe. "Early detection of colon cancer and, more importantly, the identification and removal of polyps that ultimately could become cancers can decrease the mortality for this disease," stated Dr. Elta.

In addition to Drs. Menees and Elta, other research team members included John Inadomi, MD, Sheryl Korsnes, MA, and Joseph W.C. Leung, MD.

The American Society for Gastrointestinal Endoscopy (ASGE), founded in 1941, is the preeminent professional organization dedicated to advancing the practice of Endoscopy. ASGE, with more than 8,000 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to Endoscopy, and is the foremost resource for endoscopic education.

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